Specific Health Care Research Articles

Impaled trans-palatal crochet needle impacted at skull base; a multidisciplinary management challenge.

Pediatric oro-pharyngeal trauma is a common observation in hospital accidents & emergencies reception. Immense responsibility rests with specialized health care providers to instantly diagnose and manage a rather small proportion of life-threatening complication associated with such injuries. Postero-lateral oropharyngeal trauma carries a significant risk of major neurovascular insult. More-over such patients are exposed to high radiation exposure to face, head & neck regions. A multi-disciplinary approach involving high dependency nursing, neuro-observation, meticulous imaging, prompt surgical exploration where indicated and a cautious follow-up must be considered as neurovascular manifestation may become apparent after some days of initial injury.

Instrumentos para avaliação da função e da satisfação sexual das mulheres grávidas no contexto dos cuidados de saúde pré-natais: protocolo de revisão scoping

Introduction Despite the fears and beliefs related to sexual function and satisfaction during pregnancy, the healthy experience of sexuality (which is not reduced to these aspects but encompasses them) is relevant to women. Although quality of life is associated with sexual function and satisfaction, the effect of pregnancy in those dimensions, needs to be further explored in order to prevent problems and respond appropriately to women needs. Objective This scoping review aims to map, in the scientific literature, the assessment instruments to evaluate the sexual function and sexual satisfaction of pregnant women in prenatal health care context. Methods The Joanna Briggs Institute guidelines are used to conduct this protocol. The key information sources to be searched include several databases, such as MEDLINE, CINAHL, MedicLatina, Pubmed, Web of Science, Google Scholar and Open Access Scientific Repository of Portugal. Quantitative, qualitative, or mixed studies and secondary studies published in Portuguese, English, Spanish, French, and between 2018 and 2023 will be included. For inclusion criteria will be considered studies referring to instruments to evaluate sexual function and satisfaction of pregnant woman 18 years or over, in prenatal health care context [Population Concept Context framework]. Titles and abstracts of identified citations will be screened independently and assessed for eligibility by two reviewers. Potentially relevant full-text studies and data will be extracted using a data extraction form. The extraction table will show the data mapped in a descriptive way responding to research questions. Selected documents by each reviewer will be uploaded to the Covidence web tool, to optimize the systematic review process and facilitate collaboration between reviewers. For the management of references, the Mendeley software will be used. Discussion Mapping the instruments will enable to summarize the valid, reliable, and specific assessment instruments, their possibilities, and limitations. This results, will contribute to improve the access to information about sexual function and satisfaction during pregnancy, to identify women needs, and plan specific health care interventions. The outcomes relevance will help to guide health professionals and researchers to use the most appropriate assessment tools in prenatal health care context. Systematic review registration Open Science Framework - registration number: osf.io/csg8t

Telemedicine, e-Health, and Digital Health Equity: A Scoping Review.

With the progressive digitization of people's lives and in the specific healthcare context, the issue of equity in the healthcare domain has extended to digital environments or e-environments, assuming the connotation of "Digital Health Equity" (DHE). Telemedicine and e-Health, which represent the two main e-environments in the healthcare context, have shown great potential in the promotion of health outcomes, but there can be unintended consequences related to the risk of inequalities. In this paper, we aimed to review papers that have investigated the topic of Digital Health Equity in Telemedicine and e-Health [definition(s), advantages, barriers and risk factors, interventions]. We conducted a scoping review according to the methodological framework proposed in PRISMA-ScR guidelines on the relationship between Digital Health Equity and Telemedicine and e-Health via Scopus and Pubmed electronic databases. The following inclusion criteria were established: papers on the relationship between Digital Health Equity and Telemedicine and/or e-Health, written in English, and having no time limits. All study designs were eligible, including those that have utilized qualitative and quantitative methods, methodology, or guidelines reports, except for meta-reviews. Regarding Digital Health Equity in Telemedicine and e-Health, even if there is no unique definition, there is a general agreement on the idea that it is a complex and multidimensional phenomenon. When promoting Digital Health Equity, some people may incur some risk/s of inequities and/or they may meet some obstacles. Regarding intervention, some authors have proposed a specific field/level of intervention, while other authors have discussed multidimensional interventions based on interdependence among the different levels and the mutually reinforcing effects between all of them. In summary, the present paper has discussed Digital Health Equity in Telemedicine and e-Health. Promoting equity of access to healthcare is a significant challenge in contemporary times and in the near future. While on the one hand, the construct "equity" applied to the health context highlights the importance of creating and sustaining the conditions to allow anyone to be able to reach (and develop) their "health potential", it also raises numerous questions on "how this can happen". An overall and integrated picture of all the variables that promote DHE is needed, taking into account the interdependence among the different levels and the mutually reinforcing effects between all of them.

