Health Care Agencies Research Articles

Is the patient speaking or the nurse? Automatic speaker type identification in patient-nurse audio recordings.

Patient-clinician communication provides valuable explicit and implicit information that may indicate adverse medical conditions and outcomes. However, practical and analytical approaches for audio-recording and analyzing this data stream remain underexplored. This study aimed to 1) analyze patients' and nurses' speech in audio-recorded verbal communication, and 2) develop machine learning (ML) classifiers to effectively differentiate between patient and nurse language. Pilot studies were conducted at VNS Health, the largest not-for-profit home healthcare agency in the United States, to optimize audio-recording patient-nurse interactions. We recorded and transcribed 46 interactions, resulting in 3494 "utterances" that were annotated to identify the speaker. We employed natural language processing techniques to generate linguistic features and built various ML classifiers to distinguish between patient and nurse language at both individual and encounter levels. A support vector machine classifier trained on selected linguistic features from term frequency-inverse document frequency, Linguistic Inquiry and Word Count, Word2Vec, and Medical Concepts in the Unified Medical Language System achieved the highest performance with an AUC-ROC = 99.01 ± 1.97 and an F1-score = 96.82 ± 4.1. The analysis revealed patients' tendency to use informal language and keywords related to "religion," "home," and "money," while nurses utilized more complex sentences focusing on health-related matters and medical issues and were more likely to ask questions. The methods and analytical approach we developed to differentiate patient and nurse language is an important precursor for downstream tasks that aim to analyze patient speech to identify patients at risk of disease and negative health outcomes.

Revisiting Anticoagulation in Spine Surgery: Balancing Venous Thromboembolic Events and Epidural Hematoma.

Retrospective Cohort Study. Venous thromboembolic events (VTE) and post-operative epidural hematoma (EDH) are significant complications after spine surgery. Guidelines for chemoprophylaxis are controversial and variability amongst surgeons remains. The objective of this study was to establish the incidence of clinical VTE and EDH at our institution and evaluate the association of chemoprophylaxis with clinical VTE and EDH. We conducted a retrospective cohort study of patients undergoing spine surgery at a high-volume tertiary care center in Seattle, WA between January 2016 and December 2019. The Premier Health Care Database and Agency for Healthcare Research and Quality (AHRQ) patient indicators PSI-9 (Perioperative hemorrhage and hematoma) and PSI-12(Perioperative PE or DVT) were used to identify patients experiencing VTE and/or post-operative EDH. The primary outcome was the incidence of clinical VTE and EDH in post-operative spine patients. Secondary outcomes included the association of chemoprophylaxis with clinical VTE and EDH. From 2016 to 2019, 4587 patients underwent spine surgery, totaling 4764 hospital stays. The incidence of clinical VTE was .21% (10/4764) and the incidence of EDH was .10% (5/4764). Most hemorrhages occurred prior to the initiation of chemoprophylaxis. One patient with EDH received chemoprophylaxis prior to hemorrhage. The rate of post-operative clinical VTE and EDH in spine surgery is low. Despite early initiation of chemoprophylaxis after major spine surgery we did not appreciate a high rate of EDH. We attribute our low rate of clinical VTE to multimodal prophylaxis with SCDs, early mobilization and chemoprophylaxis on post-operative day 1.

Analysis of post-extraction bleeding in patients taking antithrombotic therapy using data from the longevity improvement and fair evidence study.

Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database. Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post-extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00-9.02). The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.

Database System Development of Mental Health Care for Elderly in Situation with COVID-19 Period

Database System Development of Mental Health Care for Elderly in Situation with COVID-19 Period

Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing.

Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. Qualitative study of semi-structured telephone interviews. We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints.

