Healthcare Department Research Articles

CHARACTERISTICS OF SCIATICA PATIENTS LISTED FOR A SPINAL EPIDURAL STEROID INJECTION AND CLINICAL OUTCOMES: RESULTS FROM THE POISE COHORT STUDY

BackgroundClinical guidelines recommend epidural steroid injection (ESI) for severe sciatica but there is uncertainty of effectiveness. The POiSE study aims to identify factors, routinely collected in clinical practice that predict outcome in patients who have ESI. This presentation describes characteristics and early clinical outcomes of POiSE participants.MethodsProspective cohort study in 19 NHS spinal services in England, inviting patients with sciatica listed for an ESI. Participant baseline characteristics and 6-week follow-up outcomes are presented. Outcomes include pain intensity (0–10 NRS), disability (Oswestry Disability Index 0–100) and global change in symptoms.ResultsOver 24 months, 693 patients were invited to participate and 353 (51%) completed baseline questionnaires. Mean (SD) age 49.0 years (14.4), 60% female, and 46% (n=101) of those in work had certified time-off for sciatica. Mean pain intensity was 7.2 (2.0) and 6.2 (2.7) for leg and back pain respectively and mean disability (ODI) was 46.5 (18). 60% (n=210) had leg pain for >6 months. Average confidence at baseline (0 to 10) that the ESI would help symptoms was 5.7 (2.4).Of 217 patients reaching 6-week follow-up, mean leg and back pain intensity is 5.0 (2.8) and 4.9 (2.9) respectively and ODI 36.6 (20.4), with 57% reporting improvement (completely recovered/much better/better). Follow-up data collection at 6, 12 and 24-weeks post-ESI is ongoing.ConclusionInterim analysis shows only just over half of patients are reporting improvement at 6 weeks post ESI. The POiSE cohort study will help better identify the patients with sciatica who are most likely to benefit from this treatment.Conflicts of interestNoneSources of fundingThis study is supported by Health Education England and the National Institute for Health and Care Research (HEE/ NIHR ICA Programme Clinical Lectureship, Dr Siobhan Stynes, NIHR300441). The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care

Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial

Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. For the Urdu translation of the abstract see Supplementary Materials section.

Certification of Ukrainian Doctors of All Eight Stomatological Specialties: Analysis of Certification Sheet, Personal Educational Portfolio with Continuing Professional Development Results, and Certificate

Certification of doctors-stomatologists (i.e., dentists) in Ukraine is a procedure that is not sufficiently covered in English-language articles. Understanding Ukrainian legislation in in matters of сertification is extremely important both for foreing colleagues and for stomatologists in Ukraine. The purpose of this paper is to present the original and translation of three main documents of the Procedure for Certification of Doctors of the Order of the Ministry of Healthcare of Ukraine dated February 22, 2019, No. 446 (as amended by the Order of the Ministry of Healthcare of Ukraine dated August 18, 2021, No. 1753). Namely, certification sheet, personal educational portfolio with continuing professional development (CPD) results, and certificate. Each of the documents is detailed. Document templates can be found in Appendices 1, 2, and 3 to the Order of the Ministry of Health of Ukraine No. 446, freely available on the official website of the Verkhovna Rada of Ukraine. Personal educational portfolio deserves special attention, in which the doctor who is undergoing certification must chronologically indicate the CPD activities for the past year, the place of their implementation, the duration or/and bibliographic reference and the number of accrued CPD points. Also, this document requires to indicate the number of medical services provided by doctor during the reporting period (except for the specialties specified in Appendix 5 to the Procedure for the Certification of Doctors and the specialty “Organization and Management of Health Care”). Another purpose of this article was to provide samples of certificates on the assignment and confirmation of qualification categories to doctors-stomatologists- surgeons. The presented certificates were issued by certification commissions at various health care bodies of Ukraine. Namely, at (1) the Department of Healthcare of the Kyiv Regional State Administration and (2) the Ministry of Healthcare of Ukraine. All three certificates were issued in 2021.

