Improving Health Care Management Research Articles

Development and validation of a Type 1 and Type 2 diabetes-specific patient-reported experience measure e-questionnaire: Diabetes reported experience measures (DREMS)

IntroductionSuccessful diabetes management is associated with an effective partnership between People with Diabetes (PwD) and healthcare professionals. Though possible to measure using Patient-Reported Experience Measures (PREMs), none are specific to Type 1 or Type 2 Diabetes (T1D/T2D) and validated in French. Thus, we developed and validated the DREMS (Diabetes Reported Experience MeasureS) e-questionnaire. MethodologyDREMS is comprised of 18 items evaluating 5 different factors. Validation for use by PwT1D and PwT2D (recruited online) was performed using: Exploratory Factor Analysis (EFA); Confirmatory Factor Analysis (CFA) and Cronbach's Alpha. Test-retest reliability was evaluated through Intraclass Correlation Coefficients (ICC) in a subsample. ResultsDREMS was tested by 2,513 respondents, including 942 PwT1D and 1,571 PwT2D. For both groups, EFA results indicated 18 items loaded substantially onto 5 clear factors. CFA showed all coefficients were significant in their respective factors. Goodness-of-fit, assessed using the Comparative Fit Index was >0.90 and by the RMSEA was <0.080. Cronbach's α for the entire DREMS e-questionnaire was ≥0.90. ICC was 0.87 for PwT1D (n = 136) and 0.74 for PwT2D (n = 169). InnovationDREMS is the first validated French-language diabetes-specific PREM for both PwT1D and PwT2D and can be useful to evaluate and improve health care management and patient health.

Characterization and Profiling of Gut Bacterial Microbiome and Pathobionts among HIV-negative and HIV-infected Individuals in Cameroon

Background: Knowledge of the core gut microbiome among Cameroonians is a preliminary step for a better implementation of treatment strategies to correct dysbiosis and improve health care management. HIV infection has continued to cause high mortality among those infected, but the types and frequency of human gut microbiota associated with or without HIV/AIDS presence have not been identified in the adult populations in Cameroon.&#x0D; Methods: This was a case-control and comparative study design that ran from June 2018 to September 2019. Stool Samples were purposively collected from 40 participants (15 HIV-negative and 25 HIV-positive) for the 16S rRNA gene sequencing on the next-generation Illumina® MiSeq™ sequencer. Blood samples were collected for HIV determine testing, CD4 Tcell count, and HIV viral load. Sequences were clustered into operational taxonomic units (OTUs) at ninety-nine percent identity and their representatives were accustomed to using a phylogenetic approach.&#x0D; Results: The study showed a phylogenetic taxonomy of the gut microbiome communities in two kingdoms (Archea and Bacteria) and eight Phylum [Firmicutes (44.7%), Bacteroidetes (43.7%), Proteobacteria (8.7%), Actinobacteria (1%), Fusobacteria (0.2%), Euryarchaeota (0.01%), Synergistetes (0.01%), Verrucomicrobia (0.01%) and unclassified phylum (1.7%)]. A total of 347 gut microbiota species were identified, including 55 unique species/oligotypes, and 28 pathobionts from the study population. HIV infection was characterized by significant gut microbiota compositional changes with HIV-positive less diverse (56 strains absent) with significantly increased OTUs of the butyrate-producing microbiome species as compared to HIV-negative individuals (p=0.001).&#x0D; Conclusions: A profile of 347 gut microbiome bacterial species was identified in the Cameroonian community. Particularly, from the 347 gut microbiome bacterial species profiled, eight phyla were identified, with 55 unique species/oligotypes containing more than one sequence and 28 pathobionts. A host of unknown/unclassified gut microbiome bacterial species were also noted circulating among the study population.

Digital Twins for Managing Health Care Systems: Rapid Literature Review.

BackgroundAlthough most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk.ObjectiveThis paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology.MethodsWe performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized.ResultsThe DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient.ConclusionsThe use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences.

The effect on dental care utilization from transitioning pediatric Medicaid beneficiaries to managed care.