A Systematic Review of Risk Factors, Obstetric and Perinatal Outcomes in Teenage Pregnancy: Evidence Base for Policy Recommendations

It is commonly accepted that teen pregnancies raise the risk of both mental and physical health problems, although, worldwide, research amply supports the impact of adolescent pregnancies on the expansion of human capital. The association implies that, in the long-run, a teenage mother’s prospects will be harmed, expanding the gender gap. The purpose of this study was to identify the risk factors of adolescent pregnancy, the health issues that they and their unborn babies must deal with, and to ascertain -- through a systematic review -- what additional developmental needs are brought on by early pregnancy. Nine studies were chosen to research the primary risk factors of teen pregnancy, while ten articles evaluated the negative effects of early pregnancy. A total of 19 articles, published in reliable journals between 2009 and 2021, were chosen for the study. Reviews, meta-analyses, and case studies were not chosen: only original work from reputable journals was considered. The most common causes of teenage pregnancy were found to be the lack of formal education, ignorance of how contraception should be handled, ignorance of sex and pregnancy risks, and early marriage. The analysis revealed that neonatal disorders such as eclampsia, severe anaemia, haemorrhage, and premature birth are more common among adolescent mothers. The results show that neonates and adolescent mothers both have negative impacts from early pregnancies. The study emphasizes the importance of sex education and campaigns to promote the use of contraception. Also, proper physical care and psychosocial support through health care agencies should be promoted.Keywords:, , , and

Pengembangan Rumah Desa Sehat Dengan Implementasi Sistem Informasi Gizi Keluarga (SIGA)

Increasing health problems both physical and psychological in elderly partners are of particular concern. Partners' health problems include the increased risk of psychological health problems and the absence of an activity program to maintain the psychological health of the elderly. The Golansia Program in Family Psychoeducation is an elderly health approach program in psychological health education that was developed to increase the mental health strength of the elderly. The Golansia program was developed following the Unmuh Jember community service strategic plan and government policies regarding elderly health care. This program collaborates with the Head of the Aisyiyah Patrang Branch in the field of Elderly Health in the Patrang Village, Patrang District, Jember. The methods that will be used to achieve these goals are 1) education; 2) family psychoeducation practice; and 3) family psychoeducation assistance for the elderly and families through Aisyiyah recitation or health councils with an evaluation of the processes and results of the Golansia Program activities for the elderly to improve Latagis with the Family. The results of this activity obtained an increase in good knowledge of 47.1%. The output of this activity is that it is hoped that there will be continuity for families who provide psychoeducation to the elderly so that psychologically resilient elderly people are formed in the Working Area of the Aisyiyah Patrang Branch, Jember Regency.

Program Latihan Mindfulness Untuk Menurunkan Stres Lansia Dengan Diabetes Melitus di Desa Jumerto, Kecamatan Patrang, Kabupaten Jember

Partners' health problems include the increasing problem of Diabetes Mellitus which causes a lot of stress for the elderly, and the absence of an activity program to reduce stress for the elderly in Jumerto village. The mindfulness training program is an exercise program developed to reduce stress and reduce the occurrence of health problems experienced by the elderly caused by psychological disorders. This program was developed in line with the Muhammadiyah University of Jember's service strategic plan and government policies related to elderly health care. This program works with the elderly posyandu in Jumerto Village, Patrang District, Jember Regency. The targets and outcomes resulting from this community service program are 1) service products in the form of knowledge and mindfulness training for the elderly with Diabetes Mellitus and posyandu cadres, 2) the availability of simple modules or books about the physical and mental health of the elderly with Diabetes Mellitus, 3) articles that national accreditation. The methods that will be used to achieve this goal are 1) mentoring, 2) education and 3) practice of mindfulness exercises in the elderly with Diabetes Mellitus and elderly Posyandu cadres with an evaluation of the process and results of the mindfulness training program activities. The mindfulness training program was carried out from April 24 -May 16 2023 every Saturday at the Jumerto Village Hall, Patrang District, Jember Regency, and was attended by 45 elderly people. Activities carried out include socialization of activities, screening of the physical and mental health of the elderly and mindfulness exercises. The results of the process evaluation carried out on 45 elderly people participating in the mindfulness training program were carried out by facilitators accompanied by 2 elderly cadres and 2 nurses starting on April 24 2023. The results evaluation was carried out on May 16 2023 and found 100% of the elderly expressed satisfaction with the mindfulness program at Posyandu Elderly with proven patients with Diabetes Mellitus Most of them experience mild stress (66.6%). So that this program can be continued by the Elderly Posyandu

Identifying Type II workplace violence from clinical notes using natural language processing.

