Health Care Centers Research Articles

Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study.

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Primary healthcare professionals’ attitudes toward patients with current or previous drug use

Objective People with current or previous drug use (PCPDU) often lack long-term healthcare contacts in primary healthcare (PHC). While international research has shown negative attitudes toward PCPDU in healthcare, PHC professionals’ attitudes toward PCPDU have not been assessed in Sweden. The aim of this study was to investigate PHC professionals’ attitudes to PCPDU, and to compare attitudes toward people who actively use illicit drugs with those toward patients in opioid assisted treatment (OAT). Design In this survey study, respondents were asked for background data, and their attitudes toward patients using illicit drugs, OAT patients and patients with depression were assessed by using an adapted version of the Medical Condition Regard Scale (MCRS). Setting and subjects Nurses and physicians at primary healthcare centers (PHCCs) in Skåne, Sweden. Main outcome measures Mean MCRS scores, dichotomized responses to MCRS items, and associations between MCRS score and background covariates (age, sex, profession and duration of professional experience). Results Eighty-nine PHC professionals from 13 PHCCs responded (approximately 39% of relevant workforce). The median MCRS score was 44 for patients with illicit drug use and patients in OAT, and 51 for patients with depression. Drug use and OAT displayed similar minimum, maximum and interquartile range values as well, while scores regarding depression displayed a higher minimum value and smaller spread. No significant associations were found between background covariates and MCRS scores for either drug use or OAT. Conclusions The results indicate widespread negative attitudes to PCPDU, with implications for health equity in the clinic. Further studies are needed to see if the results reflect attitudes in Swedish PHC in general. Key Points People with current or previous drug use (PCPDU) often lack necessary primary healthcare (PHC) and are commonly subject to prejudice. Swedish PHC professionals held more negative attitudes toward PCPDU than toward patients with depression. Attitudes toward patients with active drug use and patients in opioid assisted treatment (OAT) were almost identical. Study findings have potential implications for the health of PCPDU as well as health equity in the clinic. Widespread negative attitudes to PCPDU in our sample indicate the need of larger-scale studies of attitudes toward PCPDU in Swedish PHC.

A qualitative study on diverse experiences of medication safety among foreign-born persons living in Sweden

BackgroundThe ongoing global migration has led to multicultural societies, with many migrants who do not speak the official language in the host country. This could contribute to communication problems with staff in healthcare and a risk to patient safety. Research on patient safety in medication use in migrants is an under-researched area. The aim was to explore diverse foreign-born people’s experiences and perceptions of self-management of medication and determine if home-based practice patterns have implications on medication safety, and what factors may support safe medication use.MethodsA qualitative explorative study, with individual semi-structured interviews and participant observations in the patients’ home. Qualitative content analysis was applied.ResultsA purposeful sample of 15 foreign-born persons identified by healthcare staff as having language difficulties in Swedish that may pose a safety risk in connection with medication use at home, was selected. Three categories were identified. The first category showed respondents being dependent on another person, having experiences of not receiving information about their medications due to language barriers, having difficulties getting access to the healthcare centre and feeling distrusted/misunderstood. The second category showed respondents being independent and self-motivated Although they struggled, they managed to get access/contact with the healthcare centre themselves and felt understood/listened to by the staff. The last category concerned factors that facilitating medication use; such as having a medication list in the respondents’ own language and offering a choice of language on the answering machine at the healthcare centre. Although they knew it was impossible to get an interpreter at the pharmacy, they felt safe knowing there was always a solution for receiving understandable information.ConclusionThe findings highlighted that language barriers can complicate the communication between migrants and the healthcare, which can affect the medication safety. Understanding of this group is essential to improve the cooperation between patients and staff, leading to culturally congruent care. This knowledge should be used in healthcare to understand the gap in communication to increase patient safety. Further research from other angles, e.g. pharmacy/healthcare staff and relatives is needed to identify and evaluate facilitation to improve the outcome of the intended medication treatment.

Self-reported symptom burden among patients attending public health care facilities in India: Looking through ICPC-3 lens.