Rare disease 101: an online resource teaching on over 7000 rare diseases in one short course

BackgroundAn estimated 3.5 million people in the UK live with a rare disease however due to the rarity of each individual condition this is not currently reflected in mainstream medical education. As a result, common features of living with a rare condition include diagnostic delay, poor coordination of health and social care and lack of access to specialist care and treatment. This is well documented in reports published by patient advocacy groups collating the patient experience and has been highlighted by the Department of Health and Social Care in its UK Rare Diseases Framework. One of the four priority areas outlined in this policy published in 2021 is ‘increasing awareness amongst healthcare professionals’.Medics4RareDiseases (M4RD), a charity based in the UK, has proposed a disease-agnostic approach to educating doctors about rare disease, focusing on the common challenges experienced across this heterogeneous collection of conditions, rather than on the minutiae of each of the > 7000 rare conditions. A literature search using MEDLINE, PubMed Central and Bookshelf confirmed a lack of broad rare disease teaching in medical literature; none of the 10 final resources identified focused on the topic as a whole.ResultsTo address this, M4RD created the course ‘Rare Disease 101’. It is accessed online using a learning management system that is free, contains interactive lessons, hosts a discussion board and is easily updated. In the 29 months since going live, 942 individuals have registered with 204 having completed the course; early feedback from 33 respondents was unanimously positive (all participants rated at least good (76%: excellent)) demonstrating that both clinicians and patients can benefit from broad rare disease education. The course is freely available to all at https://learn.m4rd.org/.ConclusionsDisease-agnostic training about rare disease as a large patient population, focusing on its unique profile of unmet needs, is required. Rare Disease 101 provides a pragmatic approach to an educational challenge that leads to poor patient outcomes. Early results suggest that the educational programme is well-received but further evaluation and assessment is needed.

A Secure Data E-Governance for Healthcare Application in Cyber Physical Systems

The bio-medical devices gather patient information and communicate it to data consumers via wireless networks to take the appropriate action and decision by informing the doctors. However, IoMT is adopted by healthcare departments with a greater speed, yet the majority of devices are limited to resource constraints and security perspectives. The classical e-healthcare systems that are centric have the inherent problem of single-point failure with low transparency and low control over records. Many proposals have been validated in IoT for addressing the inadequate computing and storage of records through sensors. The main focus of this paper is to propose a novel hybrid architecture called Zero Trust Blockchain Architecture for decentralized E-health-CPS systems to support low latency along with storage and processing of records while monitoring the patients. In addition, a probability distribution function may further draft an accurate and real-time monitoring of patients. The proposed mechanism is analyzed against adequate decision, storage, accuracy and transmission of records.

Nutritional improvement status of primary and secondary school students in the pilot nutrition improvement areas of Hainan, China from 2014 to 2021

ObjectiveBy meticulously tracking the evolving growth, development, and nutritional status of primary and secondary school students in Qiongzhong County from 2014 to 2021 post-implementation of the “Nutrition Improvement Program for Rural Compulsory Education Students”(NIPRCES, This project provides a supplementary food allowance of at least ￥4 per person per day for primary and secondary school students. The project area undergoes annual routine monitoring.), this study aims to offer a scientific basis for enhancing and promoting the project. Through thorough monitoring of students’ nutritional status changes influenced by this program, we strive to establish a comprehensive and evidence-based framework for its future advancement.MethodsFrom 2014 to 2021, this study employed a multi-stage sampling method utilizing cluster sampling to select six primary and six secondary schools in Qiongzhong County, Hainan Province. Data on the growth and development of respondents were collected. This cohort was a dynamic cohort with a total of 18,762 final data recovered. The prevalence of malnutrition was evaluated using the Cochran Armitage Trend Test (CATT) to assess year-to-year changes. Furthermore, height/weight and the prevalence of malnutrition between groups were compared using the t-test, χ2 test, and Bonferroni’s corrected analysis.ResultsThe average height of both boys and girls has increased. In 2021, boys and girls of all ages showed an average height increase of 2.31 cm and 1.98 cm, respectively, compared to 2014. Nevertheless, the growth and development levels, and rate of improvement of these students remain comparatively lower than their rural counterparts across China, who are of the same age. From 2014 to 2021, the prevalence of undernutrition (mainly wasting) showed a significant downward trend (P < 0.05) from 29.30% to 22.19%, and the prevalence of overnutrition showed an upward trend (both P < 0.05). The prevalence of undernutrition was higher among boys, students in grades 1–3 and those of Li nationality. Meanwhile, the prevalence of overnutrition was higher among boys, students in grades 1–3 and those of Han nationality.ConclusionsOver the 8-year period of NIPRCES, there has been progress in the growth and development of students, yet levels still lag behind the national average for rural students of the same age. While malnutrition prevalence have decreased, they remain high, with a concerning rise in overnutrition prevalence. Undernutrition and overweight/obesity are more prevalent among boys and younger students. Li students show higher prevalence of undernutrition, while overnutrition is a growing issue among Han students. Simultaneously, local education and health care departments must acknowledge the disparities in growth and nutritional status among primary and secondary school students residing in rural areas within the tropics and those in rural areas across the entire nation. Nutritional improvement measures should be tailored to local conditions.

Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland

Objective To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations. Design A retrospective register-based follow-up cohort study. Setting Public primary health care in the City of Vantaa, Finland. Subjects All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014. Main outcome measures Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department. Results Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3–1.7) to 10.5 (10.3–12.2) (p < 0.001) and registered nurse consultations from a median of 3.6 (3.0–4.0) to 14.5 (13.0–16.6) (p < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses. Conclusions It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.

Anti-Hypertension Drugs Classes of Prevention and Side Effects Diseases Efficiency Analysis in Association Rule Mining Techniques

Purpose: The Healthcare department, pharmaceutical department, Hospital and Clinical sector find out and explore the diseases of status, where it has been spreaded the communicable and non-communicable diseases among the society. The healthcare department conducting different awareness of programming about the different diseases how is affected people and how is prevented the diseases in society. Accordingly, all the healthcare awareness of information passed through the different media channel, even though high and low blood pressure is pressing public health challenges and it is recognized as the biggest contributor to the global burden of diseases. Presently people health is silently affected by blood pressure low and high level and they unable to recognize that something is amiss, high blood pressure is known as the "silent killer” and If blood pressure is excessively elevated, it may have an impact on organ damage or health issues like coronary arteries, heart valve dysfunction, diabetes, kidney diseases, heart attack and stroke this all are risk factors of blood pressure abnormal status. Hypertension diseases affected the patients need to the best prevention and feature safety. The Doctors, Pharmacist and Nurse are using Anti - hypertension drugs classes of medicines for patients. Which anti-hypertension drug classes of medicine good efficacy for patients and anti-hypertension drugs classes of medicine prevention diseases, side effects diseases knowledge is important for healthcare professional. Machine learning and Data mining knowledge discovery techniques need to understand how different classes of anti-hypertensive drugs might interact with the patient’s and medications. If the healthcare professional has access to a predictive data mining technique model, they could use this to anticipate how the patient’s condition might change over time and adjust the treatment plan proactively. This kind of analytical data mining knowledge can lead to more effective treatment and better patient outcomes. Design/Methodology/Approach: Developing machine learning concept for different anti-hypertension drugs classes of medicine efficiency analysis in hypertension prevention diseases and side effects diseases and Healthcare professional to take right decision for future adjusts treatment plan to the hypertension affected patients. Findings/Result: Orange data mining analytical tool to identify the anti-hypertension drugs classes of medicines efficacy and Doctors can take right decision to better treatment for the patients. Originality/Value: Data mining association rules of support, confidence and lift correlation analysis system helps to identified about the drug of new knowledge efficiency. Paper Type: Analytical research methods applied for analysis the different types of anti-hypertension drugs classes of association correlation efficacy in data mining machine learning system.

