Healthcare Protocols Research Articles

Lifestyle Recommendations for Patients Before and After Thoracic Aortic Surgery: A Framework Analysis

Abstract Background Patients receive many different recommendations after thoracic aortic surgery. Unfortunately, there is much variation in recommendations between different surgical centers. This variation in recommendations creates uncertainty and anxiety in patients. Therefore, we aimed to provide an overview with clear lifestyle recommendations for patients before and after thoracic aortic surgery. Methods Documentary research and a framework analysis were used to analyze brochures, website texts, and health care protocols. These documents consisted of lifestyle recommendations for patients before and after thoracic aortic surgery (direct information) or cardiac surgery (indirect information). An analytical framework was constructed and all lifestyle recommendations for patients before and after thoracic aortic surgery were coded through indexing, charting, and mapping by two researchers (N.K. and H.v.Z.). The first draft with lifestyle recommendations was prepared by two researchers (N.K. and H.v.Z.). Feedback from all authors involved patients and consulted health care professionals was processed in the final draft. Results In total, 170 documents were analyzed. Indexing revealed 414 lifestyle recommendations, which were included in the first draft. Charting, mapping, removal of duplicates, and processing of feedback resulted in a final draft with 52 lifestyle recommendations about behavioral change, body weight, nutrition, cessation of alcohol and drug use, cessation of smoking, wound healing, sedentary behavior and physical activity, mental well-being, and family and close relatives. Conclusion This study provides an overview of clear lifestyle recommendations for patients before and after thoracic aortic surgery. This overview is the first step because follow-up research is needed on which lifestyle recommendations are necessary and evidence-based. The overview of lifestyle recommendations serves as a foundation, after which individual customization can be provided.

The Impact of Muscle Energy Techniques on the Temporomandibular Motions Following Extraction Surgery of the Third Molar Tooth: A Randomised Clinical Trial.

Trismus and subsequent restricted range of motion in the temporomandibular joint may impede vital activities of daily living. The primary purpose of the current study was to explore the impact of muscle energy techniques on the range of temporomandibular motions in individuals with trismus and restricted range of the temporomandibular motions after third molar extraction surgery. Eligible volunteers were randomly assigned to either the intervention or control group. Participants in the intervention group received muscle energy techniques over seven consecutive postoperative days, while those in the control group did not receive any intervention. Both groups adhered to the recommended postoperative healthcare protocol provided by a single dentist. The range of cardinal and linear intra-articular motions of the temporomandibular joint was assessed on the first, second and seventh postoperative days in each group using a vernier calliper and an ultrasound machine, respectively. The range of linear intra-articular motion (p-value < 0.001) and cardinal motion (p-value < 0.032) of the TMJ significantly increased within groups after the first postoperative week. The range of temporomandibular motions, except for the forward displacement of the mandibular condyle (p-value = 0.193), and the range of mandibular retrusion (p-value = 0.339) exhibited a significant difference between groups (p-value < 0.017) after the first postoperative week. The current study revealed, for the first time, that muscle energy techniques increase the range of cardinal and linear intra-articular motions in individuals with trismus and restricted range of the temporomandibular motions following third molar extraction surgery. Clinical Trials: IRCT20211016052783N1.

Intersections of Compassion, Science, and Spiritual Care in Global Health for Public Health Benefits.

Across the globe, spiritual care is offered by individuals, healthcare chaplains, and humanitarian, social and related spiritual groups on account of zeal, voluntary and paid services. Sometimes, services are provided without understanding the connectivity of compassion, spiritual care, and scientific protocols. There are instances where health professionals and managers disagree with spiritual caregivers or reject spiritual services because of poor service deliveries in conflict with healthcare protocols. Against this background, this article focuses on how spiritual care services can be provided scientifically to improve service delivery. It presents leading questions to link the scientific and compassionate approach to spiritual care. These include-What is science? What is compassion? What is spiritual care? What makes compassion and spiritual care scientific? Are there tenets of compassion in religions? How are compassion, science and spiritual care linked? What are the implications of the intersections for public health and safety? Hopefully, the provided answers may improve the service delivery performance of spiritual caregivers and their collaboration with healthcare professionals, social workers, and related groups.

