Healthcare Researcher Research Articles

Pattern of Cholelithiasis and Cholecystitis among Obese Patients

Introduction: Obesity is a major health problem in western society with rapidly increasing prevalence in most countries. The healthcare burden of obesity is far reaching but many of the consequences are yet to be fully understood. While there is a perception that obesity negatively impacts on health and stone formation in gall bladder there is conflicting evidence for this. Aims & Objectives: To assess whether obesity impacts on the blood cholesterol level which leads to dislipidaemia and gall stone formation. To identify whether dislipidaemia causes cholelithiasis and cholecystitis among obese patient. Methods: Between 1st December, 2018 and 31thMay, 2019, patients admitted in dept of surgery at Shaheed Ziaur Rahman Medical College Hospital in Bogura, Bangladesh were enrolled. Following informed consent, BMI was assessed. High risk patients and complications were identified according to established criteria. Patients were grouped according to BMI categories as Normal, overweight, Obese grade-I and Obese grade-II. Various disease of gall bladder including stone formation and its complications were analysed on all obese patients treated at Shaheed Ziaur Rahman Medical College Hospital using a SQL database. Results: Total 59 people were available and consented for this study. 09 patients were excluded; 4 patient were obese but no cholelithiasis or cholecystitis, 3 patients were not agree to investigations and 2 patients declined study). The remaining 50 patients, 29 females and 21 males, included for analysis. The median age was 48 with a range from 18-55. A literature review found evidence of increased risk of dyslipidemia which induce stone formation in GB and inflammation of gall bladder associated with obesity. Conclusion: It is an important issue that obesity is increasing in our new generations. This study should take into account for the future health care researcher. This study has summarized the current body of literature and added to it by demonstrating in our cohort that obese patients were at increased risk of formation of gallstones. I have also provided the evidence that patients with increased BMI with cholelithiasis or cholecystitis or other comorbidities are associated with significantly greater cost to the healthcare system.

A data augmentation approach that ensures the reliability of foregrounds in medical image segmentation

Medical image segmentation is an important task in medical imaging and diagnosis. Data augmentation can substantially improve the accuracy of medical image segmentation when the dataset has a small amount of medical images. However, the data augmentation methods for medical image are usually based on big models that require extensive search space. Furthermore, excessively complex models often have a heavy burden for the general healthcare organization or researcher. To address this problem, we propose a method of data augmentation that is simple to implement even for the general researcher and simple to transplant across various models. Here we introduce our new methods called KeepMask and KeepMix, which can be simply ported to a variety of models and provide high performance. These methods allow data augmentation without any effect on the target organ or lesion and can also be adapted to multi-class segmentation. KeepMask and KeepMix can not only perturb the background of an existing medical image but also add target organs that are not present to it and generate new images based on the image. In this paper, we performed our methods on both binary class datasets and multi-class datasets and obtained better performance. We conducted numerous experiments showing the predicted segmentation images using our proposed methods obtained more accurate boundaries.

Artificially Intelligent? Machine Learning in Healthcare and Why It May Not Be As Advanced As You Think

Machine learning: What exactly is it, and how is it being used in healthcare? Are machines always better than a person? How do we know? Managing editor, Caitlyn Allen, sat down with Dr. Avishek Choudhury, artificial intelligence healthcare researcher, to answer these questions and more.

Evaluating a clinical ethics committee (CEC) implementation process in an oncological research hospital: protocol for a process evaluation study using normalisation process theory (EvaCEC)

IntroductionA Clinical Ethics Committee (CEC) is a multi-professional service whose aim is to support healthcare professionals (HPs) and healthcare organisations to deal with the ethical issues of clinical practice.Although CEC...

Development and use of a novel tool for assessing and improving researcher embeddedness in learning health systems and applied system improvements.

