Health Care Circumstances Research Articles

Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial

Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient’s hospitalization. We found rates of family caregiver recruitment for in-person versus virtual were 28% and 23%, respectively (p = 0.01). Differences existed across groups with family caregivers recruited virtually being more likely to be younger, white, have greater than high school education, and not be a spouse or significant other to the care recipient, such as a child. Future work is still needed to identify the modality and timing of family caregiver recruitment to maximize rates and enhance the representativeness of the population for equitable impact.

Chickenpox Outbreaks in Three Refugee Camps on Mainland Greece, 2016-2017: A Retrospective Study.

Displaced populations face disproportionately high risk of communicable disease outbreaks given the strains of travel, health care circumstances in their country of origin, and limited access to health care in receiving countries. Understanding the role of demographic characteristics in outbreaks is important for timely and efficient control measures. Accordingly, this study assesses chickenpox outbreaks in three large refugee camps on mainland Greece from 2016 - 2017, using clinical line-list data from Médecins du Monde (MdM) clinics. Clinical line-list data from MdM clinics operating in Elliniko, Malakasa, and Raidestos camps in mainland Greece were used to characterize chickenpox outbreaks in these camps. Logistic regression was used to compare the odds of chickenpox by sex, camp, and yearly increase in age. Incidences were calculated for age categories and for sex for each camp outbreak. Across camps, the median age was 19 years (IQR: 7.00 - 30.00 years) for all individuals and five years (IQR: 2.00 - 8.00 years) for cases. Males were 55.94% of the total population and 51.32% of all cases. There were four outbreaks of chickenpox across Elliniko (n = 1), Malakasa (n = 2), and Raidestos (n = 1) camps. The odds of chickenpox when controlling for age and sex was lower for Malakasa (OR = 0.46; 95% CI, 0.38 - 0.78) and Raidestos (OR = 0.36; 95% CI, 0.24 - 0.56) when compared Elliniko. Odds of chickenpox were comparable between Malakasa and Raidestos (OR = 1.49; 95% CI, 0.92 - 2.42). Across all camps, the highest incidence was among children zero-to-five years of age. The sex-specific incidence chickenpox was higher for males than females in Elliniko and Malakasa, while the incidence was higher among females in Raidestos. As expected, individuals five years of age and under made up the majority of chickenpox cases. However, 12% of cases were teenagers or older, highlighting the need to consider atypical age groups in vaccination strategies and control measures. To support both host and displaced populations, it is important to consider risk-reduction needs for both groups. Including host communities in vaccination campaigns and activities can help reduce the population burden of disease for both communities.

Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic

ObjectivesOrganisation of a screening programme influences programme resilience to a disruption as COVID-19. Due to COVID-19, the Dutch human papillomavirus–based cervical screening programme was temporarily suspended. Afterwards, multiple measures have been taken to catch-up participation. This study aimed to investigate programme resilience by examining the effect of COVID-19 and programme measures taken on participation in cervical screening. Study designObservational cohort study. MethodsData from the national screening registry and Dutch nationwide pathology databank (Palga) were used on invitations and follow-up in 2018/2019 (pre-COVID) and 2020 (COVID). Sending invitations, reminders and self-sampling kits were suspended from March to July 2020. Main outcome measures include distribution of participant characteristics (age, region and screening history), participation rates by age and region, time between invitation and participation (i.e. response time) and self-sampling use per month. ResultsParticipation rate was significantly lower in 2020 (49.8%) compared to 2018/19 (56.8%, P < 0.001), in all ages and regions. Compared to 2018/19, participation rates decreased most in women invited from January to March 2020 (−6.7%, −9.1% and −10.4%, respectively). From August, participation rates started to recover (difference between −0.8% and −2.7%). Median response time was longer in February and March (2020: 143 and 173 days; 2018/19: 53 and 55 days) and comparable from July onwards (median difference 0–6 days). Self-sampling use was higher in 2020 (16.3%) compared to 2018/19 (7.6%). ConclusionsThe pandemic impacted participation rates in the Dutch cervical screening programme, especially of women invited before the programme pause. Implementation of self-sampling in national cervical screening programmes could increase participation rates and could serve as an alternative screening method in times of exceptional health care circumstances, such as a pandemic. Due to the well-organised programme and measures taken to catch-up participation, the impact of COVID-19 on the screening programme remained small.