The objectives of this study were: 1) to describe the socio-demographics and classify the chief complaints and reasons to encounter facilities of patients presenting to public healthcare facilities; 2) to explore differences in these complaints and: International Classification of Primary Care-3 (ICPC-3) groups across socio-demographic and health system levels. This is a cross-sectional study conducted in three districts of Odisha, India. Within each district, the district hospital (DH), one Sub-district hospital (SDH) (if available), two Community health centers (CHCs), and two Primary health care centers (PHCs) were selected. Thus, a total of three DHs, three SDHs, six CHCs, and six PHCs were covered. Two tertiary healthcare facilities were also included. Patients aged 18 years and older, attending the Outpatient Departments (OPD) of sampled health facilities were chosen as study participants through systematic random sampling. A total of 3044 patients were interviewed. In general, 65% of the sample reported symptoms as their chief complaint for reason of encounter, whereas 35% reported disease and diagnosis. The most common reasons to encounter health facilities were fever, hypertension, abdominal pain, chest pain, arthritis, skin disease, cough, diabetes, and injury. Among the symptoms, the highest number of patients reported the general category (29%), followed by the digestive system (16%). In the disease category, the circulatory system has the highest proportion, followed by the musculatory system. In symptom categories, general, digestive, and musculatory systems were the key systems for the reasons of encounter in outpatient departments irrespective of different groups of the population. In terms of different tiers of health systems, the top three reasons to visit OPD were dominated by the circulatory system, respiratory system, and musculatory system. This is the first Indian study using the ICPC-3 classification for all three levels of health care. Irrespective of age, socio-economic variables, and tiers of healthcare, the top three groups to visit public health facilities according to the ICPC-3 classification were consistent i.e., general, digestive, and circulatory. Implementation of standard management and referral guidelines for common diseases under these groups will improve the quality and burden at public health facilities in India.

Stressful Life Events in Impulsive and Non-impulsive Suicide Attempters: A Cross-sectional Study

Background: Suicide is a significant public health issue, yet it can be avoided with prompt, evidence-based, and frequently inexpensive interventions. There are distinctions between the profiles of impulsive suicide attempters (ISA) and non-impulsive suicide attempters (NISA), and a significant number of suicide attempts are impulsive. A thorough multisectoral suicide prevention strategy is necessary for an effective national response. Methods: This observational cross-sectional study was conducted at a tertiary healthcare center in Karnataka. Sixty inpatients above the age of 18 years with an alleged history of suicide attempts were enrolled in the study. Their stressful life events in the past year were assessed using the Presumptive Stressful Life Events Scale (PSLES). Impulsive and non-impulsive attempters were considered based on the time gap between the suicidal ideation and the suicidal attempt with the presence or absence of plans regarding the act. They were compared using appropriate inferential statistical tests. Results: The majority of the suicide attempts were impulsive (63.3%). The ISA and NISA did not differ in socio-demographic characteristics except for age and family type, with impulsive attempters being more common at younger ages than the non-impulsive attempters ( p = .02). The majority of ISA were from joint families (44.7%), while 72.7% of NISA were from nuclear households ( p = .04). Compared to ISA, NISA recollected a higher number of stressors. Conclusion: The ISA and NISA differ in aspects of age, family type, and stressors. Characteristic distinctions between ISA and NISA should be recognized and understood in order to design policies for suicide prevention and minimize morbidity and mortality. Exploring and addressing the stressors and helping patients to overcome them through better coping skills helps in suicide prevention.

Health status and public health needs in a Togolese child health care centre modelled after the Dutch system

Background The charity foundation Association Soutien Enfants Togo started a child health care (CHC) centre in Togo that was modelled after the Dutch high-quality CHC system to improve child health. Aim To describe health care data of children who visited the centre. Subjects and methods Data were routinely collected between October 2010-July 2017. Outcomes were completed vaccinations, growth, development, lifestyle, physical examination, and laboratory testing results. Results In total, 8,809 children aged 0–24 years were available. Half (47.5%) of children aged 0–4 years did not receive all eligible free vaccinations from the government. The proportions of stunted children (all) or with a developmental delay (0–4 years) were 10.1% and 9.5%, respectively. In total, 40–50% of all children did not wash their hands with soap after toilet or before eating, or did not use clean drinking water. Furthermore, 5.1–6.6% had insufficient vision, high eye pressure or hearing loss. Sickle cell disease was detected in 5.3%. Conclusion A large group of children in need of prevention and early treatment were detected, informed and treated by the centre. Further research is needed to confirm if this strategy can improve children’s health in Sub-Saharan Africa. Our data are available for further research.