Compared to the fee‐for‐service (FFS) model, the managed care delivery system has the potential to improve health care management, increase provider accountability, and support better monitoring of health care quality. However, managed care organizations may attempt to control costs by curbing utilization among Medicaid beneficiaries or reducing reimbursement for Medicaid services. It is an empirical question whether managed care increases or decreases utilization of services. Using detailed pediatric public insurance dental claims data from 2016 through 2018, we examined whether the transition from FFS to managed care affects rates of dental care utilization. Between 2016 and 2018, Indiana, Missouri and Nebraska transitioned pediatric Medicaid beneficiaries from public dental fee‐for‐service programs to private managed care entities. Using an extended two‐way fixed‐effects estimation framework, we found that dental managed care leads to a decline in dental care utilization, especially when compared to states that maintain FFS provision of Medicaid dental services.

Assessing Patient Perceptions and Experiences of Paracetamol in France: Infodemiology Study Using Social Media Data Mining.

BackgroundIndividuals frequently turning to social media to discuss medical conditions and medication, sharing their experiences and information and asking questions among themselves. These online discussions can provide valuable insights into individual perceptions of medical treatment, and increasingly, studies are focusing on the potential use of this information to improve health care management.ObjectiveThe objective of this infodemiology study was to identify social media posts mentioning paracetamol-containing products to develop a better understanding of patients’ opinions and perceptions of the drug.MethodsPosts between January 2003 and March 2019 containing at least one mention of paracetamol were extracted from 18 French forums in May 2019 with the use of the Detec’t (Kap Code) web crawler. Posts were then analyzed using the automated Detec’t tool, which uses machine learning and text mining methods to inspect social media posts and extract relevant content. Posts were classified into groups: Paracetamol Only, Paracetamol and Opioids, Paracetamol and Others, and the Aggregate group.ResultsOverall, 44,283 posts were analyzed from 20,883 different users. Post volume over the study period showed a peak in activity between 2009 and 2012, as well as a spike in 2017 in the Aggregate group. The number of posts tended to be higher during winter each year. Posts were made predominantly by women (14,897/20,883, 71.34%), with 12.00% (2507/20,883) made by men and 16.67% (3479/20,883) by individuals of unknown gender. The mean age of web users was 39 (SD 19) years. In the Aggregate group, pain was the most common medical concept discussed (22,257/37,863, 58.78%), and paracetamol risk was the most common discussion topic, addressed in 20.36% (8902/43,725) of posts. Doliprane was the most common medication mentioned (14,058/44,283, 31.74%) within the Aggregate group, and tramadol was the most commonly mentioned drug in combination with paracetamol in the Aggregate group (1038/19,587, 5.30%). The most common unapproved indication mentioned within the Paracetamol Only group was fatigue (190/616, with 16.32% positive for an unapproved indication), with reference to dependence made by 1.61% (136/8470) of the web users, accounting for 1.33% (171/12,843) of the posts in the Paracetamol Only group. Dependence mentions in the Paracetamol and Opioids group were provided by 6.94% (248/3576) of web users, accounting for 5.44% (342/6281) of total posts. Reference to overdose was made by 245 web users across 291 posts within the Paracetamol Only group. The most common potential adverse event detected was nausea (306/12843, 2.38%) within the Paracetamol Only group.ConclusionsThe use of social media mining with the Detec’t tool provided valuable information on the perceptions and understanding of the web users, highlighting areas where providing more information for the general public on paracetamol, as well as other medications, may be of benefit.

Custom Pediatric Oncology Next-Generation Sequencing Panel Identifies Somatic Mosaicism in Archival Tissue and Enhances Targeted Clinical Care