Appraisal of the Relevant Laws, Health Care Policies, and Legal and Institutional Frameworks for the Health Care Support of Intimate Partner Violence Survivors in Nigeria

Intimate Partner Violence (IPV) remains a significant public health and human rights issue in Nigeria, yet the adequacy of existing legal frameworks to support survivors is a critical but underexplored area. This article examines the extent to which Nigerian laws address the healthcare needs of IPV survivors, evaluating both statutory and policy provisions. Through a comprehensive analysis of relevant legislation, including the Violence Against Persons Prohibition Act (VAPP), the Child Rights Act, and various state-specific laws, alongside healthcare policies and protocols, this study assesses the effectiveness and gaps in the legal infrastructure. Findings indicate that while there are progressive laws aimed at preventing and addressing IPV, substantial gaps persist in their implementation, particularly regarding the integration of healthcare support services for survivors. The article highlights the need for a more coordinated approach that aligns legal provisions with healthcare practices, ensuring that IPV survivors receive comprehensive support. Recommendations are provided to strengthen the legal framework and enhance inter-sectoral collaboration to better meet the needs of survivors in Nigeria. Keywords: Health care Support, IPV, Legal Framework, Survivors

Enhancing COVID-19 Vaccination Awareness and Uptake in the Post-PHEIC Era: A Narrative Review of Physician-Level and System-Level Strategies.

Following the World Health Organization's declaration that the COVID-19 pandemic is no longer a public health emergency of international concern (PHEIC), COVID-19 remains an ongoing threat to human health and healthcare systems. Vaccination plays a crucial role in reducing the disease's incidence, mitigating its severity, and limiting transmission, contributing to long-term public health resilience. However, incomplete vaccination coverage and vaccine hesitancy exist. This narrative review investigates strategies at the system and physician levels aimed at sustaining awareness and uptake of COVID-19 vaccination in a post-PHEIC era. Through an examination of the existing literature, this review explores the effectiveness of diverse approaches utilized by healthcare systems and individual providers. These approaches address every component of the 5C model of vaccine hesitancy: confidence, complacency, constraints/convenience, calculation, and collective responsibility. Physician-level approaches include appropriate message framing, persuasive communication containing safety and personal/social benefit information, sharing of personal stories, creating a safe space for discussion, harnessing co-administration with annual influenza vaccines, and use of decision aids and visual messages. System-level approaches include messaging, mass media for health communication, on-site vaccine availability, pharmacist delivery, healthcare protocol integration, incentives, and chatbot use.

Part III - Navigating an Encounter with a Trafficked Person in the Dermatology Clinic

Patients experiencing or having experienced trafficking frequently interact with the healthcare system, highlighting the need for healthcare providers to be equipped with the appropriate tools to serve these patients effectively. The third part of this series focuses on navigating encounters with trafficked persons within the dermatology clinic, emphasizing the importance of trauma-informed, patient-centered care. We review the barriers trafficked patients face and mechanisms to overcome these, the importance of comprehensive needs assessments, and the implementation of effective healthcare protocols. Additionally, we review the role of dermatologists in mandatory reporting and the use of appropriate ICD-10 codes for documenting a potential trafficking victim encounter in the electronic medical record. We conclude with recommendations for specialized training, emphasizing the critical role dermatologists play in identifying and supporting trafficked patients within the healthcare system.