Using spirometry for screening and diagnosis of chronic respiratory diseases in primary health care: findings from a community health project in rural India

Background Chronic respiratory diseases (CRDs) such as Chronic obstructive pulmonary disease (COPD), Asthma and post-tuberculosis lung disease (PTLD) are a growing public health concern in India. Early diagnosis and management of CRDs require a good quality spirometry test, a technician to conduct spirometry and a chest physician to interpret the results. In India, these are not available at the primary care level. This study reports the feasibility of a large-scale CRD diagnosis and management program in primary care using a unique point-of-care spirometry solution, Briota PFT in a Box™. # Methods A community-based cross-sectional study was conducted among 15,602 adults in Dindori Taluka (subdivision), Nashik, Maharashtra state. This study was part of a holistic CRD diagnosis and management program SAVE™ (Spirometry Assisted Virtually Early). Make In India point of care solution Briota PFT in a Box™ was used. A House‐to‐house community-based assessment checklist (CBAC) survey, 4-parameter spirometry test, 15-parameter pre and post-bronchodilator spirometry test and a software-assisted medical examination by the medical officer at primary care were conducted. Software was used to generate CRD diagnosis and lung health score (LHS™). The diagnosis was verified by the chest physician. Confirmed diagnosed patients were provided treatment and offered a patient support program. Interviews were conducted with the patients, nurses, doctors and public health officials for understanding feasibility and documenting learning from program SAVE™. # Results Out of 15,602 adults surveyed, total 4,937 (31.6%) were identified as “CRD high risk”. 1231 participants based on medical examination, spirometry tests and software analysis were identified as CRD candidates by medical officers at primary care. 1154 participants out of 15,602 (7.4%) were confirmed diagnosed as CRD patients post independent evaluation by chest physicians. At the time of follow-up, 537 patients (75% of 712 patients enrolled in patient support program) reported improvement in symptoms and high satisfaction with the program. District health officer, Medical officers, nurses, Accredited Social Health Activist (ASHA) from the primary health care centers confirmed ease of use and feasibility of using Briota PFT in a Box™ in program SAVE™. Outcome and learning from program SAVE™ was documented and submitted to Ministry of Health and Family Welfare Government of India. # Conclusions CRD diagnosis and management in large scale settings in primary healthcare level using a point of care spirometry solution Briota PFT in a Box™ is highly feasible.

Prospective observational study on clinical profile of congenital anomalies of kidney and urinary tract (CAKUT) in children in central India: A study protocol

Background Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of structural abnormalities affecting these vital organs, frequently leading to chronic kidney disease in children. This study aims to comprehensively understand the clinical profile of CAKUT in children in Central India, an area with unique socio-demographic characteristics and limited prior research on this topic. Methods A prospective observational study will be conducted over three years in the pediatric department of AVBRH, a tertiary healthcare center in Central India. Data were collected through interviews with parents or guardians of children up to 18 admitted to the hospital. Clinical symptoms, prenatal history, physical examinations, and diagnostic investigations were meticulously documented. Expected outcome The study is expected to reveal the prevalence and clinical profile of CAKUT in Central Indian children. Anticipated outcomes include insights into anomalies, clinical symptoms, and potential correlations with factors like prenatal care and consanguineous marriages. Diagnostic investigations will help assess the severity of renal impairment. The results may also uncover regional variations and have implications for public health initiatives aimed at early intervention and improved patient care. However, these are preliminary expectations that are subject to confirmation through the completion of the study.

Increased Postoperative Opioid Consumption in the Presence of Co-administration of 5-HT3 Antagonists with Acetaminophen: A Hospital Registry Study.