Retrospective analysis of surgical treatment of adult patients with trauma and posttraumatic deformities of the middle zone of the facial skeleton

The issues of diagnosis, planning, timing and tactics of surgical treatment, possible risks of postoperative complications in patients with trauma of the middle zone of the facial skeleton have remained relevant for many years. Due to the prevalence and complexity of solving a number of problems facing specialists arising from post-traumatic deformities (PTD) in this area, the problem of treating this category of patients is not only medical, but also socio-economic. Purpose. To carry out a retrospective analysis of the data of medical documentation of adult patients with trauma and PTD of the middle zone of the facial skeleton. Material and methods. We analyzed statistical data on the provision of specialized medical care to patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. A sample of 32 495 medical records of patients who were hospitalized at the State Budgetary Healthcare Institution of the Department of Healthcare of the Moscow “Maxillofacial Hospital for War Veterans” was conducted from March 2015 to December 2023. Statistical processing of the obtained data from the study group of patients was carried out. Results. Information is presented on the specialized care provided to adult patients with trauma and PTD of the middle zone of the facial skeleton in institutions subordinate to the Moscow Department of Health for 2021 and 2022. Our study included 233 patients with trauma and PTD of the midfacial skeleton who underwent surgical treatment. Of these, 84.12% (n=196) were men and 15.88% (n=37) women. The average age of the patients was 35.74±11.11 years. The study group was divided into two subgroups: the 1st – patients with injuries to the bones of the midface (n=157, 67.38%), the 2nd – with PTD of the bones of the midface (n=76, 32.62%). The article presents the main characteristics of these patients. The methods of their examination at the prehospital stage are analyzed in detail; the time from the moment of injury to the moment of seeking specialized medical care; channels of hospitalization; causes of injuries; aesthetic and functional disorders as a result of injuries; types of injuries; applied methods and tactics of surgical treatment. Conclusions. The results of the study present a modern characterization of adult patients with trauma and PD of the middle zone of the facial skeleton. Recommendations are given on the use of four main fixation points during operations of metallosteosynthesis of the bones of the zygomatic complex, the need to reduce the time from the moment of injury to the moment of specialized medical care, the need for an integrated approach and treatment of patients with injuries and PTD of the bones of the middle zone of the face in specialized centers of maxillofacial-facial surgery.

Показатели деятельности отделений лучевой диагностики Департамента здравоохранения города Москвы в 2016–2022 гг.

Due to the dynamic development of the Moscow health care system, the analysis of the operation results of radiology departments becomes a necessary tool for making effective management decisions aimed at improving the quality of medical care. Purpose of this study is to analyze the dynamics of the operation results of radiology departments and to analyze changes in their staff structure in medical organizations of the Moscow Health Care Department in the period 2016–2022. Materials and methods. By analyzing the Federal Statistical Monitoring forms No. 30 «Information on Medical Organization» for 2016–2022 and the reporting data from the EMIAS ERIS, the calculation of the operation results of radiology departments was carried out. The following types of radiologic studies were included in the study: computed tomography (CT), magnetic resonance tomography (MRT), radiography (RG), mammography (MMG), fluorography (FLG), densitometry (RD). Results. A change in the structure of radiologic studies was determined, due to a 51% decrease in the number of radiographic studies and a 1.7-fold increase in the number of CT studies. The number of radiologists increased by 7.2% and the number of technicians by 3.8%. The workload of radiologists increased by 24.2%. The average staff complement of radiology departments with radiologists amounted to 70.8%. Findings. Advanced digital infrastructure of the radiology departments promotes high adaptability to emerging challenges. Staff shortage can be adjusted through the implementation of new digital technologies aimed at optimizing professional activity of radiologists.

Epidemiological Trends in the Incidence of Gastritis and Duodenitis among Children in Moscow

Introduction. The article analyzes the incidence of gastritis and duodenitis among children based on the data provided by medical organizations subordinate to the Moscow Healthcare Department. The disease incidence is presented by age groups. Materials and methods. The data was obtained from the Federal Statistical Observation Form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, Form of Federal Statistical Monitoring No. 30 “Information about a medical organization” for the period from 2019 to 2023, as well as data on child population in Moscow published on the official website of the Federal State Statistics Service. Results and conclusions. The analysis of the incidence of gastritis and duodenitis in the observed period showed that the most vulnerable age groups are children aged 10-14 years and adolescents (39.9% and 37.0% out of the total number over the past five years, respectively). Among all age groups, there is a negative dynamic in the overall and primary incidence of gastroduodenitis. Based on the results obtained, it can be concluded that there is a moderate incidence of gastritis and duodenitis among the child population in Moscow. Special attention should be paid to preventive measures and health-improving programs in order to reduce the incidence rate and ensure the health of the rising generation.

