Care Issues Research Articles

Integration of Machine Learning with Fog Computing for Health Care Systems Challenges and Issues: A Review

Fog computing, a distributed cloud computing model, extends the traditional cloud paradigm to the network's edge, reducing latency and alleviating congestion. It addresses challenges in classical cloud architectures exacerbated by real-time IoT applications, which produce massive amounts of data that traditional cloud computing struggles to process due to limited bandwidth and high propagation delays. Fog computing is crucial in latency-sensitive applications like health monitoring and surveillance, where it processes vast volumes of data, minimizing delays and boosting performance. This technology brings computation, storage, monitoring, and services closer to the end-user, enhancing real-time decision-making capabilities. This paper presents the challenges of IoT applications. It also demonstrates the role of two emerging technologies fog computing and machine learning in health care scenarios.

Management of potentially inappropriate medication use among older adult’s patients in primary care settings: description of an interventional prospective non-randomized study

BackgroundThe management of inappropriate medication use in older patients suffering from multimorbidity and polymedication is a major healthcare challenge. In a primary care setting, a medication review is an effective tool through which a pharmacist can collaborate with a practitioner to detect inappropriate drug use.AimThis project described the implementation of a systematic process for the management of potentially inappropriate medication use among Lebanese older adults. Its aim was to involve pharmacists in geriatric care and to suggest treatment optimization through the analysis of prescriptions using explicit and implicit criteria.MethodThis study evaluated the medications of patients over 65 years taking a minimum of five chronic medications a day in different regions of Lebanon. Descriptive statistics for all the included variables using mean and standard deviation (Mean (SD)) for continuous variables and frequency and percentage (n, (%)) for multinomial variables were then performed.ResultsA total of 850 patients (50.7% women, 28.6% frail, 75.7 (8.01) mean age (SD)) were included in this study. The mean number of drugs per prescription was 7.10 (2.45). Roughly 88% of patients (n = 748) had at least one potentially inappropriate drug prescription: 66.4% and 64.4% of the patients had at least 1 drug with an unfavorable benefit-to-risk ratio according to Beers and EU(7)-PIM respectively. Nearly 50.4% of patients took at least one medication with no indication. The pharmacists recommended discontinuing medication for 76.5% of the cases of drug related problems. 26.6% of the overall proposed interventions were implemented.DiscussionThe rate of potentially inappropriate drug prescribing (PIDP) (88%) was higher than the rates previously reported in Europe, US, and Canada. It was also higher than studies conducted in Lebanon where it varied from 22.4 to 80% depending on the explicit criteria used, the settings, and the medical conditions of the patients. We used both implicit and explicit criteria with five different lists to improve the detection of all types of inappropriate medication use since Lebanon obtains drugs from many different sources. Another potential source for variation is the lack of a standardized process for the assessment of outpatient medication use in the elderly.ConclusionThe prevalence PIDP detected in the sample was higher than the percentages reported in previous literature. Systematic review of prescriptions has the capacity to identify and resolve pharmaceutical care issues thus improving geriatric care.

Representações discursivas e relações de poder de profissionais de saúde na prática de cuidado paliativo neonatal

This work aims to investigate how healthcare workers discursively represent the practices involved in neonatal palliative care, in a Neonatal Intensive Care Unit of a public hospital in the Federal District, Brazil. This study is theoretically and methodologically based in Critical Discourse Analysis, using the discursive-ethnography approach, which allowed us to reflect on the interactions and representations of 14 interviews with healthcare workers, from different professions, considering the ideologies involved in the context of their relationships. The results reveal a dependence on high technology to maintain life, leading to reflections on the limits of postponing neonatal death, considering the child's dignity and quality of life. Representations related to problems such as social inequality suggest that professionals need knowledge and understanding about how to relate to these families and how to deal with the issue of palliative care.

Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings.

Workplace violence is a significant challenge in psychiatric hospital care. Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools. Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools. The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance. Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice. More profound change in practices towards recovery-oriented care is required also in risk assessment. INTRODUCTION: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods. To assess the attitudes of nurses and nurse managers towards violence risk assessment and management. A cross-sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting. Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk-taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools. The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement. Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes.

