Healthcare Service System Research Articles

Experiences in healthcare for weight management – a qualitative interview study of retired individuals with obesity and low or high education

BackgroundOverweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management.MethodsThis qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis.ResultsThree main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education.ConclusionsThe participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management.

Spatial context and informal caregivers’ Well-being: A case study of a Carer Café project in Hong Kong

This paper evaluates how a Hong Kong community Carer Café program reduce the informal (unpaid) caregivers’ navigation burden of social and health care service system. The cafés took place once biweekly at pantries and activity rooms of social service centers, community centers, and churches, which installed temporary decorations to create a café-like environment. his article will use the conceptual framework of spatial context, including spatial propinquity, spatial composition, and spatial configuration, to highlight four mechanisms in the process of informalization. They are (a) changing layout; (b) promoting spatial propinquity of caregivers; (c) creating a spatial composition facilitating social interaction; and (d) allowing the caregivers to use informal spaces flexibly. Qualitative data from 26 respondents, including social workers, project staff, volunteers, and users, sheds light on the details of four mechanisms. Results show that the Carer Cafés were transformed into a safe and caregiver friendly third place by the informalization process. Thus, caregivers from communities visit cafés frequently. These frequent visits facilitate the Cafés become a hub for informal caregivers access different resources and supports. This paper suggest that spatial context would be an important consideration to further explore in the future community caregiver support service practice and policy.

Digital Intelligence Drives the High-Quality Development of the Healthcare Service System: Development Mechanisms and Implementation Pathway

The rapid development of digital intelligence technologies is providing a powerful boost to the high-quality development of the healthcare system. Considering the current state of our healthcare services and guided by General Secretary Xi Jinping's insights on new quality productive forces and the directives from Third Plenary Session of Communist Party of China's 20th Central Committee, the high-quality development of the healthcare service system should focus on digital intelligence technologies such as cloud computing, big data, privacy computing, blockchain, Internet of Things (IoT), mobile computing, and AI. The key measures should include the optimization of production factors, services, and governance. Emphasis should be placed on enhancing the efficient and intensive development of the development model, ensuring the high-quality and continuous integration of the supply model, and transitioning to scientific and modern management methods. Herein, we analyzed the "factor optimization-service optimization-governance optimization" development mechanism driven by digital intelligence and proposed corresponding implementation pathways, intending to provide references for establishing a high-quality and efficient healthcare service system with Chinese characteristics.

Multi-Label Emotion Recognition of Korean Speech Data Using Deep Fusion Models

As speech is the most natural way for humans to express emotions, studies on Speech Emotion Recognition (SER) have been conducted in various ways However, there are some areas for improvement in previous SER studies: (1) while some studies have performed multi-label classification, almost none have specifically utilized Korean speech data; (2) most studies have not utilized multiple features in combination for emotion recognition. Therefore, this study proposes deep fusion models for multi-label emotion classification using Korean speech data and follows four steps: (1) preprocessing speech data labeled with Sadness, Happiness, Neutral, Anger, and Disgust; (2) applying data augmentation to address the data imbalance and extracting speech features, including the Log-mel spectrogram, Mel-Frequency Cepstral Coefficients (MFCCs), and Voice Quality Features; (3) constructing models using deep fusion architectures; and (4) validating the performance of the constructed models. The experimental results demonstrated that the proposed model, which utilizes the Log-mel spectrogram and MFCCs with a fusion of Vision-Transformer and 1D Convolutional Neural Network–Long Short-Term Memory, achieved the highest average binary accuracy of 71.2% for multi-label classification, outperforming other baseline models. Consequently, this study anticipates that the proposed model will find application based on Korean speech, specifically mental healthcare and smart service systems.

Public Healthcare System in China: Issues, challenges and survival strategies

Public Healthcare System in China faces numerous challenges due to the country's size, population, and socio-economic diversity. This paper intends to examine a modern management system for public hospitals to fulfil the needs of the society in the new era of China. It also explores the evolution of healthcare, growth of the healthcare sector, challenges, and survival strategies to the healthcare sector. With the strategic triangle as a base, the research will make attempts to translate the public value framework combined with the hospital context into a blueprint for solving some of the key challenges facing the healthcare service system.

Suicide Mortality During the Perinatal Period

The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality. To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide. This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023. Pregnancy status at death (perinatal or nonperinatal). The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis. This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression. This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.