Type II workplace violence in health care, perpetrated by patients/clients toward home healthcare nurses, is a serious health and safety issue. A significant portion of violent incidents are not officially reported. Natural language processing can detect these "hidden cases" from clinical notes. In this study, we computed the 12-month prevalence of Type II workplace violence from home healthcare nurses' clinical notes by developing and utilizing a natural language processing system. Nearly 600,000 clinical visit notes from two large U.S.-based home healthcare agencies were analyzed. The notes were recorded from January 1, 2019 to December 31, 2019. Rule- and machine-learning-based natural language processing algorithms were applied to identify clinical notes containing workplace violence descriptions. The natural language processing algorithms identified 236 clinical notes that included Type II workplace violence toward home healthcare nurses. The prevalence of physical violence was 0.067 incidents per 10,000 home visits. The prevalence of nonphysical violence was 3.76 incidents per 10,000 home visits. The prevalence of any violence was four incidents per 10,000 home visits. In comparison, no Type II workplace violence incidents were recorded in the official incident report systems of the two agencies in this same time period. Natural language processing can be an effective tool to augment formal reporting by capturing violence incidents from daily, ongoing, large volumes of clinical notes. It can enable managers and clinicians to stay informed of potential violence risks and keep their practice environment safe.

Human Activity Recognition Using Hybrid Coronavirus Disease Optimization Algorithm for Internet of Medical Things.

In our current digital world, smartphones are no longer limited to communication but are used in various real-world applications. In the healthcare industry, smartphones have sensors that can record data about our daily activities. Such data can be used for many healthcare purposes, such as elderly healthcare services, early disease diagnoses, and archiving patient data for further use. However, the data collected from the various sensors involve high dimensional features, which are not equally helpful in human activity recognition (HAR). This paper proposes an algorithm for selecting the most relevant subset of features that will contribute efficiently to the HAR process. The proposed method is based on a hybrid version of the recent Coronavirus Disease Optimization Algorithm (COVIDOA) with Simulated Annealing (SA). SA algorithm is merged with COVIDOA to improve its performance and help escape the local optima problem. The UCI-HAR dataset from the UCI machine learning repository assesses the proposed algorithm's performance. A comparison is conducted with seven well-known feature selection algorithms, including the Arithmetic Optimization Algorithm (AOA), Gray Wolf Optimizer (GWO), Whale Optimization Algorithm (WOA), Reptile Search Algorithm (RSA), Zebra Optimization Algorithm (ZOA), Gradient-Based Optimizer (GBO), Seagull Optimization Algorithm (SOA), and Coyote Optimization Algorithm (COA) regarding fitness, STD, accuracy, size of selected subset, and processing time. The results proved that the proposed approach outperforms state-of-the-art HAR techniques, achieving an average performance of 97.82% in accuracy and a reduction ratio in feature selection of 52.7%.

Expert Consensus on Targeted Therapy of NSCLC with MET Exon 14 Skipping Mutation

The mesenchymal-epithelial transition factor (MET) exon 14 skipping mutation is mainly caused by the loss of c-Cbl tyrosine binding site. This mutation could result in a decrease in the degradation rate of proteasome-mediated MET proteins, trigger continuous activation of downstream pathways, and ultimately lead to tumorigenesis. The incidence of MET exon 14 skipping mutation in patients with non-small cell lung cancer (NSCLC) is 0.9% to 4.0%. Patients with advanced NSCLC are recommended to test MET exon 14 skipping mutations who may benefit from MET inhibitors-targeted therapy. MET inhibitors have a high objective response rate and good safety profiles, which could prolong the survival of NSCLC patients with MET exon 14 skipping mutations. The Lung Cancer Specialty Committee of Chinese Elderly Health Care Association organized multidisciplinary experts to give suggestions on the important issues of clinical aspects for targeted therapy of MET exon 14 skipping mutation in NSCLC according to the clinical practice experiences and evidences based medicine. "Expert Consensus on Targeted Therapy of NSCLC with MET Exon 14 Skipping Mutation" is proposed, aiming to provide standardized guidances for the clinical practice of Chinese physicians. .

Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.

Traditional perinatal care alone cannot address the social and structural determinants that drive disparities in adverse birth outcomes. Despite the wide acceptance of partnerships between healthcare systems and social service agencies to address this challenge, there needs to be more research on the implementation factors that facilitate (or hinder) cross-sector partnerships, particularly from the perspective of community-based organizations. This study aimed to integrate the views of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership designed to address social and structural determinants in pregnancy. We used a mixed methods design (in-depth interviews and social network analysis) to integrate the perspectives of healthcare clinicians and staff with those of community-based partner organizations to identify implementation factors related to cross-sector partnerships. We identified seven implementation factors related to three overarching themes: relationship-centered care, barriers and facilitators of cross-sector partnerships, and strengths of a network approach to cross-sector collaboration. Findings emphasized establishing relationships between healthcare staff, patients, and community-based partner organizations. This study provides practical insights for healthcare organizations, policymakers, and community organizations that aim to improve access to social services among historically marginalized perinatal populations.

Establishing the gap in elderly health care competencies in nursing education in Uganda.

Establishing the gap in elderly health care competencies in nursing education in Uganda.

Health Policy: Nursing Theory as Inspiration for Policy Development.

The theoretical knowledge base of nurse policy-makers enhances their thoughts with inspiring opportunities with communities and healthcare agencies. Nursing theory and frameworks can serve as a motivating, inspirational force for nurses to be imaginative and view situations in innovative ways. In this paper, the author explores some ways in which health and nursing policy-makers may be inspired by unique nursing knowledge to craft policies that are consistent with nursing's theories and models.

Transition of Care in Children with Chronic Kidney Disease, Dialysis, and Transplantation.

Improvement in management of pediatric renal disorders has led to patient survival rates of 85-90%, increasing the number of adolescent and young adult (AYA) patients with childhood onset chronic kidney disease (CKD) transitioning to adult care settings. Pediatric CKD patients differ from adults with CKD in view of early onset of disease (sometimes with fetal onset), different disease spectrum, the potential effect of CKD on neurodevelopment, and substantial involvement of parents in medical decision making. In addition to the usual challenges of emerging adulthood (graduation from school to work, independent living, peak in impulsivity and risk-taking behaviors), young adults with pediatric CKD need to learn to manage a serious medical condition independently. In kidney transplant patients, regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric CKD patients must move from a pediatric to adult-focused settings and this transition is a longitudinal process requiring collaboration and interactions of AYA patients, their families, providers, health care environment and agencies. Consensus guidelines have provided recommendations to pediatric and adult renal teams to enable successful transition. Suboptimal transition is a risk factor for poor adherence to treatment and unfavorable health outcomes. The authors discuss the process of transition as it applies to pediatric CKD patients and review challenges faced by patients/families, pediatric and adult nephrology teams. They provide some suggestions and available tools to optimize the transition of pediatric CKD patients to adult-oriented care.

Generating Actionable Evidence for School-Based Mental Health Service Delivery: Public-Academic Partnership Based Evaluations.

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence.