A Literature Review of China’s Smart Elderly Care Industry

With the aging population in China, the issue of elderly care has gradually become a topic of concern in today’s society. Traditional elderly care models can no longer meet the needs of contemporary elderly people. Therefore, smart elderly care, as a new type of elderly care model formed by the development of information technology, can provide efficient, convenient, and personalized services for the elderly, with broad market prospects and development space. Therefore, the smart elderly care industry is also receiving increasing attention from researchers, and the number of related papers is also increasing year by year. This article uses China National Knowledge Infrastructure (CNKI) as the database source and conducts a search under the theme of “smart elderly care industry” in the search box. A visual analysis is conducted on 525 articles found from 2013 to 2024. It is found that research on the smart elderly care industry in China began in 2013, and the annual circulation of related papers has been on the rise since 2019. This paper reviews the literature on three research directions including problems and strategies of the smart elderly care industry, the elderly care industry under Internet plus and artificial intelligence, and related policies of the smart elderly care industry. Through analysis, it finds that some researchers are committed to studying some problems of the smart elderly care industry, and put forward some suggestions, such as establishing a unified smart elderly care service standard and finding an appropriate industrial integration path based on the needs of the elderly. Some researchers believe that the Internet and artificial intelligence will bring opportunities to the elderly care industry, help to accurately position the market, and meet the needs of the elderly. Some policy researchers have also found that the Chinese government is increasingly valuing the smart elderly care industry. Hence, by summarizing and evaluating the current situation, development, and related policies of the smart elderly care industry, this study hopes to provide some ideas and directions for researchers in the research of the smart elderly care industry.

Reporting and managing ethical issues in intensive care using the critical incident reporting system

Reporting and managing ethical issues in intensive care using the critical incident reporting system

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.

Distress financing associated with out-of-pocket expenditure for non-communicable diseases in India

ABSTRACT Objective The objective of this study is to assess the coping mechanisms used by the households who incur out-of-pocket expenditure (OOPE) due to Non-communicable Diseases (NCDs). Also, it seeks to examine the underlying factors responsible for various coping strategy. Data and Methods Data from the 75th round of the National Sample Survey Office (NSSO) has been used for the study. Descriptive statistics, concentration index (CI), and multinomial logistic regression have been employed to do the analysis. Results Households having cancer patients have a higher rate (46.80%) of distress financing, followed by cardiovascular diseases (27.43%), chronic respiratory diseases (26.91%), and diabetes (24.77%). The result of multinomial logistic regression shows that households belonging to the other caste categories, availing healthcare at private health centre, lower economic status, lack of insurance coverage, and households with casual labour are more likely to depend upon distress financing for NCDs hospitalisation. Conclusion The issue of financing inpatient care for NCDs, specifically cancer and cardiovascular diseases, is a significant concern in India. Therefore, an increase in public expenditure and investment in public health facilities is essential to increase health seeking behaviour of people by reducing OOPE, particularly among the poor and marginalised groups.

Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility.

The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information-AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples-Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a "garbage in, garbage out" phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.

Unveiling the patient-centered approach: exploring the needs of Javanese stroke patients in home health services

Home-based care can be effective, efficient, safe, and affordable, if this care is performed using a patient-centered approach. Patient-centered care prioritizes the patient’s needs and preferences. The issue of patient-centered care remains the focus of various parties. This study aimed to explore the expectations of patients who have experienced a stroke, their family caregivers as recipients of home-based care services and healthcare workers as home-based care providers. This study used a qualitative explorative model. Semi-structured interviews were conducted with 19 participants, in addition to 4 focus group discussions. Data was analyzed using a content analysis approach with open code 13 software and the results were presented in COREQ systematics for qualitative studies. There were four main themes present in the results: physical well-being, self-actualization, psychological condition and balance between family burden and coping. Physical limitations were highlighted as the most burden some for the majority of the participants. At the time of the study, the majority of the patients, their family and health workers were diligently working towards to achieving the best outcome regarding physical well-being. Physical well-being is a fundamental need. Reaching this goal, could lead to better self-actualization, better physiological condition and improving the burden on families. This study may be useful as preliminary data to compile a home-based care construct indicators for stroke patients.