New coronavirus infection SARS-CoV-2 in adult patients with inborn errors of immunity

BACKGROUND: Diagnosis and treatment of COVID-19 in patients with primary immunodeficiency, or inborn errors of immunity, are often challenging. AIM: Description of the COVID-19 course and therapy of adult patients with primary immunodeficiency treated in medical organizations of Moscow Healthcare Department. MATERIALS AND METHODS: We analyzed a cohort of 68 patients over 18 years (median ― 35 years) with primary immunodeficiency; 91% of patients have primary immunodeficiency with predominantly antibody deficiencies. Altogether 90 cases of the new СOVID-19 were analyzed: in 68 cases infection occurred for the first time, in 22 cases it recurred. The duration of the disease ranged from 3 to 80 days. Duration of PCR-positivity ranged from 0 to 59 days, median 8 days. RESULTS: Patients with Wuhan and Delta strains had more severe inflammatory signs according to C-reactive protein and lactate dehydrogenase, in patients with Wuhan lung involvement on CT-scam was larger. In demonstrated group of patients higher C-reactive protein correlated with larger lung involvement, longer duration of the disease and PCR-positivity, significant lymphopenia also correlated with higher C-reactive protein. To our data regularity of intravenous immunoglobulin therapy and IgG trough level didn’t correlate with infection severity and duration of the disease and virus-carriage. Indirectly, the change in the spectrum of medicine used in patients of the analyzed group coincided with the virus strain evolution. Anti-inflammatory therapy was mainly presented by dexamethasone and antagonists to interleukin 6 or its receptor (anti-IL-6): 55% and 73% for Wuhan, 63% and 50% for Delta, 17% and 39% for Omicron. Then, preference was gradually given to the target anti-cytokine medicine. Etiotropic antiviral therapy was more often used to treat infection caused by Wuhan and Delta strains ― 32% and 38%, respectively (in 17% for Omicron). With shifting toward immunotherapy by specific against COVID-19 immunoglobulins and monoclonal antibody to SARS-CoV-2: 5% and 9% for Wuhan, 0% and 75% for Delta, 48% and 83% for Omicron, respectively. Immune and etiotropic therapy was not carried out in Wuhan in 39%, in Delta in 43%, in Omicron in 41% of cases. The overall mortality rate from COVID-19 in the analyzed group was 3%. CONCLUSION: Patients with primary immunodeficiency represent a vulnerable group to the SARS-CoV-2 virus with a high risk of not only severe, but also a protracted and undulating course of infection, what must be taken into account for the correct interpretation of the patient's condition and the timely administration of the appropriate therapy.

Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city

BackgroundAlthough countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care.MethodsThe dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care.ResultsWe demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual’s risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts.ConclusionThis study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

Results of the use of an integrated risk scale for postoperative complications in patients with colorectal cancer

