Health Care Issues Research Articles

Bibliometric Analysis of Risk Factors Contributing to Maternal Mortality: Trends and Research Directions

ABSTRACT Maternal mortality remains a significant global health challenge, with high maternal mortality rates in many parts of the world being a key indicator of disparities in maternal health care. While great efforts have been made to reduce these mortality rates, the various contributing risk factors remain a major focus of efforts. This study aimed to conduct a bibliometric analysis of the scientific literature addressing risk factors contributing to maternal mortality over the period 2017 to 2024. In this study, data was obtained from 50 relevant articles retrieved from Google Scholar using Publish or Perish software. The articles were filtered based on relevance and analyzed in depth. The data collected included information on publication year, country of origin, publisher, number of citations, and article type. To generate a comprehensive bibliometric map, VOSviewer was used with the parameters of occurrence of at least 4 and 19 terms, as well as network visualization, overlay, and density. The analysis showed that research on maternal mortality has consistently focused on various risk factors and aspects of maternal health, with a significant emphasis on factors related to pregnancy complications, postnatal care, and socioeconomic health conditions. Developed countries such as the United States are often the primary location of research, indicating a high concentration of studies in these countries. In addition, the research highlighted consistent attention to the importance of adequate health care and specific health issues faced by pregnant women. The analysis also revealed that key themes in the current literature include the management of postpartum hemorrhage, postpartum infections, and the influence of socio-economic factors on maternal health. This study provides valuable insights into current research directions and trends in maternal health and underscores the importance of continuing to identify and mitigate risk factors that contribute to maternal mortality. The findings are expected to guide the development of more effective interventions and health policy strategies that can reduce maternal mortality globally and improve maternal health outcomes worldwide. Keywords: Maternal Mortality, Risk Factors, Bibliometric Analysis, Healthcare Interventions, Research Trends

How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars.

The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. This study examined scholars' conceptualization and scope of work focused on HL and DHL. Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators' research. A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues.

Precision Medicine for Acute Lymphoblastic Leukemia in Children: A Review

The clinical outcome for children diagnosed with acute lymphoblastic leukemia is a testimony to the success of modern medicine. Over the past few decades, survival has climbed from ∼10% to >90% for certain subgroups. Yet, the outcome for those with relapsed disease is often poor, and survivors struggle with a multitude of healthcare issues, some of which are lifelong. In recent years, the advent of the widespread sequencing of tumors has made available patients with previously unrecognized subtypes of leukemia, who have the potential to benefit from the addition of targeted therapies. Indeed, the promise of precision medicine, encompassing a person’s environment, genetics and lifestyle, is likely to have profound impact on further tailoring therapies that are likely to improve outcomes, diminish toxicity and ultimately pave the pathway for a healthier population.

Can public hospital reform reduce medical resource mismatches? Evidence from China

BackgroundThe mismatch of medical resources is a significant issue in global healthcare, undermining both service accessibility and system efficiency. In China, despite the implementation of the “Healthy China” strategy, persistent mismatches remain due to factors such as industrialization, urbanization, and population aging. This study empirically evaluates the impact of Public Hospital Reform (PHR) on mitigating these mismatches.MethodsA Difference-in-Differences (DD) approach is applied to panel data from 300 cities spanning 2010 to 2021, using the phased implementation of PHR as a quasi-natural experiment. This allows for a comparative analysis of changes in resource allocation between cities that adopted the reform and those that did not. Quantile regression assesses the effects of PHR across varying levels of resource mismatch, while mechanism tests investigate how PHR influences mismatches through cost reduction and supply expansion.ResultsPHR is found to reduce medical resource mismatches by 13.9%, primarily driven by cost reductions and increased resource supply. The effects are more pronounced at both lower and higher levels of mismatch, with a limited impact at mid-levels. Furthermore, the reform’s effectiveness diminishes as it is extended to more cities, suggesting a potential saturation effect.ConclusionsThis study demonstrates that PHR significantly alleviates medical resource mismatches in China. The findings underscore the need to focus on cost control and resource supply in future healthcare reforms, providing key insights for policymakers in developing countries facing similar healthcare resource challenges.

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

Implications of Big Data Analytics, AI, Machine Learning, and Deep Learning in the Health Care System of Bangladesh: Scoping Review.

The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. This scoping review aims to collate (1) the existing research in Bangladesh's health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5%), DL (7/77, 9%), and BDA (1/77, 1%) technologies. Among the reviewed articles, 52% (40/77) relied on primary data, while the remaining 48% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19%), noncommunicable diseases (23/77, 30%), child health (11/77, 14%), and mental health (9/77, 12%). This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh's health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh.

