Inadequate Care Research Articles

[Anaesthesia for Emergent Caesarean Section: A Population-based Study on Icelandic and Migrant Women during 2007-2018].

General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts. This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis. Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p< 0.001). Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.

Abstract LB095: ASPYRE-Lung addresses critical gaps in NGS-based biomarker testing: Robust variant calling from NGS QC fails

Abstract Advanced NSCLC treatment guidelines recommend testing patients for genomic biomarkers to utilize over 30 FDA-approved targeted therapies. A major challenge with current NGS-based testing methods is that ~45% of patient samples fail NGS quality control (QC), leading to inadequate patient care. The ASPYRE® technology addresses the urgent need for rapid, accessible and affordable diagnostics informing actionable genomic target variants. The ASPYRE-Lung® panel covers 114 variants in 11 genes (ALK, BRAF, EGFR, ERBB2, KRAS, RET, ROS1, MET &amp; NTRK1/2/3) to robustly inform clinical management, based on clinical practice guidelines. The assay concurrently detects single nucleotide variants, insertions, deletions, and gene fusions from NSCLC tissue-derived DNA and RNA. In this study, we investigated an NSCLC patient sample set from Precision for Medicine, including biobanked clinical specimens that had previously failed NGS QC, and for which genomic biomarker data were unavailable. 120 matched DNA and RNA biobanked NSCLC FFPE patient samples previously analyzed by Illumina TSO 500 were tested using ASPYRE-Lung in Biofidelity’s CLIA laboratory, including 94 samples which failed NGS QC parameters for DNA, RNA, or both, and 26 control samples which passed NGS QC. Samples were tested by ASPYRE-Lung using an input of 20 ng DNA and 6 ng RNA, except for 5 patient samples that were run at lower inputs, ranging from 4.25 to 14 ng DNA. Key findings:•Of the 94 patient samples that failed NGS QC, 98% of samples (92/94) passed ASPYRE-Lung QC and could inform patient care.•In the 92 patient samples that passed ASPYRE-Lung QC, 47% (43/92) had a detectable variant identified by ASPYRE-Lung.•All 26 control samples that passed NGS QC also passed ASPYRE-Lung QC.•Of the 5 samples with 4.25 to 14 ng DNA inputs to ASPYRE-Lung, data were generated on 4/5 samples and 2/4 had a detectable variant.•ASPYRE-Lung has the potential to provide actionable clinical information on patient samples deemed to be of insufficient quantity for NGS testing.ASPYRE-Lung has a high success rate, is easily adoptable and cost effective making it suitable as a first-line testing option, or for samples that are either QNS or fail NGS QC, and can provide a large fraction of NSCLC patients with actionable biomarker information, with potentially smaller tissue requirements. ASPYRE-Lung genomic testing is transformative for cancer care management, and allows more patients with NSCLC to benefit from effective and better tolerated therapies. Citation Format: Ryan T. Evans, Elyse Shapiro, Elizabeth Gillon-Zhang, Julia N. Brown, Candace King, Cory Kiser, Mary Beth Rossi, Darren Davis, Michelle L. Taylor, Jennifer Clower, Jian Yang, Cullen A. Taylor, Robert W. Snyder, Wendy J. Levin. ASPYRE-Lung addresses critical gaps in NGS-based biomarker testing: Robust variant calling from NGS QC fails [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB095.

Infantile tremor syndrome with global developmental delay and microcephaly in a 16-month-old male: A case report