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment.

Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact. To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea. We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus. Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used. The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.

An PPG signal and body channel based encryption method for WBANs

With the rapid development of the Internet of Medical Things (IoMT) in recent years, Wireless Body Area Network (WBAN) has become a hot topic in the scientific and industrial community, since it defines a novel network architecture for medical and healthcare circumstances in IoT and loMT. Considering that unauthorized data tampering and information leakage in WBAN may cause life-threatening issues, Data security is an important technical support to ensure the smooth implementation of WBAN. Due to the characteristics of the WBAN system, the traditional wireless communication data security method is not suitable for WBAN because of the high complexity and high cost. This paper adopts the Photoplethysmography (PPG) signal feature and the channel characteristic values from the WBAN system to calculate the base key, then generates the key sequence for data encryption of WBAN through Linear Feedback Shift Register (LFSR). Experimental results show that this data security method has the advantages of less resource consumption, low computational complexity, and dynamic key update.

Self-cleaning application of mesoporous ZnO, TiO2 and Fe2O3 films with the accommodation of silver nanoparticles for antibacterial activity

BackgroundThe infections spread in healthcare circumstances is a growing and persistent issue worldwide, motivated by the development of microbial durability to disinfectants and antibiotics. Self-cleaning or disinfecting is one of the most attractive and promising technologies for glass windows, buildings, operating rooms, and hospitals. MethodThe transparent films of mesoporous TiO2, ZnO and Fe2O3 with different layers were synthesized and coated with silver nanoparticles through the sol-gel technique. The contact angles of the Ag/ZnO, Ag/TiO2 or Ag/Fe2O3 films were found to be less than 10°, indicating the obtained films were superhydrophilic. These films were tested for their disinfection ability for different bacteria species under direct light illumination. Significant FindingsResults have shown that Ag/TiO2 exhibited strong anti-bactericidal performances, and the Ag/TiO2 1-layer (1L), 2-layer (2L) and 3-layer (3L) films were the best of all treatments producing consistently higher antibacterial activity with Vibrio parahaemolyticus, Aeromonas hydrophila, and Bacillus subtilis in the reducing order of efficacy. The exposure time of 3 h was sufficient to reduce the cell counts of bacterial strains. The reason behind the higher antibacterial activity of Ag/TiO2, Ag/ZnO and Ag/Fe2O3 films compared with pristine ZnO, Fe2O3 and TiO2 films might be the surface plasmon resonance of Ag nanoparticles. The small Ag clusters create sinks for electrons, thus expediting the photoinduced electron- holes separation and enhancing the antibacterial activity. Therefore, the highest antibacterial activity observed for the Ag/TiO2 films was referred to as the most effective separation of charge carriers during the fast charge transfer.

PSDCE: Physiological signal-based double chaotic encryption for instantaneous E-healthcare services

As fundamental technical support to instantaneous E-healthcare services, Wireless Body Area Networks (WBANs) have attracted huge attention in the scientific and industrial community in recent years, which defines a unique wireless communication protocol for medical and healthcare circumstances. However, the concerns of the network and data security in WBANs have become an obstacle to the rapid development of it. In this paper, a double chaotic encryption method containing the natural randomness by adding physiological signal, electroencephalogram (EEG), is proposed. Initially, the three-dimensional eigenvalues contained deep multi-domain features are extracted as the initial factors of the chaos-based pseudo-random number generator to ensure the natural randomness of the initial values. Then, a hybrid pseudo-random number generator based on two chaotic maps, Piecewise linear Map (PLCM) and Coupled Logistic-Tent map (LTM), is proposed, which has the advantages of high randomness and low hardware complexity. Finally, the double chaotic encryption method based on the EEG eigenvalue for WBANs is presented. Various types of evaluations are performed to verify the efficiency and robustness of the proposed solution.