Health issues in primary care during hot weather periods

Health issues in primary care during hot weather periods

Adhésion à la kinésithérapie respiratoire chez les adultes atteints de mucoviscidose

Chest-physiotherapy is a key element in treatment of cystic fibrosis and patient adherence is a major issue in global cystic fibrosis care. This study aims to assess adherence to chest physiotherapy in adults with cystic fibrosis who not treated with tritherapy and to analyze the impact of certain factors on adherence. Thus is a cross-sectional study, conducted using a questionnaire and a physiotherapy evaluation. Adherence to this treatment was measured in terms of quantitative and qualitative aspects. The impact on adherence of 15factors was then assessed. Only 47% of patients could be considered as adherent, with a significant disparity between a quantitative and qualitative assessment. Gender, working time, pathology severity, the fact of being regularly followed by a physiotherapist, the perceived benefit of the sessions and their replacement by physical activity, seem associated with adherence to this treatment. Taking into account the qualitative aspect of the sessions, our study reveals a low rate, in our cohort, of adherence to respiratory physiotherapy, and highlights six factors likely to predominate. Regular follow-up by a physiotherapist seems to be a determining factor in adherence to this treatment.

Advancing suicide prevention in Germany, Austria and Switzerland: a qualitative study.

Suicide is a significant public health problem, impacting individuals, families and communities worldwide. Effective suicide prevention requires a comprehensive approach with diverse integrated interventions and collaboration across sectors, stakeholders and professions. This study aims to identify challenges, gaps and success factors in current suicide prevention efforts in Germany, Austria and Switzerland, providing specific recommendations for advancement. We conducted online, semi-structured interviews with 36 suicide prevention experts from Germany, Austria and Switzerland, incorporating perspectives from policy, science and practice. Interviews were conducted between September 2022 and February 2023, audio-recorded, transcribed verbatim and analyzed using the Framework method. Despite progress in national strategies and coordinated efforts for suicide prevention, challenges such as resource scarcity, stigma and structural issues in psychiatric and psychotherapeutic care persist. The interviewees identified several areas for advancement, including developing targeted prevention measures for men and older people, strengthening collaboration across sectors, stakeholders and professions, and increasing the involvement of individuals with lived experience. While the COVID-19 pandemic has exacerbated challenges in psychiatric and psychotherapeutic care, it has concurrently strengthened interest in suicide prevention among policymakers and the media. National suicide prevention strategies play a crucial role in setting priorities, raising public awareness, and guiding action. However, since most suicide prevention efforts are still predominantly health sector-driven, a more comprehensive approach is needed to promote the involvement of all relevant actors and address suicidality as a collective societal responsibility. Tailoring prevention programs for risk groups like older people and men is important, as these populations show high suicide rates and face a lack of targeted interventions. Our study underscores the importance to continuously monitor, refine and strengthen collaborative and evidence-based suicide prevention efforts.

Delivering Integrated Community Care for the Elderly: A Qualitative Case Study in Southern China.

The rapid aging and increasing care demands among the elderly population present challenges to China's health and social care system. The concept of aging in place has prompted the implementation of integrated community care (ICC) in the country. This study aims to provide empirical insights into the practices of integrated care policies and approaches at the community level. Data for this study were collected through six months of participatory observations at a local community health service center in a southern Chinese city. Semi-structured interviews were conducted with the multidisciplinary community care team to gather frontline formal caregiver perceptions of ICC, thereby facilitating a better understanding of the obstacles and opportunities. Qualitative analysis revealed four themes: the ICC delivery model and development strategies within the community care scheme, the person-centered guiding principle, and the challenges and struggles encountered by formal caregivers within China's current ICC system. The case study presented herein serves as a notable example of the pivotal role of primary care in the successful implementation of elderly care within a community setting. The adoption of a private organization-led approach to medico-social integration care in the community holds significant potential as a service delivery model for effectively addressing a wide range of elderly care issues.