BackgroundDisorders in the PIK3CA-related overgrowth spectrum because of somatic mosaicism are associated with segmental overgrowth of the body in conjunction with vascular, skeletal, and brain malformations such as hemimegalencephaly. A pathogenic variant may only be detectable in affected tissue and not in peripheral blood or saliva samples; therefore archival tissue may be the only relevant available specimen for testing. Although this is a common approach for cancer testing, it is not typically used for constitutional genetic disorders. MethodsPIK3CA mosaicism was assessed with a custom pediatric oncology next-generation sequencing panel (OncoKids) designed to capture somatic mutations in pediatric malignancies. The panel covers a wide range of targets including PIK3CA and AKT1 hotspots. We used OncoKids on archival formalin-fixed, paraffin-embedded or frozen samples from seven patients with facial hemihypertrophy and lipomas, hemimegalencephaly, or hemihypertrophy with a lymphovascular malformation. The age of the archival tissue examined by next-generation sequencing ranged from two to 13 years (median 5 years). Every patient had clinical manifestations within the PIK3CA-related overgrowth spectrum and had a sample of an affected tissue available for testing from a prior surgical intervention. ResultsPIK3CA mosaicism was detected in all seven patients and the mutant allele fraction was lower in the lymphovascular malformation tissues (8% to 11%) than in brain (20% to 32%) and lipomatous (16% to 23%) tissues. ConclusionsOur study highlights the clinical utility of using a robust, oncology-focused next-generation sequencing assay to identify PIK3CA mosaicism in noncancer cases. It is feasible to use archival samples that are more than a decade old to obtain a molecular diagnosis, which can then be used to improve health care management.

Prevalence, treatment, control of type 2 diabetes and the risk factors among elderly people in Shenzhen: results from the urban Chinese population

BackgroundType 2 diabetes is regarded as one of the major public health problems worldwide. We aim to investigate the prevalence, treatment, and control rate in the Chinese urban population aged 65 years or older and also identified associated risk factors.MethodsOne hundred twenty-four thousand seven participants aged 65 years old and older were recruited from January 2018 through December 2018 at local community health service centers in Shenzhen. Fasting plasma glucose, as well as other biochemical indicators, were measured by standard methods. The analysis of multivariate logistic regression was applied to assess associated risk factors of type 2 diabetes.ResultsApproximately 22.5% of elderly urban Chinese residents had diabetes. Among people with diabetes, 54.8% received medical treatment. Only 34.4% of those who were treated had their glycemic controlled. The prevalence of T2D increased with increasing age before 80 years old, male, inadequate active physical activity, drinking, previous history of CVD, higher BMI, central obesity, and hypertension.ConclusionsOur findings suggested that attention should be paid to the prevention and control of T2D in Chinese urban elderly population. The health policy department should develop effective strategies aimed at improving health care management of T2D in elderly adults.

Improving Health Care Management in Hospitals Through a Productivity Dashboard.

Health information systems have been developed to help hospital managers steer daily operations, including key performance indicators (KPIs) for monitoring on a time-aggregated basis. Yet, current literature lacks in proposals of productivity dashboards to assist hospitals stakeholders. This research focuses on two related problems: (1) hospital organizations need access to productivity information to improve access to services; and (2) managers need productivity information to optimize resource allocation. This research consists in the development of dashboards to monitor information obtained from a hospital organization to support decision makers. To develop and evaluate the productivity dashboard, the Design Science Research (DSR) methodology was adopted. The dashboard was evaluated by stakeholders of a large Portuguese hospital who contributed to iteratively improving its design toward a useful decision support tool. Additionally, it was ascertained that monitoring productivity needs more study and that the dashboards on these themes are valuable assets at a monitoring level and subsequent decision-making process.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review

Abstract Background Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. However, they face multiple difficulties in accessing primary health care and receive less preventive health care than the general population. Methods We performed a literature review that included articles which described and evaluated primary care programs for homeless people. We searched into the MEDLINE, PsycINFO, COCHRANE library, and Cairn.info databases primary articles published between 1 January 2012 and 15 December 2016. We also performed a grey literature search, and we added relative articles as we read the references of the selected articles. We described the main characteristics of the primary care programs presented in the selected articles. Then we classified these characteristics in main categories, as a descriptive thematic analysis. Secondarily, we synthetized the main results about the evaluation of each intervention or organization. Results Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Key messages To improve the health care management of homeless people it seems necessary to priorize multidisciplinary approach, integrated care, involve community health and answer their specific needs. It is necessary to evaluate more non-tailored primary care programs that collaborate with tailored structures.

Using Mental Health Indicators to Improve Health Care Management: A Web-based Approach.