Introduction and Importance: Infantile Tremor Syndrome (ITS) affects children aged 6 to 18 months, and is characterized by tremors, pallor, developmental regression, skin pigmentation changes, and sparse hypopigmented hair. This case report highlights an ITS presentation in a 16-month-old exclusively breastfed male, emphasizing the significance of complementary feeding. Case presentation: The patient presented with abnormal body movements, loss of developmental milestones, hyperpigmented skin changes, hypopigmented scalp hairs, pallor, and microcephaly. Born to a vegetarian mother with inadequate prenatal care, the child’s exclusive breastfeeding without complementary feeding led to severe developmental delay and moderate malnutrition. Diagnostic workup revealed vitamin B12 deficiency, anemia, and neurologic abnormalities. Clinical discussion: ITS is associated with various manifestations, including pallor, hyperpigmentation, and tremors, commonly linked to vitamin B12 deficiency. In our case, developmental delays and malnutrition underscored the importance of early recognition. Despite neurological improvement with vitamin B12 supplementation, ITS’s long-term impact on cognitive functions necessitates vigilance and appropriate nutritional interventions. Conclusion: Early recognition of ITS is vital for the prevention of long-term neurodevelopmental sequelae. Injectable vitamin B12 supplementation and nutritional interventions have demonstrated significant developmental gains. Increased awareness among mothers about nutritional intake during pregnancy and lactation is crucial, especially among vegetarians.

Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%—29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 – 13.301), lower social class (OR 4.455, 95% CI 1.236 – 16.050) and functional impairment (3.643, 95% CI 1.373 – 9.668) were found to be significant factors associated with self–neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.

Hypertension clinical pathway: Experience of Aseer region, Saudi Arabia

BACKGROUND: Hypertension (HTN) is a common chronic health problem with many complications and high morbidity rates. This study aimed to describe the HTN pathway, to assess the performance of screening and registration programs, to explore the challenges and suggest solutions for those challenges. MATERIALS AND METHODS: This study was conducted in primary care centers in the Aseer region, Saudi Arabia, at the end of 2022. The study consisted of three parts namely: Screening for HTN, registration of known hypertensive patients and opinions of representatives of Primary Healthcare Centers (PHCs) on challenges to the implementation of HTN pathway and suggestions for overcoming these challenges. Three Google forms were developed by the investigators to achieve the objectives of this study. The first two forms were completed by doctors and nurses at each PHC and reviewed by the leader of HTN pathway, and the third form completed by a representative of each PHC. SPSS version 26 was used for data management and analysis. Chi-square test was used to determine association between categorical variables; binary logistic regression analysis was performed to determine the correlates of being hypertensive and having good control of HTN. RESULTS: A total of 159,243 individuals were screened for HTN, 55% of whom were females and 94% were Saudis. The prevalence of HTN was 13%; 70% were overweight or obese and 14% had diabetes. The total registered number of patients was 55,628; 50% had good HTN control. Major challenges were inadequate health coaches, care coordinators, laboratory and radiology facilities, lack of coordination with hospitals, and ineffective appointment system. CONCLUSION: This study revealed that the current HTN pathway was successful with regard to screening and registration of patients with HTN. Many challenges need an executive plan with SMART objectives to optimize the care for HTN patients in the region.

Gay & Gray XI: Somewhere Over the Rainbow - Aging with Pride!

Having previously tackled topics such as LGBTQ military sexual trauma, revisiting aging populations and HIV, and the intersectional experience of black queer older adults, Gay & Gray this year will focus on the transitional process of aging itself. While seniors cope with life changes as they grow older, LGBTQ seniors face specific challenges that may be especially burdensome. Often, older LGBTQ adults “have to make a hard choice at the end of their lives: Go ‘back into the closet’ or accept inferior care and discrimination” (CBC). This predicament embodies “a fear of loss of autonomy, identity, and freedom of sexual expression,” and often results in compromise “in order to feel safe during a period in which they anticipate… being vulnerable and lacking in power” (Wilson, et al.).In this session, we will discuss powerful issues including the threat of isolation while aging, healthcare access, and moving to long-term housing through the lens of gender and sexual minorities. First, we will explore how older LGBTQ adults are often more isolated than their heterosexual counterparts, with higher rates of living alone, fewer sources of family and social supports, and greater stigma among their peers (SAGE “US Army Vet”, Progress Lifeline). We will also consider reasons why LGBTQ adults may be hesitant to disclose their sexual orientation and gender identity to healthcare providers, fearing inadequate care and even outright discrimination. Afterwards, we will discuss how LGBTQ adults’ transitions from independent living into assisted living and nursing homes are further complicated by concerns about experiencing physical and verbal harassment, as more and more LGBTQ individuals fear “being forced back into the closet” and “conceal… their true selves” in order to access services and avoid harassment (Wilson, et al.). Lastly, we will evaluate potential solutions to promote community and enhance access to safe housing for aging LGBTQ individuals.