This paper outlines the development, deployment and use, and testing of a tool for measuring and improving healthcare researcher embeddedness - i.e., being connected to and engaged with key leverage points and stakeholders in a health system. Despite the widely acknowledged importance of embeddedness for learning health systems and late-stage translational research, we were not aware of useful tools for addressing and improving embeddedness in scholar training programs. We developed the MN-LHS Embeddedness Tool covering connections to committees, working groups, leadership, and other points of contact across four domains: patients and caregivers; local practice (e.g., operations and workflows); local institutional research (e.g., research committees and agenda- or initiative-setting groups); and national (strategic connections within professional groups, conferences, etc.). We used qualitative patterns and narrative findings from 11 learning health system training program scholars to explore variation in scholar trajectories and the embeddedness tool's usefulness in scholar professional development. Tool characteristics showed moderate evidence of construct validity; secondarily, we found significant differences in embeddedness, as a score, from baseline through program completion. The tool has demonstrated simple, practical utility in making embeddedness an explicit (rather than hidden) part of applied and learning health system researcher training, alongside emerging evidence for validity.

Evaluation eines Zukunftsszenarios zur Nutzung von Big-Data-Anwendungen für die Verbesserung der Versorgung von Menschen mit seltenen Erkrankungen

IntroductionIn Germany there are about 4 million people living with a rare disease. Studies have shown that big data applications can improve diagnosis of and research on rare diseases more effectively. However, no concrete comprehensive concept for the use of big data in the care of people with rare diseases has so far been established in Germany. As part of the project “BIDA-SE”, which is funded by the German Ministry of Health, a first scenario has been designed to show how big data applications can be usefully incorporated into the care of people with rare diseases. MethodsThe aim of the present study was to evaluate this scenario with regard to acceptance, (clinical) benefits, economic aspects, and limitations and barriers to its implementation. To evaluate the scenario, an online survey was conducted in Germany in October/November 2019 amongst a total of N = 9 physicians, N = 69 patients with rare diseases/patient representatives, N = 14 IT experts and N = 21 health care researchers. The online questionnaire consisted of both standardized, validated questions taken from already tested survey instruments and additional questions which were constructed on the basis of a preceding literature analysis. The evaluation of the survey was primarily descriptive, with a calculation of frequencies, mean values and standard deviations. ResultsThe results of the evaluation show that the scenario has been accepted by a majority of all groups surveyed (physicians, patients/patient representatives, IT experts and health care researchers). From the point of view of physicians, patients/patient representatives and health care researchers, the scenario has the potential to accelerate the diagnosis and initiation of therapy and to improve cross-sectoral treatment. From the physician’s and health care researcher’s perspective, investments in the application presented in the scenario would be profitable. Financing the scenario would, however, require adjusting the reimbursement situation. The limitations and barriers identified by all groups for a medium-term implementation of the scenario can be grouped into seven thematic areas where action is needed: (1) financing and investment, (2) data protection and data security, (3) standards/data sources/data quality, (4) acceptance of technology, (5) integration into the daily work routine, (6) knowledge about availability as well as (7) habits and preferences/physician's role. DiscussionWith the present study, a first interdisciplinary, practical scenario using big data applications was evaluated with regard to acceptance, benefits and limitations/barriers. The scenario is widely accepted among the majority of all surveyed target groups and is considered (clinically) useful, although legal, organisational and technical barriers still need to be overcome for its medium-term implementation. The evaluation results contribute to the derivation of recommendations for action to ensure the medium-term implementation of the scenario and to channel access to the Centres for Rare Diseases in the future. ConclusionMany activities have been initiated at a national level to improve the health care situation of people with rare diseases. The scenario developed in the “BIDA-SE” project complements these research activities and illustrates how big data applications can be usefully implemented into practice to improve the diagnosis and therapy of people with rare diseases in a sustainable way.

Development and Validation of the Data Instrument for Surgical Global Outreach.