A Versatile and Ubiquitous IoT-Based Smart Metabolic and Immune Monitoring System.

In the present medical age, the focus on prevention and prediction is achieved using the medical internet of things. With a broad and complete framework, effective behavioral, environmental, and physiological criteria are necessary to govern the major healthcare sectors. Wearables play an essential role in personal health monitoring data measurement and processing. We wish to design a variable and flexible frame for broad parameter monitoring in accordance with the convenient mode of wearability. In this study, an innovative prototype with a handle and a modular IoT portal is designed for environmental surveillance. The prototype examines the most significant parameters of the surroundings. This strategy allows a bidirectional link between end users and medicine via the IoT gateway as an intermediate portal for users with IoT servers in real time. In addition, the doctor may configure the necessary parameters of measurements via the IoT portal and switch the sensors on the wearables as a real-time observer for the patient. Thus, based on goal analysis, patient situation, specifications, and requests, medications may define setup criteria for calculation. With regard to privacy, power use, and computation delays, we established this system's performance link for three common IoT healthcare circumstances. The simulation results show that this technique may minimize processing time by 25.34%, save energy level up to 72.25%, and boost the privacy level of the IoT medical device to 17.25% compared to the benchmark system.

Behavioural Economics and Human Decision Making: Instances from the Health Care System

Over the last two decades behavioural economics has gained much momentum among scholars because of its innovative and controversial ways of explaining processes and mechanisms underpinning individuals’ judgements and decision making. Thanks to these features, behavioural economics has been applied to diversified domains, namely finance, public choice and marketing. Although the intrinsic characteristics of the health care sector, ranging from incomplete and asymmetrical information to high frequency of critical choices, make the sector a fertile ground for behavioural economics applications, research on the influences of behavioural economics on health care and clinical decision making are still rather fragmented. Therefore, through an interdisciplinary literature review integrating behavioural economics research with medical and behavioural decision-making studies, this article contributes to behavioural decision-making literature by providing a wide overview of how behavioural economics strategies may impact, and be implemented in, diverse health care circumstances. Examples of behavioural economics applications to health care circumstances include: organ donation and transplantation; habitual choices; individuals’ loss aversion and trust; present-biased preference; decision fatigue and excessive choice. Hence, this article aims to promote the effective behaviour of both consumers and providers in health care.

Balancing competing interests and obligations in mental health-care practice and policy.

It is often challenging for mental health-care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health-care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care-related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, there is a gap in decision-making support in other mental health-care domains. This article proposes that a set of targeted, decision-making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization).

Does clinic-based education have a sustainable impact on asthma patient awareness?

ABSTRACTIntroduction: Asthma patient education is an essential component of asthma management, just as inhaler treatment adherence and inhaler technique education. These issues face challenges in the developed world communities and the literature demonstrates data of various validity supporting the need for educational activities. However, communities with poor health-care facilities and low socioeconomic status have seen little or no effort to tackle this challenging area of research. Methods: This interventional study aims to impact on sustained asthma awareness with clinic-based asthma patient education. The quasi-experiment recruited asthma patients from achest clinic within apoor healthcare system at desperate economic and political times. The educational intervention consisted of an educational video, posters and leaflets, in addition to the doctor’s clinic encounter and inhaler technique education by clinic nurse. Results: 24 patients of the initially recruited 87 patients were re-assessed 4 to 12 weeks later, on the impact of the educational activity on certain asthma awareness parameters. Patients’ awareness of their diagnosis of asthma did not improve despite the educational activity with p= 0.141. However, there was asignificant improvement with the awareness of patients for the need of long-term inhalers (p = < 0.0001), adherence to inhaler treatment (p = < 0.0001) and correct use of inhaler (p = < 0.021). Discussion & Conclusion: The study supports the feasibility and efficacy of asthma patient education in poor health-care circumstances at basic levels of asthma knowledge, adherence and inhaler technique. This interventional study is unique in the circumstances it was carried out under. Limitations include the large number of dropouts.