A Qualitative Exploration of Acceptance of a Conversational Chatbot as a Tool for Mental Health Support among University Students in Sudan

Background: Sudan’s political and economic challenges have increased mental health issues among university students, but access to mental healthcare is limited. Digital health interventions, such as chatbots, could provide a potential solution to inadequate care. This study aimed to evaluate the level of acceptance of a mental health chatbot prototype among university students in Khartoum, Sudan. Materials and Methods: This qualitative study investigated the perspectives of university students regarding a mental health chatbot prototype designed specifically for this research and deployed on Telegram. Twenty participants aged 18+, owning smartphones, and not receiving mental health treatment tested the prototype. Data was collected through individual, face-to-face, in-depth, semi-structured interviews. The data was analysed using both deductive and inductive content analysis methods. Results: Most of the participants acknowledged the importance of mental health but felt that it was an overlooked issue in Sudan. Participants considered the chatbot to be a unique and innovative concept, offering valuable features. They viewed the chatbot as a user-friendly and accessible tool, with advantages such as convenience, anonymity, and accessibility, and potential cost and time savings. However, most participants agreed that the chatbot has many limitations and should not be seen as a substitute for seeing a doctor or therapist. Conclusion: The mental health chatbot was viewed positively by participants in the study. Chatbots can be promising tools for providing accessible and confidential mental health support for university students in countries like Sudan. Long-term studies are required to assess chatbot’s mental health benefits and risks. Keywords: mental health, chatbots, university students, Sudan, young adults

Race and Place Matter: Inequity in Prenatal Care for Reservation-Dwelling American Indian People.

Early initiation and consistent use of prenatal care is linked with improved health outcomes. American Indian birthing people have higher rates of inadequate prenatal care (IPNC), but limited research has examined IPNC among people living on American Indian reservations. The current study uses birth certificate data from the state of Montana (n = 57,006) to examine predictors of IPNC. Data on the community context is integrated to examine the role of community health in mediating the associations between reservation status and IPNC. Results suggest that reservation-dwelling birthers are more likely to have IPNC, an association partially mediated by community health. Odds of IPNC are higher for reservation-dwelling American Indian people compared to reservation-dwelling White birthers, highlighting intersecting inequalities of race and place.

Fear, gratitude, and the normalization of obstetric violence in Cuban maternity hospitals

AbstractObstetric violence is endemic in Cuba, a highly medicalized society where the obstetrics institution is unquestioned and, in the afterlives of Atlantic slavery and US occupation and intervention, emotions of fear and gratitude work to normalize obstetric violence and control birthing bodies for the state. I draw on ethnographic observations, birth stories, and experiences as a patient to examine how birthing people, providers, and the Revolutionary state negotiate care and responsibility for health. I describe three fears: the fear of failure to protect maternal‐infant health (and its repercussions for clinicians and the state); the fear of physiological childbirth; and fears of inadequate or violent care. Obstetric violence in Cuba is structural. As birthing people shift between primary and tertiary healthcare infrastructures with distinct epistemologies of care, they exert ambiguous agency to domesticate the hostile space of the hospital, building relations of reciprocity and performing docility and compliance. Finally, I look at the gratitude expected of patients and the consequences of refusing to recognize healthcare as a “gift.” This contemporary account of obstetric violence in Cuba contributes to calls by abolition feminists to study the obstetric institution in order to refuse and dismantle it, building life‐affirming futures for maternity care worldwide.

Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic.

Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic causedchanges in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers. We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit. We conducted an analytical and cross-sectional studyduring November and December 2022.We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19. A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality. During the pandemic, the stress of health workers increaseddue to work alterations that were necessary to treat the greatest number of patients, so theirquality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study.

Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.