Acetaminophen and 5-hydroxytryptamine-type-3 (5-HT3) receptor antagonists are administered as standard prophylaxes for postoperative pain, nausea, and vomiting. Preclinical studies however suggest that 5-HT3 antagonists may compromise acetaminophen's analgesic effect. This hospital registry study investigates whether 5-HT3 antagonists mitigate the analgesic effect of prophylactic acetaminophen in a perioperative setting. This study included 55,016 adult patients undergoing general anesthesia for ambulatory procedures at a tertiary healthcare center in Massachusetts, United States of America, from 2015 to 2022. Using binary exposure variables and a comprehensive selection of pre-planned patient- and procedure-related covariates for confounder control, we investigated whether intraoperative 5-HT3 antagonists affected the association between pre- or intraoperative acetaminophen and postoperative opioid consumption, gauged by opioid dose in mg oral morphine equivalents (OME) administered in the post-anesthesia care unit (PACU). A multivariable, zero-inflated negative binomial regression model was applied. 3,166 (5.8%) patients received only acetaminophen, 15,438 (28.1%) only 5-HT3 antagonists, 31,850 (57.9%) both drugs, and 4,562 (8.3%) neither drug. The median PACU opioid dose was 7.5 mg OME (interquartile range 7.5 to 14.3 mg OME) among 16,640/55,016 (30.3%) patients who received opioids and the average opioid dose was 3.2 mg OME across all patients (maximum cumulative dose: 20.4 mg OME). Acetaminophen administration was associated with a 5.5% (95%CI -9.6% to -1.4%;p=0.009; adjusted absolute difference -0.19 mg OME;95%CI -0.33 to -0.05;p=0.009) reduction in opioid consumption among patients who did not receive a 5-HT3 antagonist, while there was no effect in patients who received a 5-HT3 antagonist (adjusted absolute difference 0.00 mg OME; 95%CI -0.06 to 0.05;p=0.93,p-for-interaction=0.012). A dose-dependent association of pre- or intraoperative acetaminophen with decreased postoperative opioid consumption was not observed when 5-HT3 antagonists were co-administered, suggesting that physicians might consider reserving 5-HT3 antagonists as rescue medication for postoperative nausea or vomiting when acetaminophen is administered for pain prophylaxis.

Analysis of language and influencing factors of children with speech disorder in Beijing

Objective: To investigate the features and influencing factors of language in children with various types of speech disorders. Methods: A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children's Healthcare, Children's Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin-comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi-square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors. Results: There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs.96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F=5.46, 4.69, 3.68, all P<0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P<0.01) and the overall language score was lower than that of children with stuttering (P<0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ2=7.93, 10.28; both P<0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder (OR=1.87, 2.18, 2.01; 95%CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P<0.01). Negative family history are protective factors for the progress of language ability (OR=0.37, 95%CI 0.17-0.81, P<0.05). Conclusions: Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.

The link between social care deficiencies and healthcare pressures

In the UK, demand on the social care sector is rising, while a substantial reduction in funding makes meeting those demands a challenge. Exploring potential solutions to address the growing demands on health and social care, this commentary provides a critical evaluation of a systematic review that investigated the association between the availability and supply of social care services and the use of healthcare services among older adults in high-income countries. The commentary used the Rapid Conversion of Evidence Summaries methodology to critically appraise the study. There is some evidence for the benefits of care home support during hospital discharge, although research in the area is scarce. Increasing the supply of social care services may ease the pressures on the healthcare system, but the findings of this systematic review do not provide quantifiable evidence to support this. Nevertheless, it highlights the need for further investigation regarding the association between social care provision and healthcare service use.