The psychiatric-mental health nurse practitioner as coordinating practitioner in the Netherlands: A multiple case study.

Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care. To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance. A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach. We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors. Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care. Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

Investigating the Influence of Patient Eligibility Characteristics on the Number of Deferrable Rheumatologist Visits: Planning for a Patient-Initiated Follow-Up Strategy.

Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of having regularly scheduled follow-up. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. We conducted a retrospective chart review of 7 rheumatologists' practices at 2 university-based clinics between March 1, 2021, and February 28, 2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in 4 criteria sets that were based on early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. Records from 770 visits were reviewed from 365 patients with RA (71.5% female, 70% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5% and 20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and patients with RA on conventional synthetic disease-modifying antirheumatic drugs or no medications (n = 161, 20.9%). PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.

Pregnancy assistance for foreign women in Trentino Region (Northern Italy): retrospective cohort epidemiological study.

to identify any differences between Italian and foreign women in the access to prenatal care, including the number and appropriate scheduling of visits, the execution of diagnostic, blood, and microbiological tests and the use of specific healthcare services. retrospective cohort epidemiological study, based on the monitoring of current information flows. data extrapolated from the Birth Attendance Certificate information flow of the Autonomous Province of Trento (Northern Italy) between 2012 and 2016. A total of 23,165 women with data regarding citizenship were included in the analysis. outcome variables used to assess appropriateness of antenatal care were medically assisted procreation techniques, use of invasive prenatal diagnosis, gestational age at the first appointment, total number of appointments and ultrasounds during pregnancy, blood and microbiological tests taken, and participation in antenatal classes. data indicates a significant difference in the use of chorionic villus sampling, testing for Cytomegalovirus, and vaginal-rectal swab for the detection of group B streptococcus, which are lower in the foreign population. Furthermore, there is a statistically significant difference in the gestational age at which the first appointment is attended, in the total number of visits, and in the number of ultrasounds performed during pregnancy as well as in participation in antenatal classes. this study reveals significant differences in access and use of pregnancy assistance between foreign and Italian women. There are also differences in terms of social determinants of health, with a concentration of unemployment and low education in the foreign population. It is therefore necessary to identify the factors that can potentially create health inequalities, considering the socioeconomic determinants and the specific needs of migrant women.

Actioning the findings of hard endpoint clinical trials as they emerge in the realm of chronic kidney disease care: a review and a call to action.

Fewer than half of patients treated with hemodialysis survive 5 years. Multiple therapeutics are used to address the complications of advanced chronic kidney disease but most have not been found to improve clinical outcomes. Clinical trials of treatment innovations for chronic kidney diseases and dialysis care have been suboptimal in number and quality. Recent trials are changing this trend. Practice and policy change when new evidence emerges remains frequently impeded by resource and organizational constraints and accordingly, clinical practice guidelines are updated years or decades after definitive evidence is produced. Ultimately, practice change in health systems is slow, leading to impaired uptake of effective medical interventions and lower value healthcare, although innovations in rapid guideline production are emerging. What can be done to ensure that conclusive evidence is taken up in practice, policy and healthcare funding? We use the example of the recently published hard endpoint study "Comparison of high-dose HDF with high-flux HD" (CONVINCE) (hemodiafiltration versus hemodialysis), to explain how a new trial can impact on medical knowledge and change in practices. We (i) assess how the trial can be placed in the context of the totality of the evidence, (ii) define whether or not further trials of convective dialysis therapies are still needed and (iii) examine whether the evidence for convective therapies is now ready to inform practice, policy and funding change. When looking at CONVINCE in the context of the totality of evidence, we show that it addresses dialysis quality improvement priorities and is consistent with other trials evaluating convective dialysis therapies, and that the evidence for convective dialysis therapies is now definitive. Once updated evidence for cost-effectiveness in specific healthcare settings and patient-reported outcomes become available, we should therefore determine whether or not clinical practice guidelines should recommend uptake of convective dialysis therapies routinely, and move on to evaluating other treatments.