Resolving conflict and promoting coordination for an integrated old-age healthcare service system in China: GMCR-AHP based decision analysis approach

China faces a healthcare challenge due to its aging population, necessitating an integrated old-age healthcare system considering multiple stakeholders' interests. Conflict and inequality may arise from varying stakeholder interests. This study develops a conflict resolution strategy for the coordination of stakeholders involved in the old-age healthcare service system, promoting harmonization and minimizing conflict to establish an equitable system meeting elderly needs. It contributes to a robust healthcare system for comprehensive, quality care. The focus of the study is to identify relevant stakeholders and decision-makers involved in developing an integrated old-age healthcare service system and explore a feasible solution through stakeholder analysis using the Mitchell score-based technique and stakeholder theory. Decision-makers' preferences are estimated using the Analytic Hierarchy Process (AHP). Solution strategies are developed through multiple stability concepts within the graph model for conflict resolution (GMCR). The conflict resolution analysis based on the integrated AHP-GMCR approach reveals that the development of an integrated old-age healthcare system is feasible by addressing potential conflicts among the stakeholders. Considering the current predicament of comprehensive medical services in China, governments should distribute authority, simplify procedures, and improve the insurance system. Furthermore, medical institutions should explore funding options, expand services, and enhance accessibility. Elderly individuals should prioritize healthy aging and seek suitable healthcare providers. Stakeholder participation is crucial for effective implementation. These recommendations enable China to advance integrated elderly care successfully, addressing challenges posed by the aging population.

Development in the adoption of a national digital healthcare system and experience at taking new technology in use – changes from 2019 to 2022

Introduction. The adoption of a national digital system for healthcare services in Iceland, and how people perceive their possibilities to adopt new technology is examined. Method. Surveys using random samples of people aged 18 years and older were conducted. The samples consisted of 1.800 people in 2019 and 1.200 in 2022. People 18-59 years old were reached by emails and 60 or older by phone. Response rates were 39% in 2019 and 45% in 2022. Analysis. The analysis is descriptive. Survey results from 2019 and 2022 are compared and differences by sex and age examined. Results. Considerable change was detected in use of the system for communication with health professionals tailored to participants health, while no increase was in obtaining information regarding issues not directly connected to people’s health history. The possibilities of adopting health technology were considered substantially better in 2022 than in 2019. Conclusion. People are likely to use digital healthcare systems when the situation requires, and they receive necessary support. It is important to consider the needs of those who are getting older for people to have equal opportunity to benefit from digital health information. Furthermore, reliable information offered by health professionals need to be promoted.

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

COMPLIANCE WITH STANDARD PRECAUTIONS AMONG PEDIATRIC NURSES IN SELECTED GOVERNMENT HOSPITALS: A CROSS-SECTIONAL STUDY

Background: Healthcare-associated infections (HAIs) are complex conditions that appear in any healthcare facility. They truly become an economic and financial burden for the family and healthcare service system, particularly in developing countries. Nurses directly provide care for patients because they can be the cause of the spread of HAIs in healthcare institutions. Thus, nurses’ compliance with standard precautions plays a critical role in HAIs prevention efforts, especially in caring for children. Objectives: to examine compliance with standard precautions among pediatric nurses and related factors. Materials and methods: A cross-sectional descriptive correlational design was used. Sample size comprised of 285 pediatric nurses at selected government hospitals who have at least 6 months of experience as a nursing professional. Nurse’s adherence to standard precautions in caring was examined by using a 4-likert questionnaire including 20 items divided into 4 subscales as use of protective devices, disposal of sharps and waste, decontamination of spills and used articles, and prevention of cross-infection. Results: The age mean of nursing participants was 31.2 years. The overall compliance score was 3.16 (SD = 0.47) with 83.2% of nurses having good compliance with standard precautions. Among subscales of compliance, nurses’ practices with decontamination of spills and used articles had the highest scores. In contrast, the use of protective devices was the lowest. Besides, the study results showed a statistically significant relationship between nurses’ attitudes regarding HAIs prevention and their compliance with standard precautions (p<0.001). Meanwhile, there was no association between gender, level of education, experience in the year and standard precautions compliance. Conclusions: infection control practices with standard precautions among pediatric nurses were good. However, there were some aspects that should be improved. More related continuous training programs for nurses should be developed. Additionally, hospital administration and nurse managers should establish a system to regularly monitor and sustain compliance with infection control procedures among staff nurses as well as evaluate the suitability of HAIs prevention guidelines.

The Promises and Challenges toward Mass Customization of Healthcare Services

The healthcare industry is confronted with the challenge to offer an increasing variety of healthcare services while in the meantime controlling rapidly increasing healthcare costs. Mass customization has been proven to be an effective strategy to fulfill customers’ individual specific needs with high efficiency and low cost in the manufacturing industry. This paper investigates the theoretical feasibility and practical applicability of adopting mass customization as a conceptual framework for designing a healthcare service delivery system. The nature of healthcare delivery systems and their evolution are discussed relative to those of manufacturing systems. Recent research in personalized medicine, consumer-driven healthcare, consumer healthcare informatics, and integrated healthcare delivery is reviewed as enabling technologies towards mass customization of healthcare services. By synthesizing these scattered efforts in different streams of literature, this paper concludes that mass customization can contribute to the redesign of healthcare service systems, and delineates a roadmap for future research.

Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study.

The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged.

Analyzing Patterns of Service Utilization Using Graph Topology to Understand the Dynamic of the Engagement of Patients with Complex Problems with Health Services

Background: Providing care to persons with complex problems is inherently difficult due to several factors, including the impacts of proximal determinants of health, treatment response, the natural emergence of comorbidities, and service system capacity to provide timely required services. Providing visibility into the dynamics of patients’ engagement can help to optimize care for patients with complex problems. Method: In a previous work, graph machine learning and NLP methods were used to model the products of service system dynamics as atemporal entities, using a data model that collapsed patient encounter events across time. In this paper, the order of events is put back into the data model to provide topological depictions of the dynamics that are embodied in patients’ movement across a complex healthcare system. Result: The results show that directed graphs are well suited to the task of depicting the way that the diverse components of the system are functionally coupled—or remain disconnected—by patient journeys. Conclusion: By setting the resolution on the graph topology visualization, important characteristics can be highlighted, including highly prevalent repeating sequences of service events readily interpretable by clinical subject matter experts. Moreover, this methodology provides a first step in addressing the challenge of locating potential operational problems for patients with complex issues engaging with a complex healthcare service system.

Design of Patient Visit Itineraries in Tandem Systems

Problem definition: Multistage service is common in healthcare. One widely adopted approach to manage patient visits in multistage service is to provide patients with visit itineraries that specify personalized appointment time for each patient at each service stage. We study how to design such visit itineraries. Methodology/results: We develop the first optimization modeling framework to provide each patient with a personalized visit itinerary in a tandem (healthcare) service system. Due to interdependencies among stages, our model loses those elegant properties (e.g., L-convexity and submodularity) often utilized to solve the classic single-stage models. To address these challenges, we develop two original reformulations. One is directly amenable to off-the-shelf optimization software, and the other is a concave minimization problem over a polyhedron shown to have neat structural properties, based on which we develop efficient solution algorithms. In addition to these exact solution approaches, we propose an approximation approach with a provable optimality bound and numerically validated performance to serve as an easy-to-implement heuristic. A case study populated by data from the Dana-Farber Cancer Institute shows that our approach makes a remarkable 28% cost reduction over practice on average. Managerial implications: Common approaches used in practice are based on simple adjustments to schedules generated by single-stage models, often assuming deterministic service times. Whereas such approaches are intuitive and take advantage of existing knowledge of single-stage models, they can lead to significant loss of operational efficiency in managing multistage services. A well-designed patient visit itinerary that carefully addresses the interdependencies among stages can significantly improve patient experience and provider utilization. History: This paper was selected for Fast Track in the M&SOM Journal from the 2022 MSOM Healthcare SIG Conference. Funding: The work of the last two authors was supported in part by the National Natural Science Foundation of China [Grants 71931008 and 72001220]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0134 .

COVID-19 Patients' Experiences during the Pandemic: A Phenomenology Study

Introduction: The COVID-19 pandemic caught the world community off guard, with irreversible effects, causing numerous hospitalizations and deaths across the globe. Understanding COVID-19 patients' lived experience is crucial to care assessment. Therefore, this study aims to investigate the experiences of COVID-19 patients before, during, and after hospitalization. Methods: The present study employed a phenomenological method, and purposive sampling was used to select participants. The individuals discharged from COVID-19 treatment in the upper southern region of Thailand were recruited to participate. Data were collected through in-depth interviews conducted by telephone, LINE, and face-to-face from July 1 to September 14, 2020. Results: The study included a total of eight participants selected from seven provinces located in the southern region of Thailand. The mean age of the participants was 42 years, and the mean duration of hospitalization was 22 days, with 62.5% of them having underlying illnesses. The patients' experiences were categorized into 14 distinct sub-themes, corresponding to the various stages of pre-hospitalization, throughout hospitalization, and post-hospitalization. The pre-infection lifestyles of the participants indicated a lack of understanding and misunderstanding regarding COVID-19. This study found that the participants had more fear, depression, and suicidal thoughts during hospitalization. Nevertheless, the participants unequivocally affirmed that the nurse-patient interaction, in terms of providing assistance and addressing mental health concerns, brought them a sense of solace. However, they encountered rejection from their community after being discharged from the hospital. Conclusion:COVID-19 survivors must remain confident in their ability to continue life and believe that they made the right choice by accepting hospital care to save their own lives and prevent the spread of the disease. Healthcare practitioners and stakeholders within the healthcare service system can utilize this knowledge of patients' experiences to assist patients in the prevention, treatment, and management of COVID-19. Doi: 10.28991/HEF-2024-05-01-04 Full Text: PDF