Abstract PO5-05-13: Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study

Abstract Clinical utility of Whole Body Low Dose CT scan for detecting bone metastasis in Breast cancer patients: A cross sectional study Background: Skeletal scintigraphy (Bone scan) is the imaging of choice to detect bone metastasis in locally advanced and metastatic breast cancer patients. Nuclear medicine facilities are however limited in their availability. As an alternative diagnostic modality to bone scan, we studied the diagnostic capability of Whole-Body Low Dose CT (WBLDCT) scan for detection of bone metastasis in these patients. Materials and Method: This cross-sectional study was conducted from November 2021 to May 2023 at a tertiary healthcare center in India with an aim to study the clinical applicability of whole-body low dose computed tomography scan for detecting bone metastasis in patients with breast cancer. Breast cancer patients with primary tumor measuring 5cm or more, pathologically proven axillary lymph node metastasis, Stage III/IV disease, symptoms attributable to metastasis and suspected disease recurrence were included. All patients underwent WBLDCT and Bone scan within a period of about 2 weeks. WBLDCT was done during the same time as conventional dose CT scan was being done as part of metastatic workup. WBLDCT acquisition protocol was set in CT scan machine by modulating the technical parameters like Care dose 4D-automated, Care kV semi, rotation time &amp; noise index. The image analysis was performed by Radiologist and Nuclear medicine experts in a blinded fashion. Data was recorded in MS Excel sheet. Sensitivity, specificity, positive and negative predicative value, and concordance rates were calculated using SPSS software ver 25.0. Agreement amongst WBLDCT and Bone scan was calculated using Inter-rater agreement. p value &amp;lt; 0.05 was taken as significant. Results: 110 patients were enrolled in this study. The mean age of participants was 48.5 years and three fourth had stage III disease at presentation. Estrogen receptor positive disease was seen in 43.64% participants while 30% were triple negative. Her2neu positive disease was seen in 27.27% patients. Bone scan couldn’t be done in 03 patients who deferred treatment (these had no bone metastasis on WBLDCT). Both bone scan and WBLDCT detected bone metastasis in 19 patients. Bone scan picked up additional metastasis in three patients which were missed on WBLDCT. WBLDCT detected bone metastasis additionally in three patients which were not detected on Bone scan. Multiple lesions were most seen in vertebrae in 38.5% and 28.6% on bone scan and WBLDCT respectively. The sensitivity and specificity of WBLDCT for detection of bone metastasis was 86.36% and 96.47% respectively. The concordance rate between Bone scan and WBLDCT scan was 94.39% with an Inter-rater Kappa(k) quotient for agreement of 0.828 (p&amp;lt; 0.0001). Conclusion: WBLDCT scan has comparable diagnostic capability to skeletal scintigraphy in detecting bone metastasis in breast cancer and may be a useful alternative specially in resource limited settings. Table 1: Sensitivity, specificity, positive predictive value and negative predictive value of WBLDCT for detection of metastasis Variables Values Sensitivity (95% CI) 86.36% Specificity (95% CI) 96.47% AUC (95% CI) 0.91 Positive Predictive Value (95% CI) 86.36% Negative Predictive Value (95% CI) 96.47% Diagnostic accuracy 94.39% Inter-rater agreement (kappa) 0.828 Citation Format: Lipton Mitra, Suhani Suhani, Ankur Goyal, Rakesh Kumar, Mohit Joshi, Hemanga Bhattacharjee, Haresh KP, Raju Sharma, Rajinder Parshad. Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-13.

Virtual consultations: the experience of oncology and palliative care healthcare professionals

ObjectivesTo maintain continuity of care during the Covid-19 pandemic, virtual consultations (VC) became the mainstay of patient-healthcare practitioner interactions. The aim of this study was to explore the views of oncology and palliative care healthcare professionals (HCPs) regarding the medium of VC.MethodA cross sectional mixed methodology observational study of oncology and palliative care HCPs, analysed via an inductive thematic approach. This was undertaken in accordance with relevant guidelines and regulations.Results87 surveys were completed. Three master themes were identified. Personal, professional, and familial factors including patient age, illness and VC skillset all influenced practitioner’s experience of VC. Relationships and connection were highlighted by survey respondents as important influences, with a perception that VC could reduce usual relationships with patients, compared to previous face-to-face consults. There was a perceived loss in these domains with VC. Sharing bad news and having challenging conversations was seen as particularly difficult via VC. Many survey respondents emphasized that they preferred to have first time consultations face-to-face, and not virtually. Within the domain of logistical and practical implications reduced travel and increased accessibility were seen as a significant benefit of VC. The inability to examine patients and concerns regarding missing clinical signs was emphasised as a significant worry, alongside the challenges faced with occasionally failing technology.ConclusionVC were felt to have a role for those patients who are already known to professionals, where there was an established relationship. VC for difficult discussions and for unstable patients were felt to be inadequate. Triaging patient suitability prior to offering VC, with emphasis on the importance of patient choice, was seen as a priority in this new era of VC.