Infectious disease prevention among internally displaced people: Perspectives from Lviv, Ukraine

Abstract Background The ongoing war in Ukraine has increased the risk of infection spikes, especially among internally displaced people. The healthcare challenges in the war context necessitate teaching the population of preventative measures, which have become the primary vector of the activities of the Ukrainian Regional Centers for Disease Control and Prevention. Objectives The research aimed to highlight the activities of the Lviv Regional Center for Disease Control and Prevention (CDC) in relation to internally displaced people. Methods The research project analyzed the incidence rate of infectious diseases and vaccination coverage data among the population and internally displaced people in the region. The data were collected from monthly reports of CDC’s departments and alert messages sent by primary care institutions to the CDC. Results According to the Single register of internally displaced people (IDP), 13% of internally displaced people were permanently staying in the Lviv region (the second place was Zakarpattia region - 9% of IDP, and the third was Kyiv - 7% of IDP). In the Lviv region, 237,000 people registered as forcibly displaced. Total, over 700, 000 people are in the area, including the unregistered and 68,000 children. In 2022-2023, the morbidity rates among IDPs did not exceed the rates among the general population in the area. Each IDP residence place had its physician; 11 thousand IDPs were vaccinated, and 3,235 of those were children. In general, 46 mobile medical brigades worked on-site in the Lviv region. Only one spike of gastrointestinal infection was registered. CDC employees provided lectures and workshops on hygiene and food storage in 56 IDP residence places. Conclusions The review results show that coordination between CDCs, local physicians, and mobile medical brigades in the IDP residence areas prevents outbreaks of infectious diseases and swiftly responds to emerging threats. Key messages • The tragic events in Ukraine resulted in healthcare access issues. Lviv CDC, fighting at its own forefront, quickly assessed the risks and efficiently managed the potential hazards. • The Lviv region remains one of the biggest hubs in Ukraine for the temporary residence of internally displaced people, with CDC employees ensuring that preventive measures are effectively carried out.

Blockchain in Healthcare: Overview of Applications, Challenges, and Future Directions

There are numerous healthcare issues which show the potential of blockchain technology such as transparency, interoperability and security of data. Through this study, it tries to offer a very deep explanation of where the Blockchain applications today stand for in the healthcare domain emphasising on possible benefits from the technology and some known challenges that are being faced while actuating those. We then use blockchain applications in the above-mentioned aspects to explain different aspects of use of Blockchain in healthcare like supply chain management, clinical trials, secure medical data exchange and patient empowerment. We also talk about Blockchain from implementation point of view – smart contracts, consensus methods and data privacy. In this publication, we determine whether deploying Blockchain in healthcare raises ethical and legal issues and how existing issues can be addressed. In conclusion, we describe future directions for research and opportunities to use Blockchain to improve healthcare delivery and outcomes.

Parasport medicine and its challenges

Introduction: The field of Paralympic medicine examines the healthcare issues that are specific to athletes with disabilities. This article presents a historical phenomenon in which the introduction of further activities for patients with neurological conditions led to the hosting of the Paralympic Games. The article describes the complexity of inclusivity in disability health research and outlines the historical context of the emergence of this field of sports medicine. It also presents the main challenges posed by the developing parasport. One of the most significant issues is to guarantee that competition is conducted with the greatest degree of equity possible. This entails ensuring the precision of classification, preventing the over-medicalisation of athletes. It is also imperative that athletes with special requirements are provided with the appropriate support and equipment. The creation of adequate care pathways requires a challenging process, largely due to the inconclusive nature of research findings over the years. Further investigation is necessary to gain a more nuanced understanding of this relatively new area of study. Purpose of work: The aim of this article is to provide an overview of the broader challenges that paramedicine is facing in relation to the rapid development of this branch of sports medicine. Materials and methods: This article is based on the literature found in Pubmed database and other scientific databases. References were researched using following keywords: paralympic games, persons with disabilities, paramedicine, para-athletes, Conclusions: The advancement of Paralympic medicine is markedly expedited by a synthesis of qualitative and quantitative research methodologies. The integration of these two approaches yields invaluable insights into the personal perspectives of athletes on their health, while also facilitating statistically significant, evidence-based results on the analysis of large groups of athletes.