Countless efforts have been made by global surgery outreach organizations to provide care to individuals in low- and middle-income countries; however, there is a paucity of data on these interventions. The authors created the Data Instrument for Surgical Global Outreach to collect basic program, cost, and clinical data on surgical outreach efforts using the literature and the experience of our team. The authors performed a two-round modified Delphi technique to build content validity on the instrument and establish consensus. Experts engaged in global health or global surgery as a health care provider, researcher, or policymaker participated in the validation. In addition, the authors calculated Cronbach's alpha to determine the degree of agreement among experts. A total of 22 experts in global health participated in the validation of the data tool. Changes were made to reword, combine, remove, add, clarify, and simplify data points. There was a unanimous decision to accept the revised data collection instrument among the experts after the second Delphi round. Cronbach's alpha was 0.86 for the first round and 0.95 for the second round, indicating a high degree of internal consistency. The global surgery outreach community must define a set of strategies to collect more robust data on surgical outreach efforts to low- and middle-income countries. Such data will permit policymakers to identify shortfalls in programs and researchers to pursue sustainable treatment modalities and processes of care. Quality collaboratives for surgical outreach organizations may serve as a tool to overcome variation, reduce cost, and improve the quality of care for patients.

Threats to Patient Safety in the Inpatient Maternity Setting.

As part of our special topics issue on inpatient maternity care, experts were asked to offer their thoughts about the main issues putting mothers and babies at risk in the maternity inpatient setting and what quality and safety practices may be beneficial in keeping them safe from harm. Each of the experts has a unique perspective. Loraine O'Neill was one of the original perinatal patient safety nurses who were established as part of an effort by a professional liability company to promote patient safety in birthing hospitals that they covered in several states (). She now is the perinatal patient safety officer in a large academic medical center in New York City. Lisa Miller is a well-known expert on fetal assessment during labor, certified nurse midwife, attorney, educator, patient safety expert, and editor of a popular fetal monitoring textbook (). She has taught fetal monitoring to nurses, midwives, and physicians in multidisciplinary groups all over the United States and consulted on numerous patient safety initiatives. Annie Rohan is a dual-certified neonatal and pediatric nurse practitioner with a 30-plus year clinical practice career with infants, children, and families facing critical and chronic illness. She is currently a healthcare researcher, and oversees advanced practice and doctoral nursing programs at SUNY Downstate Health Sciences University.

'Hitting Targets': a poem from a study of cardiovascular disease prevention.

> ‘Poetry is when an emotion has found its thought and the thought has found words.’ > > (Robert Frost, 1874–1963) Practising care is an emotional business. Healthcare professionals witness and attempt to treat, or relieve, suffering of many kinds.1 However, many find that there is little space within day-to-day clinical practice to reflect — for emotions to ‘find their thought’ — far less ‘thought to find words’. In fact, this may be actively discouraged.2 Here, we present a short poem that Caroline (first author), a healthcare researcher, created from an interview with Simon (second author), a GP. The poem is constructed entirely from extracts of Simon’s own words taken from an interview carried out as part of a study of cardiovascular disease prevention in general practice.3 The poem spotlights tensions in Simon’s work as he is torn between hitting preventive targets …

Working to Have a Normal Life With Cystic Fibrosis in an Adherence-Driven Health Care System.

Adults with cystic fibrosis (CF) must continuously manage their condition, while working for a living, and want a normal life. Adherence rates to treatments/medications are less than optimal. Existing theory offers little to explain adherence rates. The purpose of this study was to develop a theory to further the understanding of how people with CF manage their condition in an adherence-driven health care system. Constructivist Grounded Theory methodology was used to conduct 27 semistructured interviews with adults with CF, family members, and health care providers. Data collection and analysis were simultaneous, using constant comparative methods, initial and focused coding, and category identification and reduction to develop a theory. Doing what works to balance life and CF is the theory generated from this study. The main concern of participants was to be seen as normal. The theory depicts what participants with CF and their family members do about their concerns and involves 4 interrelated processes: working overtime, receiving support, passing as normal, and facing disease progression. Participants did not relate to the term nonadherent; rather they described working overtime to manage CF, to work, and to have a normal life. Health care provider and researcher perspectives on adherence differ from those of people with CF. Engaging adults with CF and health care providers in a dialogue in which expectations are shared may lead to individualized treatment regimens that work, because adults with CF will do what works.