Inroduction. Polymorbidity significantly increases the risk of complications in the early postoperative period, especially in patients with colorectal cancer, taking into account the initial nutritional status disorder. At present, several scales of postoperative complications risk assessment (POSSUM, RCRI, MUST) are used, but they do not fully meet the needs of modern oncosurgery, so we consider it necessary to compare their effectiveness and propose a new integrated scale.Aim. To establish the most significant factors influencing the outcome of surgical treatment and length of hospitalization in comorbid patients with colon cancer with the development of a surgical risk assessment scale that is most adapted for this group of patients.Materials and methods. We analyzed the data of hospital charts of patients undergo surgery for colorectal cancer in the oncoproctologic department of the S. P. Botkin State Clinical Hospital of the Moscow Healthcare Department in the period from 2019 to 2022. Inclusion criteria: histologically verified colorectal adenocarcinoma; colorectal cancer in stage cT4, cN0, cM0 or cT1–4, cN1–2, cM0; presence of one or more concomitant diseases in the patient. Exclusion criteria: presence of distant metastases of colorectal cancer; absence of confirmed comorbidities; early forms of colorectal cancer (cT1–2, cN0). All patients were assessed for risk of perioperative complications using ASA, POSSUM, MUST, and RCRI scales. The study endpoints were number of days in intensive care, number of days of hospitalization, and 30-day mortality. An Excel database with POSSUM, RCRI, and MUST scale calculators was created for the study. The evaluation of parameters influencing the outcome of hospitalization was performed using ROC analysis and correlation analysis using Pearson’s criterion. To identify the most sensitive parameters affecting the outcome of hospitalization, commonly used calculators were studied in detail.Results. 200 patient records were analyzed. The results of treatment were compared with the data obtained using the postoperative risk scales POSSUM, MUST, RCRI. A comparative analysis of the scales presented above with our proposed integral scale of postoperative complications risk assessment was carried out. It was found that the parameters of our proposed integral scale showed the highest sensitivity (Se &gt;70 %) and specificity (Sp &gt;70 %) to the risk of postoperative complications. Our proposed integral scale showed a moderate correlation with the age of patients (r = 0.475, p = 0.01) and preoperative weight loss (r = 0.592, p = 0.01), as well as a high correlation with POSSUM (r = 0.649, p = 0.01; r = 0.852, p = 0.01) and MUST (r = 0.655, p = 0.01).Conclusion. The developed scale for assessment of surgical risk in comorbid patients with colorectal cancer showed a higher correlation with the outcome of surgical treatment than similar known scales, which indicates its effectiveness and possibility of application in clinical practice after its validation in prospective studies.

Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: A qualitative study applying the motivation, opportunity, and ability model.

The study aims to explore the driving forces behind physical activity engagement among patients with chronic obstructive pulmonary disease, focusing on motivation, opportunity, and capability. A phenomenological qualitative study applied the motivation, opportunity, and capability model, conducted in two respiratory units of a Chinese university hospital. Participants, selected by age, gender, and illness duration, included inpatients during the interview sessions and those recently discharged within six months. One-on-one semi-structured interviews were recorded, transcribed, and analyzed by the Colaizzi seven-step method. Seventeen participants diagnosed with chronic obstructive pulmonary disease for over one year aged between 66 (range: 42-96) participated. Three major themes were identified: Inspiring participation motivation-transitioning from recognizing significance to habit formation; Offering participation opportunities-reiterating demand for personalized strategies and ideal environmental settings; Enhancing participation capability-addressing strategies for overcoming fears, setting goals, ensuring safety, and adjusting activity levels. This research underscores the vital role of inspiring participation motivation, offering opportunities, and enhancing the capability for participation in effective engagement. Advocating increased attention from healthcare departments, fostering interdisciplinary collaboration, improving activity guidance and counseling effectiveness, and considering individual preferences can significantly benefit those patients with chronic obstructive pulmonary disease who hesitate or are unable to participate in physical activities, thereby increasing the dose of non-leisure time physical activity.

Improving transparency of longitudinal health research: glossary, infographic and accessible study summaries