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

A Study Of Accreditation Status Synchronization And Regional Public Service Agency As A Model Of Public Health Service (Puskesmas) Management Improvement

Indonesia still has public health centre (Puskesmas) health care issues. The data from Bengkulu is comparable to those from the national level. It shows that Puskesmas has not maximised gatekeeping. We need responsible Puskesmas management and high-quality, sustainable health care to address these problems. Pushesmas' accreditation and Regional Public Service Agency status help the government improve Puskesmas administration. We need a synchronization model because we implement accreditation and BLUD separately. Given the current situation, this study explores potential synchronization strategies between accreditation and BLUD to enhance Puskesmas management. The study describes the condition of accredited and BLUD Puskesmas, identifies the problems, investigates the role capabilities of the parties involved, seeks to synchronise Puskesmas management, and formulates a strategy to improve management. This qualitative descriptive research uses a case study approach with purposive sampling to examine Puskesmas, an accredited and BLUD school in Bengkulu Province. Researchers conduct in-depth interviews, observations, library studies, and documentation. Researchers analyse data through collection, reduction, presentation, and verification or conclusion. They also triangulate data, sources, and procedures for data validity analysis. This research created a Puskesmas Management Improvement Strategy Model as a Novelty

Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study.

Polypharmacy is an important healthcare issue, especially in elderly patients with dementia. As an incentive to reduce polypharmacy, a health insurance reimbursement scheme was introduced in 2016 for medication review and the reduction of medications for inpatients in Japan. However, the effects of these incentive schemes were not evaluated. We identified 1,465,881 inpatients aged ≥65 years with dementia. An interrupted time-series analysis was conducted by fitting a Prais-Winsten linear regression model. The outcome measure was the number of classes of medications prescribed during discharge. No significant changes were observed in the average number of medication classes at discharge immediately after the introduction of the scheme (coefficient: -0.022, 95% confidence interval [CI]: -0.17 to 0.13). The slope change, representing the effect of the intervention over time, was also not significant (coefficient: -0.00053, 95% confidence interval: -0.0012 to 0.00018). The incentive scheme was not associated with a reduction in the number of medication classes at discharge among older inpatients with dementia.

Cost-effectiveness of Procalcitonin (PCT) guidance for antibiotics management of adult sepsis patients in the Egyptian context

BackgroundSepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs).Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients.Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context.MethodsWe developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the“Delphi technique” to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon.Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software.ResultsBase-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice. ConclusionsIn the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.

Using interpretable machine learning to predict bloodstream infection and antimicrobial resistance in patients admitted to ICU: Early alert predictors based on EHR data to guide antimicrobial stewardship.

Nosocomial infections and Antimicrobial Resistance (AMR) stand as formidable healthcare challenges on a global scale. To address these issues, various infection control protocols and personalized treatment strategies, guided by laboratory tests, aim to detect bloodstream infections (BSI) and assess the potential for AMR. In this study, we introduce a machine learning (ML) approach based on Multi-Objective Symbolic Regression (MOSR), an evolutionary approach to create ML models in the form of readable mathematical equations in a multi-objective way to overcome the limitation of standard single-objective approaches. This method leverages readily available clinical data collected upon admission to intensive care units, with the goal of predicting the presence of BSI and AMR. We further assess its performance by comparing it to established ML algorithms using both naturally imbalanced real-world data and data that has been balanced through oversampling techniques. Our findings reveal that traditional ML models exhibit subpar performance across all training scenarios. In contrast, MOSR, specifically configured to minimize false negatives by optimizing also for the F1-Score, outperforms other ML algorithms and consistently delivers reliable results, irrespective of the training set balance with F1-Score.22 and.28 higher than any other alternative. This research signifies a promising path forward in enhancing Antimicrobial Stewardship (AMS) strategies. Notably, the MOSR approach can be readily implemented on a large scale, offering a new ML tool to find solutions to these critical healthcare issues affected by limited data availability.

An Observational Study on Clinical Benefits of CytoSorb in Patients with Severe Sepsis