An Intelligent Cardiac Ailment Prediction Using Efficient ROCK Algorithm and K- Means &amp; C4.5 Algorithm

The data mining techniques have the ability to discover hidden patterns or correlation among the objects in the medical data. There are many areas that adapt data mining techniques, namely marketing, stock, health care sector and so on. In the health care industry produces gigantic quantities of data that clutches complex information relating to the sick person and their medical conditions. The data mining has an infinite potential to make use of healthcare data more effectually and efficiently to predict various kinds of disease. The present-time healthcare industry heart ailment is a term that assigns to an enormous number of health care circumstances related to heart. These medical circumstances relate to the unexpected health circumstance that straight control the cardiac. In this paper we are using a ROCK algorithm because it uses Jaccard coefficient on the contrary using the distance measures to find the similarity between the data or documents to classify the clusters and the contrivance for classifying the clusters based on the similarity measure shall be used over a given set of data. Afterward, C4.5 algorithm is used as the training algorithm to show the rank of a cardiac ailment with the decision tree. The C4.5 can be referred as the statistic classifier as well as this algorithm uses avail radio for feature selection and to build the decision tree. The C4.5 algorithm is widely used because of its expeditious classification and high exactitude. Lastly, the cardiac ailment database is clustered using the K-means clustering, which will alienate the data convenient to cardiac sickness from the database.

An Intelligent Cardiac Ailment Prediction Using Efficient ROCK Algorithm and K- Means &amp; C4.5 Algorithm

The data mining techniques have the ability to discover hidden patterns or correlation among the objects in the medical data. There are many areas that adapt data mining techniques, namely marketing, stock, health care sector and so on. In the health care industry produces gigantic quantities of data that clutches complex information relating to the sick person and their medical conditions. The data mining has an infinite potential to make use of healthcare data more effectually and efficiently to predict various kinds of disease. The present-time healthcare industry heart ailment is a term that assigns to an enormous number of health care circumstances related to heart. These medical circumstances relate to the unexpected health circumstance that straight control the cardiac. In this paper we are using a ROCK algorithm because it uses Jaccard coefficient on the contrary using the distance measures to find the similarity between the data or documents to classify the clusters and the contrivance for classifying the clusters based on the similarity measure shall be used over a given set of data. Afterward, C4.5 algorithm is used as the training algorithm to show the rank of a cardiac ailment with the decision tree. The C4.5 can be referred as the statistic classifier as well as this algorithm uses avail radio for feature selection and to build the decision tree. The C4.5 algorithm is widely used because of its expeditious classification and high exactitude. Lastly, the cardiac ailment database is clustered using the K-means clustering, which will alienate the data convenient to cardiac sickness from the database.

Pure intervention effect or effect in routine health care - blinded or non-blinded randomized controlled trial

BackgroundRandomized trials provide the most valid evidence of effectiveness of interventions. The study aims to determine the primary study question for randomized controlled trials; to evaluate the study questions in trials on effectiveness of arthroscopic meniscectomy for meniscal rupture of the knee; and to explore the clinical and research implications.MethodsPrevious studies on benchmarking controlled trials were utilized. A literature search was undertaken to find the trials on arthroscopic surgery for meniscal rupture of the knee, data was extracted, and checked for accuracy twice.ResultsThe first question in RCTs is whether to assess the pure intervention effect, or intervention effect in routine health care circumstances. The former necessitates a double blinded design and the latter a non-blind design. The trials on arthroscopic meniscectomy of the knee showed considerable differences in study characteristics.ConclusionsThe study question in RCTs on pure intervention effect dictates use of blinded design, while question of intervention effect in routine health care dictates use of non-blinded design. Blinding should not be considered a validity criterion when study question is on effectiveness in routine health care. When informing patients, the potential for other effects besides the pure intervention effect should be considered.