Functioning of Hospitals: Vital in Promoting Good Health and Well-Being

The hospitals are regarded as one of the prominent organizations, which have the primary goals of promoting good health and well-being of the individuals. This needs to be focused on physically and psychologically. The individuals, belonging to all age groups are experiencing different types of health problems and illnesses. Hence, they make visits to hospitals to get these treated. The medical practitioners and health care specialists need to make sure, they treat these in a well-ordered and disciplined manner. The measures are required to be put into practice appropriately in order to promote functioning of the hospitals in a satisfactory manner. The individuals are required to be well-versed in terms of different types of pioneering methods and materials in the implementation of job duties and responsibilities. Furthermore, it is necessary for the individuals to be well-versed in terms of traits of morality, ethics, diligence and conscientiousness. These are the key in enabling the individuals to cope with different types of dilemmas and challenging situations. Furthermore, they will achieve desired goals and objectives. As a consequence, they will render an important contribution in leading to overall functioning of hospitals in a well-ordered manner. Therefore, functioning of hospitals is vital in promoting good health and well-being. The main concepts that are taken into account in this research paper are, understanding the meaning and significance of functioning of hospitals, measures to be implemented in promoting functioning of hospitals and advantages of promoting functioning of hospitals.

Organization of Hospitals: Essential in Promoting Community Well-Being

The individuals, belonging to all communities, categories and socio-economic backgrounds are overwhelmed by different types of health problems and illnesses. These are overwhelming to the individuals and they are required to make visits to hospitals. Within hospitals, the medical and health care facilities are required to be made available in order to provide medical treatment to the individuals. The hospital services and overall management are required to be put into practice in a well-ordered manner. The members are required to work in collaboration and integration with each other in carrying out tasks and activities efficiently. In urban communities, these are in a well-developed state, whereas, in rural communities, these are not in a well-developed state. Hence, rural individuals are required to migrate to urban communities in order to get their health problems and illnesses treated. There should be recruitment of well-qualified and experienced medical practitioners and health care specialists. Furthermore, there should be made provision of modern, scientific and innovative methods and materials in the implementation of different types of job duties and responsibilities. As a consequence, individuals will render an important contribution in putting into operation different tasks and activities in a well-ordered and regimented manner. Therefore, organization of hospitals is essential in promoting community well-being. The main concepts that are taken into account are, understanding the meaning and significance of organization of hospitals, factors highlighting the organization of hospitals and measures to be implemented in organization of hospitals in a well-ordered manner.

Assessment of the adoption of cloud computing system in the Nigeria healthcare sector

The Nigeria healthcare sector has potential for disruptive innovations that will help to raise the country's health outcomes using technologies such as cloud computing. However, lack of digitization hinders the effective delivery of healthcare services, making it difficult to track patient information, monitor treatment progress, and allocate resources effectively. This motivated the study to identify the specific healthcare services that can be improved through the adoption of cloud computing. In this study, a Figma software platform was used to design a prototype of the healthcare software while Java was used for building the healthcare software. The prototype can be found here https://bit.ly/3owXTZk. Findings revealed that cloud computing has the potential to surpass existing systems in terms of telemedicine, scheduling, health status monitoring, laboratory testing, and interactive knowledge sharing. The study therefore recommended that the implementation of healthcare software can reduce administrative costs, improve patient outcomes, and enhance patient satisfaction.

Mental disorders and symptoms with persistent opioid use for chronic non-cancer pain – a registry study

Knowledge of mental disorders among patients with persistent opioid use for the treatment of chronic non-cancer pain is essential, as mental disorders and symptoms can exacerbate or perpetuate pain and impact on the ability of patients to manage their illness. We have studied the prevalence of mental disorders and symptoms, including substance use disorders, in patients with persistent opioid use in 2019. Persons ≥18 years with persistent opioid use and persons ≥18 years with at least one registered mental disorder in the specialist healthcare service in 2019 were included. Data were retrieved from national health registries in Norway. Patients who received opioids reimbursed for the treatment of chronic pain were compared with those who received opioids without reimbursement. The prevalence of mental disorders and symptoms was 34% among 14403 persons who received reimbursed opioids, and 42% among 38001 persons who received opioids without reimbursement. This is equivalent to a two to threefold increase in prevalence compared to the general population. There was a particularly higher prevalence of anxiety disorders and substance use disorders. The prevalence of mental disorders and symptoms was highest in the age group 18-44 years (49-55%). Among patients with persistent opioid use, a large proportion had mental disorders and symptoms, which are known risk factors for developing problematic opioid use and opioid use disorder.