Background and Aim: Sepsis is a well-recognized healthcare issue worldwide. Despite research, the ability to positively influence outcome remains limited. Newer evidences have pointed that using adsorption of cytokines is beneficial during endotoxemia and sepsis. Therefore, this study was aimed to determine the clinical benefits of CytoSorb usage in patients with severe sepsis admitted in intensive care units (ICU). Study Design: Prospective, observational, comparative study. Material and Methods: Forty patients with sepsis admitted to ICU were included. The CytoSorb group included 20 patients who received CytoSorb therapy in addition to Standard-care (SOC) and 20 patients in SOC group who received SOC alone as per routine ICU protocols. Clinical and laboratory parameters were analyzed pre/post-treatment in both groups and compared. Results: CytoSorb and SOC groups were comparable at baseline. There was significant reduction in serum creatinine (2.59±2.0 vs. 2.89±1.2, mg/dl; P=0.042), serum lactate (3.26±1.1 vs. 3.27±0.9, mmol/lit; P<0.001), serum procalcitonin (2.75±2.4 vs. 3.39±3.5, ng/ml; P<0.001), serum CRP (90.2±57.4 vs. 175.6±100.9, mg/dl; P<0.001) and serum IL6 (1769.7±4444.1 vs. 256.8±392.4, pg/ml; P=0.03) levels in CytoSorb compared to SOC. There was significant improvement in mean arterial pressure (MAP) (65.75±1.8 vs. 62.75±2.8, mmHg; P<0.001) and reduction in norepinephrine dose (6.47±2.7 vs.10.65±3.6, mcg/min; P<0.001) in CytoSorb group reflecting better hemodynamic stability. The post-treatment increase in SOFA score was lesser in CytoSorb group (11.85±2.9) than SOC group (12.3±2.3), but was not significant (P=0.135). Conclusion: CytoSorb therapy along with SOC was associated with significant improvements in hemodynamic stability, MAP and Norepinephrine requirements than SOC alone in severe sepsis.

A conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression.

Medication non-compliance is a significant healthcare issue that is widespread. Extensive research has identified factors that contribute to medication non-compliance in different healthcare settings. As a result, there was a need to develop a conceptual framework to facilitate medication compliance among adults living with depression. The purpose of this study was to develop a conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression. A qualitative, exploratory, descriptive and contextual research design was utilised to investigate the experiences of adults living with depression who are non-compliant with medication. The study consisted of three phases: an empirical phase, a classification of concepts and a development phase. Following the empirical phase, a conceptual framework was developed based on the classified concepts. Three sets of results were merged for the cross-validation analysis, combining findings from the systematic review, the researcher's previously conducted and published minor dissertation and the current study. A conceptual framework was developed to assist psychiatric nurses in effectively promoting an internal locus of control among adults living with depression. The resulting conceptual framework provides valuable insights and serves as a valuable tool for future research endeavours aimed at enhancing medication compliance among adults living with depression.Contribution:This framework serves as a valuable guide for future studies that aim to explore medication compliance among adults living with depression, specifically by focussing on the concept of internal locus of control.

The influence of job enrichment on job embeddedness and sick presenteeism among nurses.

To understand how job enrichment influences job embeddedness and sick presenteeism among nurses. Job satisfaction and retention are critical issues in healthcare, particularly among nurses. Job enrichment has been identified as a potential strategy to enhance job satisfaction and reduce turnover rates. Understanding its impact on job embeddedness and sick presenteeism can inform policies to improve nurse well-being and organizational effectiveness. A cross-sectional descriptive design following STROBE guidelines was used. Data were collected from 360 nurses working in critical care units of a large university hospital. Three scales were used to measure job enrichment, job embeddedness, and sick presenteeism. Nurses reported high job enrichment and embeddedness levels. However, a significant proportion also exhibited high levels of sick presenteeism. Strong positive correlations existed between job enrichment, job embeddedness, and sick presenteeism. Regression analyses revealed that job enrichment significantly predicted job embeddedness and sick presenteeism. The findings highlight the complex interplay between job characteristics, organizational commitment, and employee health behaviors among nurses. Job enrichment emerged as a critical factor influencing job satisfaction, organizational commitment, and sick presenteeism. The study underscores the need for health policies that promote job enrichment strategies, as they can contribute to nurse retention, reduce sick presenteeism, and enhance productivity in healthcare settings. Nurse retention and job satisfaction can be improved by implementing job enrichment practices in healthcare organizations. Policies to reduce sick presenteeism should prioritize creating healthier work environments and promoting employee well-being. Understanding the cost-effectiveness and productivity gains associated with job enrichment can inform workforce planning and staffing policies, ensuring adequate nurse staffing levels and quality patient care.

A Prospective Study on the Spectrum of Liver Abscess With Special Reference to Ruptured Abscess in a Tertiary Care Hospital.