Mental health indicators are essential for monitoring people's mental health status, developing mental health policies, and evaluating the performance of such policies. The aim of this paper is to describe the development of a web-based tool for mental health indicators capable to support the management of Brazilian mental health care networks. The SISAM is a web information system responsible for management and provision of mental health information in Brazil and it was chosen as the use case of this study. The indicators were developed as a decision support web tool for public health managers. The tool is able to calculate 11 indicators related to inpatient care. A descriptive analysis of all indicators is presented using SISAM data from 2017. The results generated by the tool are promising and could provide improvements on care monitoring, evaluation of possible trends and investments in prevention and promotion in mental health care.

A Comprehensive Overview of Polypharmacy in Elderly Patients in Saudi Arabia.

Background/Objectives: Saudi Arabia has a great percentage of geriatric patients associated with multiple chronic diseases who require close attention and monitoring for their medications. The purpose of this study is to develop a full-framed picture about the utilization of medications for geriatric patients and how to provide better health-care management. Methodology: A retrospective cross-sectional study targeting patients 65 years of age and older, who are taking multiple chronic medications for different indications. Descriptive analysis and frequency of the main variables were used as appropriate. Only qualified and professional candidates were chosen for data entry to present the quality and accuracy of data. Results: A total of 3009 patient profiles were analyzed, with the patients’ average age in years being 73.26 ± 6.6 (SD). It was found that 55% of the patients have polypharmacy. An average of 6.4 medications were prescribed for patients aged between 65 and 70 years compared with a significant difference for patients aged 71 years and above, while a linear correlation between age and comorbidity diseases associated with all elderly patients. Hypertension, hyperlipidemia, and diabetes mellitus are the most common comorbidity diseases for elderly patients aged 65 years and older. Conclusion: Polypharmacy in geriatrics is defined as a patient aged 65 years and older receiving five or more appropriate medications. It is the responsibility of health-care professionals to reduce the number of medications in elderly patients. Awareness of geriatric medications and diagnosed diseases will improve managing adverse drug reaction and other risk factors. Awareness of geriatric medications should elaborate on how to avoid adverse drug reaction and other risk factors. It is the responsibility of physicians and pharmacists to reduce the number of medications in elderly patients. We also prove that the number of medications will not necessarily increase with age. The main impact of this study is to follow the main recommendations to improve health care management in geriatrics.

The use of Fionet technology for external quality control of malaria rapid diagnostic tests and monitoring health workers' performance in rural military health facilities in Tanzania.

IntroductionInternal and external quality control (QC) of rapid diagnostic tests (RDTs) is important to increase reliability of RDTs currently used to diagnose malaria. However, cross-checking of used RDTs as part of quality assurance can rarely be done by off-site personnel because there is no guarantee of retaining visible test lines after manufacturers’ recommended reading time. Therefore, this study examined the potential of using Fionet™ technology for remote RDT quality monitoring at seven clinics, identifying reasons for making RDT processing and interpretation errors, and taking corrective actions for improvement of diagnosis and consequently improved management of febrile patientsMethodsThe study was conducted at seven military health facilities in Mainland Tanzania and utilized RDTs capable of detecting Plasmodium falciparum specific Histidine-rich protein 2 (Pf-HRP2) and the genus specific Plasmodium lactate dehydrogenase (pLDH) for other species of plasmodium (P. vivax, P. malariae or P. ovale; pan-pLDH). Patients’ data and images of processed RDTs from seven clinics were uploaded on a Fionet web portal and reviewed regularly to monitor preparation procedures and visual interpretation of test results compared to automated analysis using the Deki reader of RDT. Problems detected were rapidly communicated to remote laboratory personnel at the clinic for corrective action and follow-up of patients who were falsely diagnosed as negative and missed treatment. Factors contributing to making errors in visual interpretation of RDT results were analyzed during visits to the health facilities.ResultsA total of 1,367 (1.6%) out of 83,294 RDT test images uploaded to the Fionet portal had discordant test results of which 822 (60.1%) and 545 (39.9%) were falsely reported as negative and positive, respectively. False negative and false positive test results were common for a single test line in 515 (62.7%) and 741 (54.2%) tests, respectively. Out of 1,367 RDT images assessed, 98 (7.2%) had quality problems related to preparation procedures of which 95(96.9%) errors were due to putting too much blood on the sample well or insufficient buffer in the respective wells. The reasons for discrepant results included, false reporting of none existent lines in 526 (38.5%) tests, missing a faint positive line in 493 (36.1%), missing a strong positive line in 248(18.1%) and errors caused by poorly processed RDTs in 96 (7.2%) tests. Among the false negative tests (n = 822), 669 (48.9%) patients were eligible for follow–up and only 339 (48.5%) were reached and 291 (85.8%) received appropriate anti-malaria therapy.ConclusionFionet technology enabled remote monitoring of RDT quality issues, identifying reasons contributing to laboratory personnel making errors and provided a rapid method to implement corrective actions at remote sites to improve malaria diagnosis and consequently improved health care management of febrile patients infected with malaria.