Satisfaction and anxiety level during clinical training among nursing students

BackgroundQuality is a primary concern of health care agencies worldwide. A conducive clinical training environment is essential for nursing students to be capable of enhancing their learning experiences and achieving the desired training outcomes.AimThis study aimed to examine the satisfaction and anxiety levels during clinical training among nursing students.Type of studyA descriptive -analytical cross-sectional study design was utilized. The research was conducted at the Faculty of Nursing, Assiut University and Colleges of Applied Medical Sciences in Alnamas and Bisha, University of Bisha. Sampling method: A convenience sampling technique was used. Sample size: a sample of 1052 undergraduate nursing students. The data was gathered via a structured questionnaire including the socio-demographic characteristics and nursing students’ satisfaction with the hospital and laboratory training. Additionally, Self-Rating Anxiety Scale (SAS) was adopted to measure the anxiety level.ResultsThe mean age of the studied sample was 21.9 ± 1.83 years, and 56.9% are females. Moreover, 90.1% & 76.4% of the nursing students were satisfied with their hospital and laboratory training. Furthermore, 61.1% & 54.8% of the students had mild levels of anxiety regarding their hospital training and laboratory training, respectively.ConclusionThe undergraduate nursing students had a high level of satisfaction with their clinical training at the hospitals and laboratories. Moreover, they had mild anxiety related to hospital and laboratory clinical training.RecommendationsDeveloping clinical orientation and training programs and improvement strategies to enhance the effectiveness of the clinical training environment. The establishment of a modern, tastefully designed, and fully stocked skill lab for the college's student training should receive more attention.Clinical relevanceThrough the provision of ongoing education about different method of practice, nursing was intended to shape future professional nurses who master core competencies of the profession. Organizations may benefit from developing a comprehensive strategy to achieve an effective teaching program.

The Potential Impact of Ayurvedic Traditional Bhasma on SARS-CoV- 2- Induced Pathogenesis

Abstract: In India, the presently ongoing infectious COVID-19 wave is caused by the delta variant of SARS-CoV-2 which has also led thousands of causalities across the globe. The government and healthcare agencies are hovering for effective strategies to counter the pandemic. The application of nanotechnology and repurposing of drugs are found an effective approach, not obsolete but partly in managing the COVID-19 disease. It has also immensely boomed the search of productive, reliable, cost-effective, and bio-assimilable alternative solutions. Since ancient times, the traditionally employed Ayurvedic bhasmas opted for diverse infectious diseases, which are now justified as a nanomedicine that could be applied for managing COVID-19 related health anomalies. Like currently existing engineered metal nanoparticles (NPs), the bhasma nanoparticles (BNPs) are also packed with unique physicochemical properties including multi-elemental nanocrystalline composition, size, shape, dissolution, surface charge, hydrophobicity, multi-pathway regulatory, and modulatory effects. Here, it is hypothesized that due to these conformational- and configurational- based physicochemical advantages, bhasma NPs might have promising potential to manage the COVID-19 pandemic and can reduce the incidence of pneumonia-like common lung infections in children as well as old-age-related inflammatory diseases by immunomodulatory, anti-inflammatory, antiviral, and adjuvant-related characteristics.

Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs

We study health-care provider agency and optimal payments, considering an expensive medication for dialysis patients. Using Medicare claims data we estimate a structural model of treatment decisions, in which providers differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we empirically characterize the optimal contracts in this environment. The optimal contracts eliminate medically excessive dosages and reduce expenditures, resulting in approximately $300 million in annual gains from better contracting. This approach could be applied to a broad class of problems in health-care payment policy. (JEL D64, D86, H51, I11, I13, J33, L21)

Usability measures used to enhance user experience in using digital health technology among elderly: a systematic review

In 2030, it is expected that 15% of the country's population will be classified as elderly and there is driving up demand for elderly healthcare services. The evolution of digital health technology has emerged as a solution to this issue. However, there has been a recent decline in the elderly adoption of digital health technologies. This issue is worsened by the emergence of interfaces and interaction styles in newly developed technologies. A systematic review was conducted in this article to investigate the usability measures used to improve the user experience of digital health technology among the elderly. This study includes articles selected from the Web of Science and Scopus databases, both of which are well-established. Using thematic analysis, data from 29 articles were analyzed, yielding four main themes: i) effectiveness; i) efficiency; iii) satisfaction; and iv) learnability. The four main themes generated 12 sub-themes. The appearance, functionality, and structure of new digital health technology are the primary barriers to adoption. User interface (UI) design should take into account the limitations of elderly users. Additionally, elderly users require motivation, support, and training to utilize digital health technologies effectively. This study's findings make significant contributions to digital health and gerontechnology fields.