Outpatient prescription drug interactions at a city-affiliated healthcare center in Vietnam

Context: Adverse drug interactions increase the risk of hospitalization, treatment costs, unfavorable treatment outcomes, and prolonged hospital stays. However, there are a limited number of studies conducted in city-affiliated healthcare settings in Vietnam. Aims: To identify drug interactions in outpatient treatment prescriptions at a city-based healthcare center in the southern region of Vietnam. Methods: A cross-sectional descriptive study was conducted on outpatient treatment prescriptions stored in the outpatient department of a city-affiliated healthcare center from January to June, 2023. The study used two databases for drug interaction checking: the Drug Interactions Checker and Medscape Interactions Checker. Univariate and multivariate regression analyses were used to identify predictors of clinically significant drug interactions. Results: Among 1203 surveyed prescriptions, 36.7% contained at least one clinically-significant drug interaction, with 3% of prescriptions having severe interactions. The highest frequency of drug interactions involved amlodipine and metformin (9.9%). Patients with five or more prescribed medications (OR = 3.305; 95% CI: 2.320-4.708), hypertension (OR = 7.142; 95% CI: 4.658-10.950), dyslipidemia (OR = 2.242; 95% CI: 1.665-3.020), and non-insulin-dependent diabetes (OR = 2.447; 95% CI: 1.817-3.295) had a higher likelihood of experiencing clinically significant drug interactions. Conclusions: This study revealed that over one-third of outpatient prescriptions were associated with clinically-significant drug interactions. This study highlights the importance of clinical pharmacists screening prescriptions to detect and reduce interactions, as well as the application of computerized alert systems with intelligent screening software to minimize drug interactions.

Oral Health-Related Quality of Life Following Root Canal Treatment of First Permanent Molars Among Children. A Cross-Sectional Study.

This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9-18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs). A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as "optimal" (no problems) or "less than optimal" (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors. There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively). RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life.

Respiratory and Other Hazard Characteristics of Substances in Cleaning Products Used in Healthcare Centres in England and Wales

Occupational use of cleaning products can cause asthma in healthcare workers but the cleaning agents responsible are not yet known. This study aimed to identify respiratory and other hazards in cleaning products on the National Health Service (NHS) supply chain online catalogue and used in the NHS. Information on cleaning products, their composition, and H-statements that identified hazard characteristics of chemical substances in them was obtained from chemical safety data sheets (SDSs). Furthermore, a quantitative structure-activity relationship model and a published asthmagen list were used to identify potential additional respiratory hazards. 473 cleaning products and 229 substances were identified. SDSs reported only 4 respiratory sensitizers but an additional 51 were suggested by the other 2 methods. In contrast, 25 respiratory irritants were identified using SDSs and only one from the asthmagen list. This comprehensive overview of cleaning agents' hazards has potential use in future risk assessment and epidemiological studies.

Iterative matheuristic for the biomedical sample transportation problem

This paper proposes an iterative matheuristic for solving the biomedical sample transportation problem (BSTP), which is a routing problem with multiple and interdependent visits in the context of healthcare services. In this problem, the biomedical samples are collected from individuals at a set of healthcare or specimen collection centers and must be transported to designated laboratories to be analyzed. The perishable nature of the specimens forces to visit the collection centers more than once a day to ensure that the time from the moment they are drawn to the arrival at the laboratory do not exceed the samples lifespan. Also, a visit to one center imposes (1) a limit on the duration of the route that transports its samples to the laboratory, and (2) a limit on the latest time at which the same center must be visited again, creating an interdependency between visits, routes and the decision concerning the centers’ opening times. This paper first proposes a mathematical formulation to model the BSTP. Since this formulation is not able to solve medium or large sized instances efficiently, it also proposes an iterative matheuristic, which includes two main steps. The first step produces an approximated solution to the BSTP by a decomposition approach that splits the problem into a series of smaller subproblems that are solved by the proposed mathematical formulation. In the second step, two fix-&-optimize strategies are used with the mathematical formulation to perform a local search around the solutions produced by the decomposition method. The matheuristic has demonstrated its efficiency solving a rich set of real-life instances corresponding to the needs of several regions in the province of Quebec, Canada, in a fraction of the time required to solve the exact mathematical formulation.