Assessing changes in social determinants of health inequalities in South Africa : a decomposition analysis

BackgroundDespite various policy interventions that have targeted reductions in socio-economic inequalities in health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus, examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid.MethodsData come from information collected on social determinants of health (SDH) and on health status in the 2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of change in a concentration index methods were employed to unravel changes in socio-economic health inequalities and their key social drivers over the studied time period.ResultsThe results show that inequalities in ill-health are consistently explained by socio-economic inequalities relating to employment status and provincial differences, which narrowed considerably over the studied periods. Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial groups, educational attainment and provincial differences.ConclusionThe extent of employment, location and education inequalities suggests the need for improved health care management and further delivery of education and job opportunities; greater effort in this regard is likely to be more beneficial in some way.

Improving Health Care Management Through Persistent Homology of Time-Varying Variability of Emergency Department Patient Flow.

Excessive admissions at the emergency department (ED) is a phenomenon very closely linked to the propagation of viruses. It is a cause of overcrowding for EDs and a public health problem. The aim of this work is to give EDs' leaders more time for decision making during this period. Based on the admissions time series associated with specific clinical diagnoses, we will first perform a detrended fluctuation analysis to obtain the corresponding variability time series. Next, we will embed this time series on a manifold to obtain a point cloud representation and use topological data analysis through persistent homology technic to propose two early real-time indicators. One is the early indicator of abnormal arrivals at the ED whereas the second gives the information on the time index of the maximum number of arrivals. The performance of the detectors is parameter dependent and it can evolve each year. That is why we also propose to solve a biobjective optimization problem to track the variations of this parameter.

PHP196 - DEVELOPMENT STRATEGIES PROMOTING PHARMACEUTICAL INDUSTRY TO IMPROVE HEALTHCARE MANAGEMENT

Nowadays, considerable restrictions of resources, exposure to environmental risks, increased competitive interactions, more diversified consumer needs, and other challenges which pharmaceutical industries are confronted to, compels the companies operating in this era to accompany the strategic approach to provide sustainable services and goods. Governmental support without sufficient attention to reinforcing factors will lead to dependence of the industry on non-strategic support programs, which finally result in patient vulnerability. The purpose of this study was to better understand the enablers of Iranian pharmaceutical industry to promote health care management. At first, by conducting a focused group discussion, consisting of experts from regulatory, academia, industry, and trade companies, relevant barriers and solutions were elicited. Then, the results were analyzed using thematic analysis qualitative method and summarized in an integrated model. According to the identified challenges, the most repetitive themes focused on were ‘increasing the transparency of laws and information’, ‘stability as well as integrity of macro policies’, ‘simplifying the regulations’, ‘focusing on patient needs through the supply chain’, ‘observing intellectual property rights’, ‘strengthening knowledge structure’, ‘establishing long-term financial policies’, ‘facilitating merging and acquisition’, and ‘developing export infrastructures’, respectively. Hence, in order to promote sustainability in service provision and competitiveness, it is imperative for policy makers to promote pharmaceutical industry in five following dimensions: reconfiguration of structures and infrastructures, rectifying operational environment, patient-centered approaches in decision making, providing investment incentives, and encouraging continuous innovation. Promoting the pharmaceutical industry operations with utilizing strategic approaches such as transparency of laws and regulations, patient oriented directions, and controlled financial as well as investment supports may lead to improved health care management.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review.

Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

Quality of Life and Its Association with Physical Activity among Different Types of Cancer Survivors.