Evaluation of the accessibility attribute in the conception of women about gynecological assistance

Objective: To evaluate the Accessibility attribute in women's conception of gynecological care in a Basic Health Unit in the Federal District, Brazil. Method: This is an exploratory, cross-sectional descriptive study with a quantitative approach. Results: They showed that the attribute of accessibility in Primary Health Care is still a major conflict, and several problems persist, such as geographic barriers and difficult access by the organization of the service, which highlights the need to break the ordinary care practices that make difficult entry, access, reception and transmission of information. Conclusion: It is necessary to organize more inclusive forms of healthcare offerings, which aim to provide a quality welcome, with a holistic view of the person as a whole, fundamental for better organization of the healthcare service system in healthcare regions.

A Window into the Use of Post-diagnostic Services for Autism and Parents' Perspective on the Quality of Early Childhood Services Trajectory in a Canadian Province.

The pathway for post-diagnostic services for autism tends to be complex, heterogeneous, and fraught with delays. This situation has repercussions for families' experience with care systems, the quality of early interventions, and family adjustment. To date, studies of parents' point of view on autism services have predominantly focused on the diagnostic phase of the services trajectory. The goal of the present study was to investigate the perspective of parents on autism early childhood services within a public healthcare and social services system in a Canadian province (Québec). Participants were 91 parents who completed a structured framework for the evaluation of the quality of services trajectories, the Evaluation of the services Trajectory in Autism by Parents (ETAP; Mello et al., in Research in Developmental Disabilities 133, 2023). Approximately three-quarters of families received interim services (e.g., punctual speech therapy interventions) for which they had overall neutral-to-positive appraisals but viewed as having comparably low validity and continuity. Although all children diagnosed with autism are entitled to receive early behavioral intervention (EBI) dispensed by the public health and social services system, approximately a quarter of families did not receive this service. Families who received EBI evaluated this service positively on all ETAP dimensions. The empathy (i.e., parent-provider relationships) dimension was rated highest for both interim and EBI services. Some systemic, family, and child-related factors were associated with the perceived quality of services for both interim and early childhood services. Our results emphasize the need for services for children and families as soon as possible, both during assessment and after diagnosis.

Secure Sharing of Electronic Medical Records Based on Blockchain

As network technology advances and more people use devices, data storage has become a significant challenge due to the explosive growth of information and the threat of data leaks. In traditional medical institutions, most medical data is stored centrally through cloud computing technology in the institution’s data center. This centralized storage method has many security risks, and once the central server is attacked, it will lead to the loss of medical data, which will lead to the leakage of patients’ private data. At the same time, electronic medical records are the most critical data in the current medical field. In the traditional centralized healthcare service system (HSS), there are data leakage problems and tampering with electronic medical records due to human factors. At the same time, each hospital is built independently, resulting in the current centralized healthcare service system having a data silo problem, making it difficult to share medical data between institutions securely. With the increase in the number of users in the system, the electronic medical record data in the system also increases gradually, resulting in the increasing overhead of decryption calculation. Therefore, this paper proposes a blockchain-based access control scheme with multiparty authorization to ensure the security of electronic medical records. The scheme uses an SM encryption algorithm to encrypt the medical data in the system. It adds the patient’s signature to ensure the confidentiality and security of the data, and the encrypted electronic medical records (EMRs) are stored in the InterPlanetary File System (IPFS) to realize the distributed storage of EMR. In addition, role-based multiauthorization access control is implemented through smart contract-based to ensure the security of EMR. We have analyzed the security of this paper’s solution and compared its performance with the existing schemes based on other cryptographic algorithms. The experimental results show that the proposed solution significantly improves the secure sharing of EMR and provides system performance.

Performance Analysis of Two Different Types of Waiting Queues with Working Vacations

This work examines a new class of working vacation queueing models that contain regular (original) and retrial waiting queues. Upon arrival, a customer either starts their service instantly if the server is available, or they join the regular queue if the server is occupied. When it is empty, the server departs the system to take a working vacation (WV). The server provides services more slowly during the WV period. New customers join the retry queue (orbit), if the server is on vacation. The supplementary variable technique (SVT) examines the steady-state probability generating functions (PGFs) of queue size for different server states. Several system performances are numerically displayed, including system state probabilities, mean busy cycles, mean queue lengths, sensitivity analysis, and cost optimization values. The motivation for this model in a pandemic situation is to analyze new healthcare service systems and reflect the characteristics of patient services.

Suicide attempts and suicides as determinants of quality and safety within hospital system of mental health care services

Suicide attempts and suicides as determinants of quality and safety within hospital system of mental health care services