BackgroundLongitudinal studies collect information repeatedly about the same group of people, allowing for analyses of changes over time. They are vital in mental health research, as elsewhere. As longitudinal studies rely on the participation of patients and the public, their methods, purposes and results must be transparent and accessible. IntroductionMany UK longitudinal research studies with mental health data are indexed via the Catalogue of Mental Health Measures (‘Catalogue’), and organisations including DATAMIND provide broader information about mental health data research. However, the information on such platforms is primarily researcher-oriented, creating a barrier to its transparency and accessibility. Barriers can be alleviated by providing clear definitions of specialist terms, a transparent overview of longitudinal mental health research, and ‘bite-sized’ summaries of the Catalogue studies. MethodsThis project was co-designed and co-created by patient/public representatives from the DATAMIND Super Research Advisory Group (SRAG) and researchers. UK Health Data Research Alliance transparency standards were followed across the delivery of three outputs. (1) To provide clear definitions of specialist terms, SRAG members and researchers collected terms commonly used longitudinal research and researchers clarified definitions. Definitions were revised by SRAG members and terms were added to an existing data science glossary. (2) To create a transparent overview of longitudinal mental health research, the patient/public involvement (PPI) lead and SRAG co-applicant proposed content for an infographic about longitudinal research. The design was discussed with a graphic designer who created the infographic, and involved the PPI lead for the UK Longitudinal Linkage Collaboration. This was then revised iteratively for clarity, accessibility and diversity. (3) To generate accessible summaries of the Catalogue studies, psychology undergraduate students drafted summaries for an initial six studies, which were reviewed via a workshop led by the SRAG. Following revisions to the content and style, summaries were created for all 55+ studies on the Catalogue. Unfamiliar terms encountered during the process were also added to the glossary. ResultsThree new resources were created. (1) We developed a glossary of terms commonly used in longitudinal studies and research, to be incorporated into the DATAMIND glossary (https://datamind.org.uk/glossary/). (2) We created an infographic ‘storyboard’ to show how researchers, patients and the public can work together in the creation and curation of longitudinal research. The infographic illustrates the intertwined relationships between patients and the public, providing a transparent representation of challenges such as sharing studies, data access, patient benefit, and the importance and impact of public involvement. It illustrates many ways to find out about longitudinal research. (3) Accessible and transparent short summaries were created for all longitudinal studies in the Catalogue (https://www.cataloguementalhealth.ac.uk/). These provide clear and concise overviews, enough to capture the essence of each study and inform researchers and the public quickly and easily. ConclusionsCo-production supports the transparency of longitudinal research, and ensures resources designed and produced for the public have public input. Two generic information resources and one specific resource are presented. AcknowledgementsProject funded by HDR UK (HDRUK2023.0465). DATAMIND is funded by the Medical Research Council (MR/W014386/1). All research at the Department of Psychiatry in the University of Cambridge is supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312) and the NIHR Applied Research Collaboration East of England; the views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Comparative analysis of robot-assisted and laparoscopic operations in oncogynecology

Aim. To determine the advantages and disadvantages of laparoscopic (LS) and robot-assisted (RA) surgery in oncogynecological operations.Materials and methods. 282 clinical cases were retrospectively analyzed. The patients were treated in oncogynecological department No. 70 of the CS.P. Botkin City Clinical Hospital, Moscow Healthcare Department for endometrial cancer of stages IA–II, cervical cancer in situ and IA1 stages or atypical endometrial hyperplasia in the period from February 2020 to September 2022, among them 74 patients were operated with Da Vinci robotic units (models Si and Xi) and 208 using laparoscopy. The standard volumes of surgical treatment, depending on the clinical diagnosis, were: hysterectomy, hysterectomy with pelvic lymphadenectomy, hysterectomy with pelvic and retroperitoneal lumbar lymphadenectomy. To compare the technical characteristics of minimally invasive operations and the condition of patients in the intra- and postoperative periods in each group, data on the duration of operations, body mass index, age, intra- and postoperative complications, as well as the number of postoperative hospital bed-days were analyzed.Results. When comparing the average duration of operations by time, a statistically significant difference was obtained. Thus, LS hysterectomy was performed 43 minutes faster on average than RA (74.2 minutes versus 117 minutes) (p &lt;0.001). When performing pelvic lymphadenectomy, the average duration of RA operations was 28 minutes longer than LS operations (142 minutes versus 170 minutes), and when adding the retroperitoneal lymphadenectomy stage, the average duration of RA operations was 128 minutes longer than LS operations.Conclusion. At this stage of technology development in surgery, LS operations have a number of advantages over RA ones in numerous ways. LS operations demonstrate statistically significantly shorter execution time, fewer perioperative complications, as well as a more controlled environment in the operating field. In the long term, RA surgery has serious potential and is currently at an early stage of its development. A real and sober assessment of its characteristics will determine the right direction for the development of this technology in the future.

Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation

Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g. We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432. Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care. KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa. Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Role of Maternal Adverse Childhood Experiences on Infant Neglect: A Multi-Perspective Approach.