Assessment of the knowledge and attitudes of nurses and social caregivers in relation to falls among elderly patients in healthcare settings in a Hungarian county

AbstractPurposeThe aim of this descriptive study was to evaluate the knowledge and attitudes of nurses and social caregivers in relation to falls among elderly patients.Materials/MethodsA total of 442 nurses and social caregivers working in acute or chronic care settings participated in our study. Data were gathered on the participants' general characteristics, the characteristics of their workplace, and their levels of knowledge in relation to risk factors and types of falls. Our questionnaire also included a survey of attitudes towards fall prevention. Data were analysed using IBM SPSS software.ResultsOur results showed a significant correlation between the participants' level of knowledge and age, level of professional education, workplace localisation, form and type of care, risk evaluation scale score, and the existence of a healthcare protocol at the workplace. Participants demonstrated a positive attitude towards fall prevention: the mean value for attitude was 48.03 out of 65 points. Participants who experienced a lower number of falls among elderly patients at their workplace demonstrated a significantly more positive attitude to prevention compared to those experiencing falls more frequently.ConclusionsIn our professional opinion, trainings focusing on fall prevention are required. In addition to knowledge transfer, these should emphasise the formation of attitudes, especially in the context of chronic healthcare, among professionals working in institutions in smaller towns.

Piggery Value Chain Mapping in Bengaluru: A Comprehensive Analysis of Rearing Systems

The study examines the piggery value chain in Bengaluru, focusing on 35 breeders and fattening farmers across Bengaluru rural and Bengaluru urban areas. It analyses distinct rearing systems, breeding practices, feeding strategies, and healthcare protocols among respondents. Breeders predominantly utilize intensive rearing systems (100%) for optimized breeding outcomes, while fattening farmers prefer semi-intensive methods (85.71%) to balance care with natural behaviours. Variations in housing preferences show that 46.67 per cent of fattening farmers use efficient drainage systems compared to none among breeders. Feeding practices differ significantly 100 per cent of breeders employ stall feeding, whereas 75 per cent of fattening farmers practice scavenging feeding with 25 per cent engaging in mixed feeding. Feeding frequency is consistently twice daily among all respondents (100%). The deworming practices at 45.71 per cent overall, with 100 per cent among breeders and 60 per cent among fattening farmers. Vaccination is practiced exclusively by breeders (100 %). Veterinary aid satisfaction rates are 31.43 per cent overall, with 40 per cent among fattening farmers. A detailed value chain map visually depicts stages from input supply to consumption, elucidating stakeholder roles crucial for productivity enhancement, animal welfare promotion, and sustainable practices within Bengaluru's piggery sector.

Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery

Abstract Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.

Revolutionizing healthcare: IoMT-enabled digital enhancement via multimodal ADL data fusion

The present research develops a framework to refine the classification of an individual’s activities and recognize wellness associated with their routine. The framework improves the accuracy of the classification of routine activities of a person, the activation time data of sensors fixed on objects linked with the routine activities of the person, and the aptness of an incessant activity pattern with the routine activities. The existing techniques need continuous monitoring and are non-adaptive to a person’s persistent habitual variations or individualities. The research involves applying Internet of Medical Things (IoMT)-based sensor information fusion to the novel multimodel data analytics to develop Activities of Daily Living (ADL) pattern, behavioral pattern generation and anomaly recognition. The novel multimodel data analytics approach is named AiCareLiving. AicareLiving is an IoMT and artificial intelligence (AI) enabled approach. The research work describes activity data using an individual’s activities within a specified area before evaluating the activity data to detect the existence of an anomaly by identifying the deviation of the activity data from the activity profile, which indicates the anticipated behavior and activity of the person. This wellness information would be shared to the caregivers, related healthcare professionals, care providers and municipalities through the secured healthcare information exchange protocol and IoMT. AiCareLiving framework aims to least false positive in terms of anomaly detection and forecasting; the high precision is close to the confidence level of 95%.

Impact of COVID-19 on patients with metastatic breast cancer: REthink Access to Care and Treatment survey results.