The Relevance of Acquiring of Legal Knowledge Concerning Labor Protection, Fire Safety, Sanitary and Epidemiological Regime for Health Care Professionals

The acquisition of legal knowledge pertaining to labor protection, fire safety, and sanitary and epidemiological regime is crucial for healthcare professionals, underscoring a multifaceted relevance in their field. Primarily, such knowledge ensures the safety and well-being of both healthcare workers and patients. Understanding labor protection laws helps healthcare professionals recognize their rights and responsibilities, leading to safer work environments. This knowledge is pivotal in preventing occupational hazards, which are prevalent in healthcare settings, including exposure to infectious diseases, chemical substances, and physical strain. Furthermore, legal knowledge in these areas enhances the professional competency of healthcare workers, promoting a comprehensive approach to patient care and facility management. It empowers healthcare professionals to advocate for better working conditions and patient safety, reflecting their commitment to ethical and legal standards in healthcare. The key aspects of the work program under the normative educational component "Occupational safety and occupational safety in the industry" in the training of specialists of the second (master's) level of higher education in the specialty 226 "Pharmacy, industrial pharmacy", specialization 226.01 "Pharmacy" of the field of knowledge 22 "Health care" were analyzed I". The training of future occupational health and safety specialists is aimed at the formation of professional skills and knowledge necessary for effective work in the modern pharmaceutical environment of occupational safety and health. The study determined the priority directions of the educational process: legislative regulation in the field of labor protection, fire safety, and the sanitary-epidemiological regime in pharmacy. The relevance of acquiring legal knowledge of labor protection, fire safety, sanitary and epidemiological regime by future healthcare sector specialists were substantiated. The presented conclusions and recommendations can serve as a basis for further improvement of the educational process and training of masters who will successfully implement their knowledge in practice, ensuring a high level of safety and efficiency in the pharmaceutical industry.

Healthcare utilization before and during the COVID-19 pandemic among mothers and birthing parents with elevated levels of postpartum depression symptoms

ABSTRACT Little is known about the healthcare utilization of mothers and birthing parents experiencing elevated levels of symptoms of postpartum depression (PPD), particularly during the COVID-19 pandemic. This study examined how healthcare utilization changed in these individuals during COVID-19. Individuals living in Ontario, Canada, with Edinburgh Postnatal Depression Scale Scores ≥ 10 were recruited into two separate randomized controlled trials of a 1-day intervention for PPD before (pre-COVID-19, n = 441) and during the pandemic (COVID-19, n = 287). Participants in both samples completed the same health resource use questionnaire, self-reporting the number of virtual and/or in-person visits to specific healthcare services over the three months preceding their treatment intervention. Use of medications, mental health care, primary care, hospital-based care, allied health care, and overall healthcare utilization were compared between the pre-COVID-19 and COVID-19 groups. While participants had higher levels of PPD symptoms during COVID-19, differences were not seen in the use of specific categories of care (e.g. mental health and primary care). However, before and after statistically adjusting for covariates, overall healthcare utilization decreased from an average of 9.5 visits prior to COVID-19 to 6.9 during COVID-19 (p < .001), a change that was at least partly contributed to by reductions in visits to allied health professionals (e.g. dentists and physiotherapists). Overall healthcare utilization decreased by 27 % in mothers and birthing parents seeking treatment for elevated levels of PPD symptoms during the COVID-19 pandemic in Ontario, Canada – despite higher levels of PPD symptoms – highlighting the need to support and address barriers to postpartum care.

Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare?

Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.