Validation of the Data Instrument for Surgical Global Outreach (DISGO)

Background: Countless efforts have been made by global surgery organizations to provide care to individuals in low- and middle-income countries; however, there is a paucity of data on these interventions. We aim to perform the first step of validation for the Data Instrument for Surgical Global Outreach (DISGO). Methods: We created this data collection instrument to collect basic program, cost, and clinical data on surgical outreach efforts. In this study, we performed a two-round modified Delphi technique to build content validity on the instrument and establish consensus. Experts engaged in the field of global health or global surgery as a healthcare provider, researcher, or policymaker participated in the validation. Additionally, we calculated Cronbach's alpha to determine the degree of agreement among experts. Findings: A total of 22 experts in global health participated in the validation of the data tool. Changes were made to reword, combine, remove, add, clarify, and simplify data points. There was a unanimous decision to accept the revised data collection instrument among the experts after the second Delphi round. Cronbach's alpha was 0.86 for the first round and 0.95 for the second round, indicating a high degree of internal consistency. Interpretation: The global surgery outreach community must define a set of strategies to collect more robust data on surgical outreach efforts to low- and middle-income countries. Such data will permit policy-makers to identify shortfalls in programs and researchers to pursue sustainable treatment modalities and processes of care. Funding: Midcareer Investigator Award in Patient-Oriented Research, National Institutes of Health. Declaration of Interest: We declare no competing of interests. Ethical Approval: This study received exempt status from our university’s institutional review board.

Spirituality in Aotearoa, New Zealand: Personal Reflections From a Spirituality in Health Care Researcher

Spirituality is about what is of utmost value; it is a values lens that asks “what really matters most to me, my family, our community, our country, and our world.” This personal reflection comes from a New Zealand academic who works in the spirituality and health care research field. Although largely biographical, this reflection offers some insight into the New Zealand context and this emergent field.

Strategies to promote adoption and usage of an application to support asthma self-management: a qualitative observational study

BackgroundApps can potentially support asthma self-management; however, attracting downloads and encouraging on-going adherence are challenging.ObjectivesWe observed the impact of different recruitment strategies and app features on adoption and continued use.MethodsPractice...

Tools for testing decision-making capacity in dementia.

dementia is a common cause of altered decision-making capacity. Determining whether an individual has the ability to make a specific decision can be very challenging for both clinicians and researchers. The UK legislation requires that we both promote residual capacity where possible, and protect vulnerable adults who cannot make independent decisions. We evaluated published instruments designed to aid in the assessment of capacity, focussing on those meeting the UK legal requirements. We also consider further disease and culture-specific factors which may influence decision making. a search of electronic databases was made for articles published between 2000 and 2017 detailing structured tools for the assessment of mental capacity. These were evaluated against the UK legal requirements. nine tools were identified which fulfilled the UK legal requirements. Their design and structure varied, as did the level of reliability and validity data available. Some instruments can be tailored for a specific decisional scenario, whilst others are designed for use by particular patient groups. a wide range of mental capacity assessment instruments is available, but not all fulfil the UK legal requirements. Healthcare professionals and researchers should be mindful of personal, cultural and disease-specific factors when assessing capacity. No gold standard for capacity assessment exists, which hampers the evaluation of different approaches. A combination of the opinion of a healthcare professional or researcher trained in capacity evaluation, plus the use of a structured assessment tool is the most robust approach.