Aim: Patients with metastatic breast cancer (MBC) may be vulnerable to changes in healthcare management, safety standards and protocols that occurred during the COVID-19 pandemic.Materials & methods: The REthink Access to Care & Treatment (REACT) survey assessed USA-based patient perspectives on COVID-19-related impacts to their MBC treatment experience between 27 April 2021 and 17 August 2021.Results: Participants (n=341; 98.5% females, mean age 50.8years) reported that overall oncology treatment quality was maintained during the pandemic. Delayed/canceled diagnostic imaging was reported by 44.9% of participants while telemedicine uptake was high among participants (80%).Conclusion: Overall, MBC care was minimally affected by the pandemic, possibly due to the expanded use of telemedicine, informing MBC management for future public health emergencies.

Discussing the Role of Explainable AI and Evaluation Frameworks for Safe and Effective Integration of Large Language Models in Healthcare

Discussing the Role of Explainable AI and Evaluation Frameworks for Safe and Effective Integration of Large Language Models in Healthcare

Post‐quantum attack resilience blockchain‐assisted data authentication protocol for smart healthcare system

AbstractThe smart healthcare system (SHS), a significant medical domain underpinning the Internet of Things (IoT), which collects and analyzes health data from many sources to provide better medical treatment. The smart healthcare system is a combination of hardware and software used in the medical care field, providing remote diagnosis and treatment via a patient‐based health data‐sharing system. To increase security, a large variety of authenticated techniques have been developed over the past several decades, most of which are based on conventional number‐theoretic assumptions such as discrete logarithms and integer factorization problems. However, Shor's method is capable of solving number‐theory‐based problems. As a result, Shor's technique might be used to resolve challenging number theory problems on a quantum computer effectively. Therefore, this article presents blockchain‐based healthcare record solutions with lattice RLWE‐based key exchange protocol using a smart card. Blockchain applications may correctly detect errors, including those that are risky, in the medical industry. It can also improve the efficiency, security, and transparency of transferring medical data throughout the healthcare protocol. The formal security of this protocol is shown under the ROM (random oracle model), and the informal security is also given in this article against well‐known attacks. The presented protocol outperforms related earlier mechanisms in terms of communication and computational cost overheads, according to the performance study.

Voice Recognition Based Vital Parameter Monitoring Patient BED

In healthcare protocols continuous monitoring of vital parameters plays a crucial role in patient care. Integrating advanced technologies for both monitoring and patient comfort enhances the efficiency of healthcare delivery. This paper presents the design and development of a novel patient bed system equipped with vital parameter monitoring capabilities and adjustable head position controlled through voice commands. The proposed system leverages state-of-the-art sensors to monitor vital parameters such as heart rate, blood pressure, oxygen saturation, and temperature. These sensors are seamlessly integrated into the bed, providing non-intrusive and continuous monitoring of the patient's health status. Real-time data acquisition and processing algorithms ensure accurate and timely assessment of the patient's condition. Furthermore, the patient bed is designed with an adjustable head position feature, allowing for optimal comfort and support. Unlike conventional manual or automated adjustment mechanisms, our system employs voice control technology for intuitive and hands-free operation. Patients can simply issue verbal commands to adjust the head position according to their preferences, enhancing overall comfort and facilitating better rest.

Safe Motherhood Initiative

Abstract In the quest to create global maternal health care protocols, African Indigenous birthing epistemologies are often overlooked in research, policy, and advocacy aiming to improve maternal health and reduce the maternal mortality ratio (MMR). The global maternal health strategy, the Safe Motherhood Initiative (SMI), excludes Indigenous birthing knowledge by requiring all childbirth to be attended by only birth attendants trained in the Western medical paradigm. This forms the bedrock of the assumed authoritative expertise of the Western medical birthing approach. Despite the campaign for sole reliance on SMI, Africa’s MMR remains the highest compared to other regions. Nigeria, Africa’s most populous country, also has the third-highest MMR in the world as of 2020. This failure of SMI to reduce MMR for Nigeria and Africa more broadly calls for the inclusion of marginalized Indigenous birthing knowledge for its epistemological and practical significance. Using Nigeria as a case study, with a transnational connection with the United States, the article argues that excluding African birthing knowledge and methods in SMI promotes epistemic and obstetric violence. Adopting the reproductive justice framework as a decolonial tool, the article asserts that African Indigenous birthing knowledge is simultaneously valid and valuable for holistic approaches to maternal health.