Problematic issues and development of classifications of the main parameters of quality and adherence to pharmacotherapy. Part II: physician adherence to clinical guidelines and official drug labels

The second publication is presented, devoted to the classification of the main parameters of quality and adherence to pharmacotherapy. Despite the fact that patients play a central role in the problem of medical adherence, the role of attending physicians is extremely significant both in prescribing/non-prescribing proven effective and safe therapy, and in influencing patient medical adherence. This led to the identification of a special commitment type — the physician adherence to the basic principles of rational treatment. Collection, analysis and systematization of information, as well as the related development of a classification of physician adherence/non-adherence were the aim of this review and analytical work. We searched data using keywords among Russian and English-­language sources. When compiling the classification, categories of adherence/non-adherence were identified in accordance with the implementation by physicians of the main provisions of clinical guidelines for long-term therapy for patients with non-communicable diseases (NCDs), as well as following official drug labels reflecting data on clinical pharmacology, the main side effects, drug-drug interactions. The classification of physician adherence/non-adherence to implementing the principles of rational treatment of patients with NCDs can be used in the development of electronic medical decision support systems for providing therapy with proven effectiveness and safety in specific clinical situations. In addition, on the basis of the developed classification, checklists for monitoring by healthcare specialists of the implementation of the rational treatment of patients with chronic NCDs should be created.

Importance of dialysis specialists in early mortality in elderly hemodialysis patients: a multicenter retrospective cohort study

The early mortality rate in elderly patients undergoing hemodialysis is more than twice that in young patients, requiring more specialized healthcare. We investigated whether the number of professional dialysis specialists affected early mortality in elderly patients undergoing hemodialysis. This multicenter retrospective cohort study analyzed data from 1860 patients aged ≥ 70 years who started hemodialysis between January 2010 and December 2017. Study regions included Seoul, Gyeonggi-do, Gangwon-do, Daejeon/Chungcheong-do, Daegu/Gyeongsangbuk-do, and Busan/Ulsan/Gyeongsangnam-do. The number of patients undergoing hemodialysis per dialysis specialist was calculated using registered data from each hemodialysis center. Early mortality was defined as death within 6 months of hemodialysis initiation. Gangwon-do (28.3%) and Seoul (14.5%) showed the highest and lowest early mortality rate, respectively. Similarly, Gangwon-do (64.6) and Seoul (43.9) had the highest and lowest number of patients per dialysis specialist, respectively. Relatively consistent results were observed for the regional rankings of early mortality rate and number of patients per dialysis specialist. Multivariate Cox regression analysis—adjusted for previously known significant risk factors—revealed that the number of patients per dialysis specialist was an independent risk factor for early mortality (hazard ratio: 1.031, p < 0.001). This study underscores the growing need for dialysis specialists for elderly hemodialysis patients in Korea.

Effectiveness of Establishing Seasonal Medical Centers Designated to Meet the Health Needs of Pilgrims and Umrah Performers (Prince Sultan Armed Forces Hospital Initiative in Medina as a Model)

This study aims to investigate the feasibility and effectiveness of establishing a dedicated healthcare facility to address the health needs of pilgrims during the pilgrimage seasons. The research employs a mixed-methods approach, combining qualitative and quantitative data collection methods. The qualitative phase involves interviews with healthcare professionals, religious authorities, and pilgrimage organizers to gather insights into the specific healthcare requirements of pilgrims. Additionally, focus group discussions with pilgrims provide valuable perspectives on their healthcare experiences and expectations. Based on the qualitative findings, a comprehensive framework for a Seasonal Medical Center is developed, encompassing key components such as infrastructure, staffing, medical services, logistics, and collaboration with local healthcare providers and authorities. The survey data provides insights into pilgrims' perceptions (6247) of the healthcare services available during their pilgrimage, including accessibility, quality, and satisfaction levels. It also investigates the impact of the proposed Seasonal Medical Center on pilgrims' overall health and well-being, as well as the effectiveness of preventative measures implemented. The research findings highlight the significance of establishing a Seasonal Medical Center, emphasizing the potential benefits of improved healthcare access, enhanced disease surveillance, and timely emergency response. The study also underscores the importance of collaboration between healthcare providers, religious authorities, and local stakeholders to implement and manage the Seasonal Medical Center effectively. The research contributes to the existing body of knowledge by offering insights into the design and implementation of a dedicated healthcare facility for Hajj and Umrah pilgrims. The findings can inform policymakers, healthcare professionals, and pilgrimage organizers in developing strategies to address the unique healthcare challenges associated with these annual pilgrimages.