Professional Social Media: Instrument to Meet Researcher and Healthcare Instruments with a Model for a New Scientific Social Network

The aim of this study was to analyze the relationship between professional social media use and the healthcare researcher. The innovation which was introduced with biomedical databases has improved research works by making rapid steps in all kind of scientific researches. Besides, instruments such as Internet, search engines and professional social media have brought a great development in the way of rapidly connecting with the professionals and the researchers all over the world in last decades. So it is very interesting to see how they are playing a vital role today in this field through this rapid development. For example, Linkedin, Slideshare, Research gate, PubMed, NCBI, Facebook, Skype etc. has already brought a revolutionary change in the field. The possibility to bridge researchers; for example, with similar discipline or by other different discipline using professional social media has provided with the scientific community a rapid development which was never seen in last decades.

Childhood Mishaps and Its Cognizance among Nepalese Mothers of Parsa District for Its Prevention, Small Cross-sectional Study

Several studies have shown that there several unintentional causes for the unwanted childhood accidents. In addition, Nepal demographic health survey via West University of England revealed at 2006 A.D, 11% death casualties of under- five aged children are due to unintentional injuries 1. This particular study is extremely useful to health care planner, provider and researcher to have grand design to be produced by government of Nepal, such that; there shall be minimal rate of casualties of deceased children due to accidents. This study is descriptive cross sectional study carried out in Parsa district of Nepal where the respondents were mother to assess their awareness of cause of childhood accidents and its prevention. Computer software SPSS is use to scrupulous analysis of study where the chi-square test is used with 95% level of confidence (p=0.05). Poisoning 96% cases is the cause of childhood accident unintentionally, followed by 94% foreign body aspiration, 85% flame burn. Unsupervised children are more prone to injury than supervised children. Finally and foremost the crucial correlation of parents level of awareness with childhood are as follows; inadequate level of knowledge have higher percentage of accident (58%), followed by moderately adequate (32%) and adequate (10%). This study though done on small scale on small part of Parsa district can play key role to the policy to have vigilantive and supervision power to see the loopholes that need to be detected and dealing in curative manner.

Ethical issues in pediatric pharmacogenomics.

Ethical issues in pediatric pharmacogenomics.

Enhancing the h index for the objective assessment of healthcare researcher performance and impact

To investigate whether the h index (a bibliometric tool which is increasingly used to assess and appraise an individual's research performance) could be improved to better measure the academic performance and citation profile for individual healthcare researchers. Cohort study. Faculty of Medicine, Imperial College London, UK. Publication lists from 1 January 2000 until 31 December 2009 for 501 academic healthcare researchers from the Faculty of Medicine. The h index for each researcher was calculated over a nine-year period. The citation count for each researcher was differentiated into high (h(2) upper), core (h(2) centre) and low (h(2) lower) visibility areas. Segmented regression model (sRM) was used to statistically estimate number of high visibility publications (sRM value). Validity of the h index and other proposed adjuncts were analysed against academic rank and conventional bibliometric indicators. Construct validity was demonstrated for h index, h(2) upper, h(2) centre, h(2) lower and sRM value (all P < 0.05). Convergent validity of the h index and sRM value was shown by significant correlations with total number of publications (r = 0.89 and 0.86 respectively, P < 0.05) and total number of citations (r = 0.96 and 0.65, respectively, P < 0.05). Significant differences in h index and sRM value existed between non-physician and physician researchers (P < 0.05). This study supports the construct validity of the h index as a measure of healthcare researcher academic rank. It also identifies the assessment value of our developed indices of h(2) upper, h(2) centre, h(2) lower and sRM. These can be applied in combination with the h index to provide additional objective evidence to appraise the performance and impact of an academic healthcare researcher.

Contributors

Contributors

Undertaking Sensitive Research in the Health and Social Sciences: Managing boundaries, emotions and risks ‐ by Dickson‐Swift, V., James, E.L. and Liamputtong, P.