One Hundred Fifty Years of Organized Health Care Services in Bosnia and Herzegovina.

Introduction:Austro-Hungarian monarchy had great impact on healthcare system in Bosnia and Herzegovina (B&H), and consequences of that exist today.Aim:To launch of the section „The Most Influential Physicians in the Development of Health Care in Bosnia and Herzegovina“, in which, within next issues of the Medical Archives will be presented the prominent physicians, dentists and pharmacists who gave contribution to development of healthcare system in B&H.Results:This paper provides a full overview from the literature about health care circumstances during 150 years in Bosnia and Herzegovina and important of the role health care institutions and of all the doctors working in B&H during the Austro-Hungarian administration. To some of them is devoted more attention in the texts about their life and work and their contribution to the development of the health service in B&H. Also, author gave description of the others, except for the medical activities who have contributed to our homeland, such as Dr. Jozef Kecet, Dr. Julije Makanec, Dr. Teodora Krajewska, Dr. Josef von Preindlsberger, Dr. Hamdija Karamehmedovic and others, but there are many more that we should know about and mention them. Conclusion:The fact is Austro-Hungarian model of healthcare system in that time was functional for that period and great improvement in comparison to past and the fact is that that system represents a basis even for modern medicine in territory of B&H.

Full method validation in clinical chemistry

Clinical chemistry is subject to the same principles and standards used in all branches of metrology in chemistry for validation of measurement methods. The use of measuring systems in clinical chemistry is, however, of exceptionally high volume, diverse and involves many laboratories and systems. Samples for measuring the same measurand from a certain patient are likely to encounter several measuring systems over time in the process of diagnosis and treatment of his/her diseases. Several challenges regarding method validation across several laboratories are therefore evident, but rarely addressed in current standards and accreditation practices. The purpose of this is paper to address some of these challenges, making a case that appropriate conventional method validation performed by the manufacturers fulfils only a part of the investigation needed to show that they are fit for purpose in different healthcare circumstances. Method validation across several laboratories using verified commercially available measuring systems can only be performed by the laboratories—users themselves in their own circumstances, and need to be emphasised more by the laboratories themselves and accreditation authorities alike.

Patients as partners: a qualitative study of patients' engagement in their health care.

To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient’s experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals’ openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter’s scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients’ learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement.

Patient Information, Nursing Home Care, and the Non-Medical Costs of Caregiving: One Librarian's Perspective

Little literature exists about how health sciences librarians use their training for caregiving. In line with the aims of this column, this piece summarizes predominantly personal experience gained from caring for an aging parent from September 2009 until April 2011. Health information written for consumers and patients may not adequately address complex health care circumstances, and the health sciences librarian may need to find and apply more granular information than typically provided in patient-oriented literature. Families and caregivers may need to brainstorm about additional questions and information needs as they emerge.

Expects for Academic Detailing from the Standpoints of Evidence-based Medicine (EBM)

Academic detailing, interactive information services by pharmacists for clinicians, has been getting interests in the US and European countries. A systematic review of randomized controlled trials supported the effectiveness of academic detailing. Knowledge of evidence-based medicine and clinical practice guidelines is one of the essential bases for pharmacists to promote these activities. In addition, pharmacists need to understand attitudes and ways of thinking of clinicians toward medicines. Through communications and information sharing between clinicians and pharmacists, collaborations to modify and improve the use of medicines should be facilitated. On these grounds, academic detailing will be able to play an important role in real healthcare circumstances.

Prevalence of Malnutrition in Various Political, Economic, and Geographic Settings

Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent. Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective. At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist. The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.