Generative AI as Virtual Healthcare Assistant for Enhancing Patient Care Quality

This study investigates the potential of Chat Generative Pre-Trained Transformer (ChatGPT) as a virtual healthcare assistant to enhance the quality of patient care. Inadequate patient care within healthcare systems is a key issue that has resulted in lower satisfaction and medical errors. Virtual healthcare assistants, exemplified by ChatGPT, have emerged as a promising solution to mitigate these challenges. A comprehensive literature review compares the benefits and drawbacks of using virtual healthcare assistants with those of human healthcare providers to assess their effectiveness in enhancing patient care. The article discusses the ChatGPT development process, including the data sources used, training and validation, and the integration of this technology into healthcare systems. The results of testing ChatGPT in patient care, including patient feedback, are provided. The study interprets these findings and indicates that ChatGPT can significantly enhance patient care. The implications of implementing virtual healthcare assistants in the healthcare sector are also explored, along with potential future research areas for enhancing ChatGPT. This study provides important new insights into how virtual healthcare assistants might enhance patient care and offers recommendations for healthcare organizations and legislators on leveraging ChatGPT. It shows that the astonishing development in patient care, known as ChatGPT, has the potential to revolutionize the healthcare industry.

Understanding moral distress in home-care nursing: An interview study.

Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. This study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. A qualitative interview study with reflexive thematic analysis was used. We conducted semi-structured interviews with 20 home-care nurses in Germany. The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Twenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work-privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. In cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care.

KGSCS—a smart care system for elderly with geriatric chronic diseases: a knowledge graph approach

BackgroundThe increasing aging population has led to a shortage of geriatric chronic disease caregiver, resulting in inadequate care for elderly people. In this global context, many older people rely on nonprofessional family care. The credibility of existing health websites cannot meet the needs of care. Specialized health knowledge bases such as SNOMED—CT and UMLS are also difficult for nonprofessionals to use. Furthermore, professional caregiver in elderly care institutions also face difficulty caring for multiple elderly people at the same time and working handovers. As a solution, we propose a smart care system for the elderly based on a knowledge graph.MethodFirst, we worked with professional caregivers to design a structured questionnaire to collect more than 100 pieces of care-related information for the elderly. Then, in the proposed system, personal information, smart device data, medical knowledge, and nursing knowledge are collected and organized into a dynamic knowledge graph. The system offers report generation, question answering, risk identification and data updating services. To evaluate the effectiveness of the system, we use the expert evaluation method to score the user experience.ResultsThe results of the study showed that compared to existing tools (health websites, archives and expert team consultation), the system achieved a score of 8 or more for basic information, health support and Dietary information. Some secondary evaluation indicators reached 9 and 10 points. This finding suggested that the system is superior to existing tools. We also present a case study to help the reader understand the role of the system.ConclusionThe smart care system provide personalized care guidelines for nonprofessional caregivers. It also makes the job easier for institutional caregivers. In addition, the system provides great convenience for work handover.

Personalized, interdisciplinary patient pathway for cross-sector care of multimorbid patients (eliPfad trial): study protocol for a randomized controlled trial

BackgroundMultimorbid and frail elderly patients often carry a high burden of treatment. Hospitalization due to the onset of an acute illness can disrupt the fragile balance, resulting in further readmissions after hospital discharge. Current models of care in Germany do not meet the needs of this patient group. Rather lack of coordination and integration of care combined with a lack of interdisciplinary approaches result in fragmented and inadequate care and increase the burden of treatment even more.MethodseliPfad is a randomized controlled trial conducted in 6 hospitals in Germany. Multimorbid elderly patients aged 55 or older are randomly assigned to the intervention or control group. Patients in the intervention group receive the eliPfad intervention additional to standard care. The core components of eliPfad are:Early assessment of patients’ individual treatment burden and support through a specially trained case managerInvolvement of the patient’s general practitioner (GP) right from the beginning of the hospital stayPreparation of an individual, cross-sectoral treatment plan through the interdisciplinary hospital team with the involvement of the patient’s GPEstablishment of a cross-sectoral electronic patient record (e-ePA) for documentation and cross-sectoral exchangeSupport/Promote patient adherenceTailored early rehabilitation during the hospital stay, which is continued at homeClose-tele-monitoring of medically meaningful vital parameters through the use of tablets, digital devices, and personal contacts in the home environmentThe intervention period begins in the hospital and continues 6 weeks after discharge. Patients in the control group will be treated according to standard clinical care and discharged according to current discharge management. The primary aim is the prevention/reduction of readmissions in the first 6 months after discharge. In addition, the impact on health-related quality of life, the burden of treatment, survival, self-management, medication prescription, health literacy, patient-centered care, cost-effectiveness, and process evaluation will be examined. Nine hundred forty-eight patients will be randomized 1:1 to intervention and control group.DiscussionIf eliPfad leads to fewer readmissions, proves (cost-)effective, and lowers the treatment burden, it should be introduced as a new standard of care in the German healthcare system.Trial registrationThe trial was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) on 08/14/2023 under the ID DRKS00031500.