We explored the intergenerational transmission effects of maternal adverse childhood experiences (ACEs) and infant neglect from multiple perspectives. The study included a sample of postpartum mothers and infants (N = 550) from the outpatient child health care department of a tertiary hospital in Jinan, Shandong Province, China. Our investigation followed three main lines of inquiry. First, the association of overall maternal ACEs with infant neglect was estimated. Secondly, the cumulative and independent effects of maternal ACEs on infant neglect were explored using the Adverse Childhood Experience Questionnaire-Revised (ACEQ-R) with 14 types of ACEs. Finally, the different patterns of 14 maternal ACEs were identified, and the association between the different patterns and infant neglect was explored. There were three main findings. First, infants born to mothers with ACEs experienced higher levels of neglect compared to those born to mothers without ACEs. Second, infants born to mothers with three or more subtypes of ACEs experienced the greatest levels of neglect, with maternal childhood physical neglect emerging as a particularly influential factor. Third, infants in the "median maternal ACEs" and "high maternal neglect and poor peer relationship" groups experienced more severe neglect than those in the "low maternal ACEs" group. These results suggest that early life experiences substantially shape future parenting behaviors, such as infant neglect.

Efficacy of total neoadjuvant chemotherapy in the FLOT regimen in patients with locally advanced gastric and gastroesophageal junction: results of a phase II study

Background. The established approach notably improving the therapeutic outcomes for locally advanced gastric cancer and gastroesophageal junction cancer, presently entails the amalgamation of perioperative chemotherapy aligned with the FLOT protocol and surgical intervention. However, this approach harbors limitations, as only half of the patient cohort successfully completes the entire prescribed course of drug therapy. The potential solution to this problem lies in the complete transfer of the chemotherapy volume to the preoperative period and the execution of total neoadjuvant chemotherapy with FLOT regimen.Aim. Aim is to conduct a comparative assessment of the efficacy and safety between total neoadjuvant and perioperative chemotherapy with FLOT regimen for patients with locally advanced gastric cancer and gastroesophageal junction cancer.Materials and methods. In a retrospective study we enrolled patients with histologically confirmed locally advanced gastric cancer and gastroesophageal junction cancer meeting clinical stage criteria T2–4 and N0–3, without of distant metastases, treated between 2014 and 2020 at Federal State Budgetary Institution “N. N. Blokhin National Medical Research Center of Oncology” оf the Ministry of Health of the Russian Federation and Moscow City Oncologic Hospital No. 62 Department of Healthcare of Moscow. Participants in the control group underwent 8 courses of perioperative chemotherapy (4 preoperatively and 4 postoperatively), while those in the experimental group received 8 courses of total neoadjuvant chemotherapy. Both groups received drug therapy according to the FLOT protocol: 5-fluorouracil 2600 mg/m2 , intravenous drip, over 24 hours, leucovorin 200 mg/m2 , intravenous drip, oxaliplatin 85 mg/m2 , intravenous drip, docetaxel 50 mg/m2 , intravenous drip, on day 1, with a 14-day intercourse interval. The primary endpoint was one-year progression-free survival.Results. In the study included 187 patients. Participants were divided into two groups: 95 in the total neoadjuvant chemotherapy group and 92 in the perioperative chemotherapy group. The one-year progression-free survival was higher in the total neoadjuvant chemotherapy group at 79 %, compared to 68 % in the perioperative chemotherapy group (HR 0.54, 95 % confidence interval 0.32–0.9, p = 0.02). Median disease-free survival was 27.2 and 19.5 months in the neoadjuvant and perioperative chemotherapy groups, respectively. The tolerability of the entire planned drug treatment regimen was superior in the total neoadjuvant chemotherapy group, reaching 88.4 %, as opposed to 57.6 % in the perioperative chemotherapy group (p = 0.0001).Conclusion. Among patients with locally advanced gastric cancer and gastroesophageal junction cancer, the application of total neoadjuvant chemotherapy according to the FLOT protocol, administered over 8 courses, demonstrated enhanced one-year progression-free survival and improved tolerability of the entire planned treatment regimen.