Protocol for evaluation of the feasibility and preliminary efficacy of a targeted transition readiness workshop intervention for pediatric brain tumor survivors

BackgroundPediatric brain tumor survivors (PBTS) are at risk of physical, cognitive, and psychosocial challenges related to their diagnosis and treatment. Routine follow-up care as adults is therefore essential to their long-term health and quality of life. In order to successfully navigate to adult healthcare, it is recommended that youth develop transition readiness skills. Existing transition readiness interventions often focus on disease management. However, PBTS are also at risk of social competence and cognitive functioning challenges. In this paper, we describe the protocol of this pilot study and the methodology that will be used for the evaluation of the feasibility, acceptability, and preliminary efficacy testing of the first targeted transition intervention workshops specifically designed to meet the needs of PBTS and their caregivers.MethodsThis study will use a mixed method to evaluate three 1 ½-h workshops targeted for dyads (N = 40) of PBTS (14 years or older) and their parents. Dyads will be recruited via a community pediatric cancer organization and the long-term follow-up clinic of a large pediatric hospital. Participants will complete an online survey which includes the Transition Readiness Assessment Questionnaire (TRAQ) before and after the workshops.Each workshop will cover a specific topic related to PBTS transition readiness: disease management, social competence, and cognitive functioning. Workshops will follow the same structure: topic presentation, discussion by a post-transfer survivor or parent, teaching two strategies, and workshop evaluation. Workshops will be co-led by healthcare specialists and patient partners.Feasibility and acceptability will be assessed via recruitment, attendance, retention, and Likert scales, and they will be analyzed by describing and comparing rates. Satisfaction will be measured using satisfaction surveys and audio-recorded focus groups. Qualitative data will be described through thematic content analysis. In order to test the preliminary efficacy of this study, we will compare transition readiness skills pre- and post-workshops using paired samples T test and ANCOVA to examine the impact of workshop on TRAQ skills.DiscussionResults of the study will inform refinement and future broader implementation of targeted transition readiness workshops for the specific needs of pediatric brain tumor survivors.

Simulation of transportation of acute stroke patients in border regions

Determining the optimal transportation for each stroke patient is critically important to achieve the best possible outcomes. In border regions the next comprehensive stroke center may be just across an international border, but bureaucratic and financial hurdles may prevent a simple transfer to the next stroke center. We hypothesized that in regions close to international borders, patients may benefit from an "open border, closed transfer scenario", meaning that patients in whom a large vessel occlusion (LVO) is detected in the primary stroke center will benefit from a transfer to the nearest stroke center offering endovascular thrombectomy—even if this may be across a national border. We used the Swiss-German–French trinational region as an example for a region with several international borders within close proximity to one another, and compared two feasible scenarios; (a) a “closed borders, open transfer” scenario, where the patient is transported to any center in the same country, (b) an “open border, closed transfer” scenario, where patients are always transported to the nearby primary stroke center first and then to the nearest comprehensive stroke center in either the same or a neighboring country and (c) and “open borders, open transfer” scenario. The outcome of interest was the predicted probability of acute ischemic stroke patients to achieve a good outcome using a conditional probability model which predicts the likelihood of excellent outcome (modified Rankin scale score of 0–1 at 90 days post-stroke) for patients with suspected LVO. Results were modeled in a virtual map from which the ideal transport concept emerged. For an exemplary LVO stroke patient in Germany, the probability of a good outcome was higher in an open border, closed transfer scenario than with closed borders, open transfer (33.1 vs. 30.1%). Moreover, time to EVT would decrease from 232 min in the first scenario to 169 min in an open border, closed transfer scenario. The catchment area of the University Hospital Basel was almost double the size in an open border, closed transfer scenario compared to closed borders (1674 km2 vs. 2897 km2) and would receive transfers from 3 primary stroke centers in other countries (2 in Germany and 1 in France). Stroke patients showed a higher likelihood of good outcome in the “open border” scenarios without transfer restrictions to a specific healthcare system. This probably has implications for stroke treatment in all border regions where EVT eligible stroke patients may benefit from transport to the closest EVT capable center whenever possible, regardless of whether this hospital is located in the same or a neighboring country/jurisdiction.

Advancements in robotic surgery: innovations, challenges and future prospects.

The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.