Health Promotion in Efforts to Prevent Stunting in the First 1000 Days of Life (HPK) at Puskesmas X Koto 1 Tanah Datar Regency

Stunting, a persistent global nutritional issue from inadequate care and nutritional intake, becomes evident when a child ages two. Tanah Datar recorded a 21.5% stunting rate in 2022, prompting a targeted service to enhance the literacy of pregnant women, mothers of toddlers, and cadres about the critical first 1000 days of life. Utilizing an interactive game, Emotional Demonstration, and drawing on four modules from the Global Alliance for Improved Nutrition (GAIN), the service employed printed modules and game equipment. Held on 10 June 2023 at Wali Nagari Pandai Sikek Hall, the event gathered 20 participants, including pregnant women, mothers, cadres, and X Koto Community Health Center officers. Activities commenced with a pre-test, followed by interactive game-based education, and concluded with a post-test. The community service positively contributed to increased health literacy and awareness in the first 1000 days, validated by significant T-test results (p-value = 0.001), indicating a substantial knowledge improvement post-intervention.

Emergency Care for Pediatric and Adult Patients Affected by Complex Vascular Malformations

Objectives: To characterize the experiences of patients with vascular malformations (VMs) when seeking care for acute or emergent health needs. Methods: Semistructured qualitative interviews and survey study. Setting: National recruitment through patient advocacy groups and multidisciplinary vascular anomaly clinics. Patients/Participants: Adult patients and parents of children with self-reported VM. Results: We interviewed 25 young adult patients and 34 parents. We received survey responses from 138 adult patients and 73 parents who answered all items of interest (analytic cohort = 211). Interview participants described negative experiences with emergency care related to 4 themes: (1) delayed or inadequate care, (2) lack of competent, knowledgeable clinicians, (3) lack of collegial collaboration, and (4) insufficient trust of clinicians in parent’s or patient’s knowledge. Patients and parents reported an average of 1.7 and 2.6 VM-related health problems requiring emergent management in the prior year, respectively. In multivariable logistic regression, having at least one acute or emergent problem in the prior year was associated with household income ≥$100 000 (odds ratio = 0.34, 95% confidence interval, 0.17–0.70), but not gender, race, and ethnicity, age, having a VM specialist, or primary care doctor’s knowledge of VMs. Conclusions: Many patients with VMs require emergent or acute care for complications of their VM. Patients with lower household incomes are more likely to experience these emergent events. Negative experiences often focused on nonsupportive clinician behaviors. Future studies should develop tools to empower patient self-advocacy and provide high-yield information to nonspecialist clinicians.