Oral hygiene practices and dental care challenges in children with Microcephaly

At the university level, the academic community must understand that, for quality education, it is necessary to carry out extension activities to integrate the training of both teachers and students. But what would extension actions be developed for an extremely vulnerable population, such as children with microcephaly? What would be the oral health care protocol guidelines for these individuals? What would this exchange of knowledge be like between the two groups: university and this vulnerable population? Based on these questions, this article proposes to report the experiences of professors and students of the Dentistry course at the State University of Southwest Bahia about oral health practices and challenges in dental care for children with microcephaly based on the principles of universality, equity and integrality.

Health Care Waste Assessment in a Secondary Health Care Facility in Anambra State, Nigeria

Background: Proper management of waste generated in healthcare facilities is very important for patient safety, disease containment, and the general safety of healthcare workers in the facilities. It is important that healthcare workers have a good knowledge of healthcare waste management, develops good attitude towards healthcare waste management and practices standard health care waste management protocols as stipulated by the World Health Organization. Objectives: This study therefore assessed the knowledge, attitude and practice of health care waste management among health care workers in Borromeo Hospital, Anambra State. Methods: A cross sectional descriptive study was carried out among healthcare workers selected using multistage sampling technique in 6 categories of healthcare workers (doctors, nurses, lab scientists/technicians, pharmacists/technicians, hospital attendants) in Borromeo Hospital, Onitsha, using a pre-tested, semi-structured, interviewer-administered questionnaire. Data collected were analyzed using SPSS version 22 and associations and correlations between dependent and independent variables were tested at the bivariate level using Pearson Chi-square test and t-test as appropriate. The level of statistical significance was set at 5%. Results: A total of 73 healthcare workers were studied. Most of the respondents were female nurses with 0-5 years of working experience.58.9% of respondents had a very good knowledge of health care waste management and 37% had a relatively good knowledge. Majority of respondents (85%) agreed that HBV immunization prevents hospital transmission while 79.4% disagreed that containment of sharps does not help in safe management of hospital wastes.89% of the respondents adheres strictly to waste management regulations while only 2.7% of the respondents do not wear gloves in handling medical waste. Most of the respondents (83.6%) agreed that the number of patients in the facility was the single main factor .......

A comprehensive review of the use of lemborexant in treating insomnia

Abstract Lemborexant (LEM), a dual orexin receptor antagonist, represents a significant advancement in treating insomnia, a prevalent sleep disorder affecting a considerable portion of the population, especially older adults in India. LEM has several benefits over conventional sedatives in the treatment of insomnia, such as the selective mechanism of action, lower risk of tolerance and dependence, better sleep architecture, reduced possibility of cognitive impairment, various dosing options, the risk of rebound insomnia, and the risk of drug–drug interactions are also decreased. This thorough examination explores the pharmacological mechanisms, pharmacokinetics, clinical effectiveness, and safety profile of LEM, providing valuable insights into its distinct mode of action compared with traditional medications targeting gamma-aminobutyric acid receptors. By blocking orexin receptors (orexin 1 receptor and orexin 2 receptor), LEM regulates neuropeptides orexin A and orexin B, crucial for controlling wakefulness and arousal. Clinical trials demonstrate its predictable pharmacokinetics, dose-dependent effects, and minimal adverse reactions, confirming its efficacy in improving sleep initiation and maintenance. Long-term studies on LEM’s sustained therapeutic benefits show no signs of rebound insomnia or withdrawal. Its favorable safety profile, including minimal impact on next-day functioning, cognitive abilities, and postural stability, sets it apart from other treatments. The exploration of potential drug interactions underscores the importance of cautious prescribing, especially concerning cytochrome P450 3A inhibitors and inducers. As LEM becomes integrated into healthcare protocols, it promises to be a well-tolerated and effective solution, reshaping standard treatment approaches for insomnia and overcoming the limitations of older medications. In summary, LEM is a valuable addition to the pharmacotherapeutic toolbox, offering a novel strategy for managing sleep disturbances with sustained efficacy and favorable safety features.