PurposeThe main goal of this study was to compare the quality of life (QOL) and its association with physical activity (PA) among patients diagnosed with different types of cancer. Based on the results, we tentatively present suggestions for the cancer health care model.MethodA cross-sectional study was conducted with 2915 cancer survivors recruited from multi-community cancer rehabilitation centers, all of which were affiliated with the Shanghai Cancer Rehabilitation Club. We collected data including socio-demographic characteristics and information about PA. All the subjects included were asked to complete the European Organization for Research and Treatment Quality of Life Questionnaires (EORTC QLQ-C30) and Functional Assessment of Cancer Therapy—General Questionnaire (FACT-G). Multiple linear regression models were employed to control the potential confounding factors.ResultsLung cancer survivors reported the worst dyspnea. Colorectal cancer survivors claimed the highest level of constipation and diarrhea. Liver cancer survivors indicated greatest loss of appetite and financial difficulties. Generally, survivors with PA tended to reported better QOL, although these associations among liver cancer survivors were not statistically significant. Moreover, survivors of all cancer types who performed PA did not report significant lower level of constipation or diarrhea. The relationship between PA frequency and QOL among cancer survivors remained unexplored.ConclusionsBoth QOL and its association with PA vary among survivors of different cancer types. The detailed results can assist clinicians and public health practitioners with improving health care management.

Healthcare System Based on Semantic Web and XML Technologies

The purpose and the goal of the paper is using a semantic web and XML (the Extensible Markup Language) technologies for managing medical information during a diagnostic process is studied. Following a steady international move towards optimization of health care delivery, the latest development in information technology has drawn the health care industry decision makers’ attention. The introduction of proper information technology innovations within the health care processes should provide the necessary optimization. In this manner can be proposed an approach to manage medical data during the whole diagnostic process using the semantic Web and XML technologies. The purpose of the Semantic Web is to bring structure to the content of Web pages allowing software agents to carry out intelligent tasks for the user. This opens a new set of opportunities that can be utilized to improve health care management on a personal and health care provider level.The aim of this paper in progress is to identify the needs and match them to the services possible with the Semantic Web. In this paper, presented an ontology-based framework that successfully combines both Semantic Web and XML technologies to enable the integrated access to biological data sources. The main goal is the seamless integration and application of these technologies in such a way that their deficiencies are over come and their utility maximized.Keywords: Health Care, Semantic Web, Ontology, XML.

Health Care System Based on Semantic Web and XML Technologies

The purpose and the goal of the paper is using a semantic web and XML (the Extensible Markup Language) technologies for managing medical information during a diagnostic process is studied. Following a steady international move towards optimization of health care delivery, the latest development in information technology has drawn the health care industry decision makers’ attention. The introduction of proper information technology innovations within the health care processes should provide the necessary optimization. In this manner can be proposed an approach to manage medical data during the whole diagnostic process using the semantic Web and XML technologies. The purpose of the Semantic Web is to bring structure to the content of Web pages allowing software agents to carry out intelligent tasks for the user. This opens a new set of opportunities that can be utilized to improve health care management on a personal and health care provider level. The aim of this paper in progress is to identify the needs and match them to the services possible with the Semantic Web. In this paper, presented an ontology-based framework that successfully combines both Semantic Web and XML technologies to enable the integrated access to biological data sources. The main goal is the seamless integration and application of these technologies in such a way that their deficiencies are over come and their utility maximized. Keywords : Health Care, Semantic Web, Ontology, XML

Development of an Ecological Model to Improve Health Care Management for Children in Child Care Centers.

PURPOSE: This study was conducted to identify current health care management and barriers in health care management according to ecological systems, and to develop an ecological model for enhancing health care in child care centers.METHODS: Focus group interviews were conducted with directors and teachers of child care centers, and with parents of children enrolled in child care. Data were analyzed by the latent content analysis method.RESULTS: Twelve categories of health care management were identified. Barriers to child health care included knowledge deficit and lack of competence in health care by teachers, lack of useful health care manuals, non-existence of professional child health care personnel in child care centers, lack of mutual information sharing and disagreement on child health conditions between child care personnel and parents, lack of specific health related child care inspection criteria and time flexible child care centers with a lack of policy on collaboration with health care facilities. The ecological model developed included specific strategies to improve health care management in child care.CONCLUSION: The proposed ecological model to improve child health care management should be useful to plan future health care program considering both the immediate and indirect social environment surrounding children in child care.