Fragility Fracture Network-Japan: The challenge of establishment of a national hip fracture database and successful achievement of nationwide health system change for hip fracture care in Japan

BackgroundIn April 2022, a new reimbursement scheme for hip fracture was implemented by the Japanese health ministry. Japan is one of the world's most aged societies, facing a significant, rapidly growing burden of osteoporosis and fragility fractures. The incidence of hip fractures is projected to increase from 240,000 in 2020 to 320,000 by 2040. In 2015, Fragility Fracture Network-Japan (FFN-Japan) was formally established as a nonprofit organization in order to create the optimal fragility fracture care system in Japan. MethodsFFN-Japan launched the Japan National Hip Fracture Database (JNHFD) in 2017, initially with only eight participating hospitals across Japan. The number of patients enrolled from May 2017 to the end of 2020 in the JNHFD from the 16 hospitals registered the patients during this period with amounting to 4271 patients in total. FFN-Japan invited officials from the Ministry of Health, Labor and Welfare (MHLW) to participate in round table meetings to discuss the data collected in the JNHFD and to consider opportunities for nationwide improvement in hip fracture care. ResultsThe proportion of patients who underwent surgery within 36 h of arrival at hospital was 48.1% in 2018, 58.6% in 2019, and 44.9% in 2020 indicating the delay of surgery. Regarding secondary fracture prevention, initiation of osteoporosis treatment during the in-patients was 60.2% in 2018, 54.0% in 2019, and 64.5% in 2020 indicating the inadequate post fracture care. In April 2022, the Central Social Insurance Medical Council of the Japanese MHLW announced a new reimbursement scheme for hip fracture care including two key components: Early surgery (within 48 h from injury) and Secondary fracture prevention immediately after fracture. DiscussionThe new reimbursement scheme of hip fracture care in Japan will catalyze and underpin major improvements on acute multidisciplinary care and post-fracture care with secondary fracture prevention. FFN-Japan played a key role on these policy changes to the health system by means the close collaboration and ongoing communication with the government. ConclusionWithin five years of establishment of the JNHFD, FFN-Japan in collaboration with visionary leaders from the Japanese government have successfully achieved a major reform of the Japanese health system's reimbursement of hip fracture care. This reform has laid the foundation for transformation of management of this debilitating and life-threatening injury that currently afflicts almost a quarter of a million older Japanese citizens each year.

A Complete Sojorum on Thermosensitive Hydrogels for Wound Healing: Recent Developments and Ongoing Research

Abstract: The nature of the wound typically dictates the available wound-healing therapies. On the other hand, inadequate care results in persistent wounds, fibrosis, tissue loss of function, and ultimately dismemberment. Suturing, unloading, irrigation, debridement, negative pressure therapies, growth factor supplementation, and grafting are examples of current medicines that all have limitations in terms of meeting the needs of full treatment. Natural or synthetic materials/polymers have been utilized to prepare smart thermosensitive hydrogels to facilitate quick and targeted action on wounds. These are intelligent hydrogel system that shows sol-gel transitions at physiological body temperature. Hydrogel provides a moist environment, scaffold-like structure, and localized delivery of drug/growth factor that speed up wound healing even if it eliminates side effects associated with systemic administration. In this article, we summarized the detailed mechanisms of wound healing, conventional strategies, and ongoing thorough research work in the field of thermosensitive hydrogels utilized for wound healing. Moreover, the clinical needs of this formulation, as evident from the commercially available systems are also described in the prior art.

Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale zones, Ethiopia. A cross-sectional study.

Maternal mortality occurs in developing nations as a result of inadequate health care, delayed medical attention and the inability to access medical facilities. The three-delay model was employed to determine the causes of maternal death. There was limited data on maternal delay in reaching health facilities for emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the prevalence of delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariable and multivariable analysis was done by using a binary logistic regression model to identify factors associated with delay in traveling for emergency obstetric care services. Statistical significance was declared at P-value < 0.05. In this study, the prevalence of delay in reaching health facilities during emergency obstetric care was 38.1% (95%CI: 33.3, 43). The following factors showed significant association with delay in reaching health facilities during emergency obstetric care: Average monthly income (AOR = 1.87; 95% CI: 1.12, 3.14), distance (AOR = 4.35; 95% CI: 2.65, 7.14), a referral from other health facilities (AOR = 1.77; 95% CI: 1.01, 3.11) and delay one (AOR = 2.9; 95% CI: 1.7, 4.93). This study showed that the prevalence of delay in reaching health facilities for emergency obstetric care services in the study area was high. Promoting road accessibility and transport mechanisms and strengthening referral mechanisms shall be emphasized.