Dirofilaria immitis in Italian Cats and the Risk of Exposure by Aedes albopictus.

Background: Dirofilaria immitis, the agent of canine and feline heartworm disease (HWD), is a widespread mosquito-borne helminth. The true prevalence of HW infection in cats is likely underestimated due to the difficulty in establishing a definitive diagnosis. Aedes albopictus, a recognized competent vector for D. immitis, is currently considered the most invasive mosquito species worldwide and Italy presents the highest abundance of Ae. albopictus in Europe. Materials and Methods: The present study was aimed at evaluating the current seroprevalence of D. immitis antibodies in cats in Italy. Further, the ecological niche model (ENM) was applied to evaluate the potential future risk of feline HWD associated with the presence of Ae. albopictus. Results: Sera of 812 Italian cats were analyzed, and the average prevalence of D. immitis antibodies was 12%. Seropositivity was significantly associated with age (<6 years), whereas there was no association with sex or geographical area. Data obtained with the risk map showed that the highest risk of infection was found in northern inland areas and along coastal areas, whereas the lowest risk was identified at higher altitudes. The ENM correctly classified most of the areas where D. immitis seropositive cats were found, with 80.4% occurring in high and very high-risk areas. Conclusions: Results of the present study suggest that cats in Italy are exposed to D. immitis infection, and that routine prevention should be part of the general health care protocols in cats. Moreover, the resulting risk maps indicate that areas with a suitable habitat for Ae. albopictus may put cats at risk of exposure to D. immitis.

Addressing the unmet needs in patients with type 2 inflammatory diseases: when quality of life can make a difference.

Patients with asthma (AS), atopic dermatitis (AD), allergic rhinitis (AR), eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), chronic urticaria (CU), non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD), and certain phenotypes of chronic obstructive pulmonary disease (COPD), among others, have a common underlying pathogenesis known as Type 2 inflammation (T2i). These diseases often coexist with other T2i conditions and have a substantial impact on the quality of life (QoL) of patients. However, limited data on patients' experiences, perspectives, and current management of T2i diseases have been published thus far. This survey, promoted by the patient-driven T2i Network Project, aimed at identifying the common drivers and challenges related to the QoL of patients with T2i diseases by putting the patient's perspective at the force and including it in the design of new care strategies. An anonymous online survey was carried out through convenience sampling between May and June 2023. The survey was codesigned by members of different patient associations, healthcare professionals and healthcare quality experts, and implemented using EUSurvey and distributed through eight patient associations from Spain. The survey consisted of 29 questions related to the participant's sociodemographic features, a series of self-reported multiple choice or rating scale questions, including diagnosis, QoL measures, disease severity, healthcare resource utilization, and quality of care. The survey included 404 participants, members from eight patient associations, the majority of whom had moderate-to-severe self-reported disease severity (93%) and one or more coexisting pathologies related to T2i (59%). Patients with more than one pathology had a significantly greater impact on QoL than those with only one pathology (p < .001). Participants with self-reported severe symptoms reported significantly worse QoL than those with mild-to-moderate severity (p < .001). More than half of the patients (56%) felt constantly bothered by the unpredictability of their illness caused by potential exposure to known or unknown disease triggers. The lack of coordination between specialists and primary care was also expressed as an area of dissatisfaction by participants, with 52% indicating a complete lack of coordination and 21% indicating an average coordination. This article reports the initial findings of a patient-led initiative, which highlights the common QoL challenges faced by individuals with type 2 inflammation-related diseases and emphasizes the importance of further clinical research to improve the management of this patient group. Considering the significant impact on QoL, a multidisciplinary approach integrated into new healthcare protocols has the potential to improve patient management and QoL, shorten the time to diagnosis and reduce healthcare resource utilization.