Introduction Liver abscesses are one of the most concerning healthcare issues in Western countries, with a prevalence rate of three per 100,000. Although with the improvement in the socio-economic status and the health care system, its incidence has decreased in developed nations, pyogenic and amoebic liver abscesses are still high in resource-poor countries. Low socioeconomic conditions, improper hygiene, lack of awareness, and often a delay in diagnosis can lead to fatal complications and high mortality. Methods This prospective study was conducted in the Department of General Surgery, Calcutta National Medical College (CNMC) from 1st January 2019 to 31st August 2020 after obtaining approval from the Institute Ethical Committee (IRB no: EC-CNMC/2019/238/1). Patients over 10 years old with clinical and radiological features of liver abscesses were included in the study. Demographic, clinical, and treatment parameters were analyzed. Clinical and biochemical data were also compared statistically between ruptured and unruptured cases. Results Sixty patients with liver abscesses were included in the study. A pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were 28 and 32 cases, respectively. Most patients were between 21 and 40 years of age (53.3%, n=60), with male predominance (76.7%, n=60).The most common symptom was fever in both PLA (89.2%, n=28) and ALA (65.6%, n=32). Most abscesses were 5-10 cm in size (56.6%, n=60). Clinical parameters like pedal edema, ascites, respiratory distress, intercostal tenderness, and peritonitis were associated with ruptured abscesses. Biochemical parameters like low albumin raised total leucocyte count (TLC), increased prothrombin time, and large size of the abscess were predictors of ruptured abscess (p<0.001). Image-guided aspiration was performed in 14 patients (23.3%, n=60), and CT-guided percutaneous catheter drainage was done in 30 cases (50%, n=60). The most common organism isolated was E. coli. The ruptured abscess was diagnosed in six patients (10%, n=60). All ruptured abscesses required laparotomy and open surgical drainage. After three months of follow-up, a complete resolution of abscess cavities were seen in 38 patients (63.3%, n=60). Mortality in our study was 5 (8.3%, n=60). Conclusion Although modern diagnostic tools can efficiently diagnose liver abscesses, the identification of clinical features still has its place. Percutaneous catheter drainage is most commonly performed as a minimally invasive procedure without significant morbidity.Clinical suspicion of a ruptured liver abscess should be dealt without a delay. Improved hygiene and awareness can reduce its incidence, but early identification of clinical features, prompt diagnosis, and treatment can reduce mortality and morbidity.

Delivering Culturally Competent Care to Migrants by Healthcare Personnel: A Crucial Aspect of Delivering Culturally Sensitive Care

The increasing cultural and ethnic diversity within global migrant populations necessitates the provision of culturally competent care by healthcare personnel. This narrative literature review critically analyzes existing literature on the delivery of culturally competent care to migrants, highlighting key theoretical frameworks, empirical findings, and practical strategies to enhance cultural competence in healthcare settings. The review identifies significant health disparities faced by migrants, including barriers to accessing healthcare, communication challenges, and systemic issues within healthcare institutions. It emphasizes the importance of comprehensive training programs, supportive organizational policies, community engagement, and the innovative use of technology and telemedicine. Furthermore, it addresses the future directions and research gaps, calling for longitudinal studies, the development of robust metrics, and targeted strategies to overcome the digital divide and ensure data privacy. By addressing these areas, healthcare providers, educators, and policymakers can improve healthcare delivery, reduce health disparities, and ensure equitable access to care for migrant populations.

Technology And Innovation In HR

In India, the high cost of medical education, particularly for an MBBS degree, poses significant challenges for new doctors, who often find that their qualifications do not justify the Expenses incurred. This financial strain is exacerbated when these highly trained professionals are employed for routine tasks such as insurance treatment and billing verification, roles that are not commercially viable given their level of education and potential. As a cost-effective measure, many insurance companies and third-party administrators (TPAs) opt to employ doctors with BHMS or BMS degrees for these tasks. However, these professionals are often underqualified for the complexities of medical verification, leading to inefficiencies and errors in treatment validation and anomaly detection. The situation also adversely affects programs like the Ex-Servicemen Contributory Health Scheme (ECHS), where the need for accurate and efficient cashless medical services is critical. Delays and inaccuracies in medical verification can complicate the provision of timely healthcare to veterans and their families, underscoring the need for improvement in these processes. This paper proposes the implementation of an Artificial Intelligence (AI) ecosystem designed to function as highly qualified medical agents. This AI system will be capable of independently verifying diagnoses, treatment plans, and medical reports for accuracy while also identifying procedural anomalies. The primary objective is to augment the capabilities of the current workforce, enhancing overall efficiency and effectiveness in medical management. By deploying AI medical agents, the project aims to not only address the gap in qualification and task complexity but also improve the accuracy and reliability of medical administrative processes. This initiative promises to revolutionize the way medical verifications are handled, providing a sustainable, scalable solution to a pressing healthcare management issue in India.