Dickson-Swift, V., James, E.L. and Liamputtong, P. Undertaking Sensitive Research in the Health and Social Sciences: Managing boundaries, emotions and risks . Cambridge : Cambridge University Press , 2008 £27.99 (pbk) xi + 154pp . ISBN 978-0-521-71823-3 Discussion of the impact on the researcher of carrying out sensitive research has been muted. This volume certainly fills this void and is one which I would recommend to all researchers about to embark on a qualitative project – whether the subject matter is of an overtly ‘sensitive’ nature or not. All too often ‘sensitive’ research is carried out by relatively inexperienced researchers (often young women on short-term contracts) with minimal supervision and protection. The authors make up for this shortfall by providing the voice of an experienced, wise, reassuring and thoughtful mentor. Chapter 1 is devoted to defining ‘sensitive’ research and points out that ‘sensitivity’ is frequently in the eye of the beholder. Interestingly, however, there is no discussion about the impact of dissemination on those who take part in research. Throughout, the authors’ assumption appears to be that ‘sensitive’ research involves engagement with those who are vulnerable, or disempowered. I would have liked to have seen some discussion about research with those at the other end of the social scale (and the issues this is likely to raise). Some discussion about research with one's peers would also be potentially illuminating – particularly given the fact that the book draws extensively on interviews with ‘sensitive’ researchers. Although this aspect brings the various debates alive, the rich data generated are under-utilized – for example, I would have liked, throughout this volume, to have known a bit more about the topics involved in these individuals’ research, their level of experience, and their funding sources. This would have allowed the authors to reflect on the role of research purpose and research design issues in shaping researchers’ experiences and possible responses. Chapter 2 is particularly helpful in locating ‘sensitive’ research in relation to key philosophical and theoretical debates. The authors promise to consider the ‘difficulties faced by researchers from the time they enter into the lives of their participants through to data collection, transcription and analysis’ (p. 33). However, much of the discussion revolves around the impact on the researcher – a ‘cri de coeur’ that will resonate with all experienced researchers, but which stops short of providing many answers. A notable exception to this is the table provided in Chapter 4 (on p. 70) where strategies for managing boundaries are presented. This chapter also covers some interesting ground in terms of managing boundaries as a health care professional and researcher and it also separates out the skills required for therapy/counselling and those involved in doing qualitative research. A curious omission (apart from a very brief aside on p. 91) is consideration of the motivations and personalities of researchers, who tend to be presented as a group sharing universal orientations. Perhaps the organisation of the book mitigates against this, since Chapter 6, which usefully theorises risk, comes rather late. One criticism is that there is comparatively little discussion of the wider structural context in which ‘sensitive’ research takes place. Welcome exceptions to this are the brief section in Chapter 5 on emotions and academia and the discussion on p. 101 of ethics approval procedures, although more attention could have been paid to the key role of the ‘ethics movement’ and the ramifications for health and social science researchers. It might have been illuminating to have compared the position of researchers in the health and social sciences with that of journalists and/or biographers. Although Dickson-Swift et al. provide much solace to the individual ‘sensitive’ researcher, this lack of engagement with the broader context serves to limit the possibility of mounting a cogent and coherent challenge to existing research mores and regulations. The micro world of supervision, and its potential, is over-looked, since this volume discusses supervision within the wider rubric of institutional responsibilities (the focus of Chapter 7) rather than focusing on the face-to-face business of interpreting data and formulating explanations. Nevertheless, there are useful recommendations for those transcribing research (often over looked), principal investigators, institutions, ethics committees, and funding bodies. In an ideal world I would recommend this book to all serving members of ethics committees. However, I do fear that, in the current climate, this would simply result in yet another set of ‘boxes’ to negotiate on already tortuous forms. What would perhaps serve to counter this prescriptive tendency is an acknowledgement of qualitative research as a process, where researchers’ insights can evolve throughout a project. These reservations aside, this was an extensively referenced, enjoyable, engaging and informative text and should be on the bookshelves of all qualitative researchers – and, especially, supervisors.