EXERCISE AND CANCER PROGRAM: A PRESCRIPTIVE EXERCISE PROGRAM IN A NON-CLINICAL SETTING

INTRODUCTION &amp; AIMS This study aimed to establish a low-cost, sustainable exercise program for cancer patients in Gippsland, Australia, where access to such programs was previously limited. By developing and implementing a collaborative program, the program aimed to improve the physical and psycho-social well-being of cancer patients while reducing burden on healthcare services. METHODS Collaboration between Latrobe Community Health Service, Morwell Leisure Centre, and Gippsland Integrated Cancer Service led to the development of a prescriptive exercise program to provide cancer survivors a sustainable cost-effective exercise and cancer program in a community leisure centre. Exercise physiologists provided initial assessments, in which clients allocated to group-based, one-on-one, or home-based exercise sessions. RESULTS After 12 weeks in the program, 100% of participants that had a reassessment improved on at least one physical test and all improved on a subjective measure like fatigue, depression, or self-worth. On average, they saw a 14.88% increase in leg strength, a 12.70% increase in grip strength, and a 16.65% increase in aerobic fitness. Additionally, they reported an average decrease in anxiety (10.96%), depression (1.59%), fatigue (6.09%), and reported illness symptoms (5.24%). Overall, participant feedback was overwhelmingly positive, highlighting the benefits of the program’s psycho-social support and the opportunity to exercise outside a healthcare setting. CONCLUSION Collaboration between healthcare and leisure centres can provide sustainable and cost-effective exercise programs for cancer patients, improving physical and psycho-social well-being while reducing healthcare burden. Participants valued the support, social interaction, and sense of belonging provided by the program.

The Pattern of Referrals to Lifestyle Clinics in PHCs, Riyadh, Saudi Arabia

Introduction: lifestyle medicine is the cornerstone of a healthy population for the prevention of disease and promotion of health attitudes and practices among community members. Description of referred population to lifestyle medicine clinic is mandatory for health care planning and allocation of resources. This study aims to describe the pattern of the referred population to the lifestyle clinic in primary health care centers in Riyadh Saudi Arabia.Methods: cross-sectional study for registry of patients referred to Lifestyle clinic, data collection for January 2023 to October 2023 were collected. Sociodemographic characteristics of the referred patients to the Lifestyle clinic were produced.Results: during the study duration from January 2023 to October 2023, a total of 1228 patients were referred to the lifestyle clinic, 598 (48.7%) were females and 630 (51.3%) were males. The age of patients referred to the lifestyle clinic ranged from 18 to 74 years, with a mean age of 42.28 years and an SD of 14.8 years old.Conclusion and recommendations: Lifestyle clinic referrals are from different age groups and from both genders. The lifestyle clinic is receiving a variety of patients from different clinics such general primary health care clinics and family medicine. There is a more detailed larger studies both quantitative and qualitative studies to describe the pattern of patients and their general needs to better planning of health care resources and improvement of health care services.

Risk Factors Associated with Pressure Ulcers among Home Health Care Patients; Riyadh, Saudi Arabia

Background: Patients, professionals, and health care systems are faced with a serious problem of pressure ulcers. They represent a significant occurrence and prevalence throughout the world. Their character iatrogenic states that its appearance is preventable, and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. Surgery may be necessary to accelerate the healing process, although most pressure ulcers are usually treated with debridement and conservative therapy. Their reported incidence and prevalence are significant worldwide. Objectives: The study's objectives are to identify the pressure ulcer risk factors in patients getting home health care, as well as to look at the quantity, type, and characteristics of pressure ulcers as well as patient comorbidities. Methods: Cross-sectional study, Home Care Nursing personnel questionnaire to determine the Risk Factors of Pressure Ulcers, patient comorbidities, and the number, and characteristics of pressure ulcers among patients receiving home care in Riyadh, Saudi Arabia. Results: PU is prevalent among the studied participants in Saudi Arabia, about 55% of these ulcers showed noticeable distraction of skin and/or deeper soft tissue against a bony prominence. We have also found a significant relationship between PU and gender, diabetes mellitus, hypertension, incontinence issues, nutritional status, and physical status, cerebrovascular accidents, trauma, and chronic kidney disease. Conclusion: Different risk factors are associated with PU such as diabetes mellitus, hypertension, and nutritional, and physical status. To monitor and promote best practices in skin care for highly dependent patients, continued measurement and evaluation of PU incidence, it is recommended more research of risk factors of PU development be assessed at home Health care Centers.