F.6 Opportunities for improvement: understanding drivers of emergency department visits within 90 days of posterior spinal decompression surgery

Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.

Palliative care for chronic heart failure: non-pharmacological methods of relieving the main symptoms

Chronic heart failure is one of the main causes of the increase in mortality and disability of the population around the world. In the final stages of chronic heart failure, when the debilitating symptoms of patients no longer respond to treatment, the issue of palliative care arises. To date, current clinical recommendations and guidelines do not contain data on palliative measures for this category of patients – in such conditions, doctors often do not understand what tactics of patient management they need to choose. Therefore, the importance of integrating palliative care into the treatment of chronic heart failure is increasing. Many symptoms associated with the terminal stages of chronic heart failure have a negative impact on the general condition and quality of life of patients. The main ones are shortness of breath, pain, manifestations of asthenia, as well as anxiety-depressive disorders. In order to maximize the possible improvement in the quality of life of such patients, palliative care should be comprehensive: regular pharmacotherapy prescribed in accordance with current clinical recommendations, combined with various non-drug methods for relieving the main symptoms. As such methods, the main cardiac rehabilitation measures can be considered, including regular physical training, training in compliance with the treatment regimen, stress management techniques, and psychological support. The relationship of patients and caregivers with medical professionals is important in the organization of palliative care. Adequate and timely communication is necessary to improve self-control and compliance with medication, prevent unplanned hospitalization, inform decision-making and, ultimately, ensure a safe death. The article discusses the basic concepts of organizing and providing palliative care to patients with chronic heart failure, as well as non-pharmacological palliative measures proposed by European, American, and Russian specialists.

Relaxant Effects of Curcuma aeruginosa Rhizome Extracts on Isolated Rat Gastric Fundus and Ileum Contraction

Curcuma aeruginosa (CA) rhizomes are used in traditional medicine as gastrointestinal remedies, postpartum care and uterine issues. However, its effects on gastrointestinal motility have not yet been explored. Extracts of CA rhizomes prepared using chloroform, methanol and water were evaluated for their effects on gastrointestinal contractions using isolated rat gastric fundus and ileum. Varied solvents aim for extraction of different compounds of CA rhizome. In the ileum, the 3 extracts did not significantly affect spontaneous contractions, but significantly reduced contractions induced by acetylcholine (ACh, 0.3 µM) and KCl (40 mM) in a concentration-dependent manner. The order of potency, based on ACh-induced contraction, was chloroform > methanol > water extracts, with respective IC50 values of 0.025 ± 0.001, 0.46 ± 0.02 and 2.57 ± 0.47 mg/mL. Similar potency order against KCl-induced contraction was observed, with IC50 values of 0.011 ± 0.002, 0.47 ± 0.06 and 1.18 ± 0.18 mg/mL, respectively. In the isolated gastric fundus model, both methanol and water extracts resulted in an increase in the force of contraction in the absence of stimulation. However, when ACh (0.3 µM) was introduced, the methanol and water extracts exhibited a concentration-dependent reduction in contractions, with IC50 values of 0.62 ± 0.06 and 2.30 ± 0.32 mg/mL, respectively. As for KCl (40 mM)-induced contraction, only the highest concentration of the water extract (3.75 mg/mL) significantly decreased the contraction by 41.29 ± 2.94 %. CA extract demonstrated relaxant effects on both isolated rat gastric fundus and ileal contractions induced by ACh and KCl. These findings support the use of CA in traditional medicine as a gastrointestinal remedy. These extracts have the potential to be used as antispasmodics and to treat infectious and non-infectious diarrhea, the latter of which occurs in functional gastrointestinal diseases. It might also be useful as a gastroprokinetic. HIGHLIGHTS C. aeruginosa extracts had no impact on rat ileum’s spontaneous contraction Extracts caused dose-dependent relaxation of precontracted ileum Extracts enhanced spontaneous contraction of isolated gastric fundus Extracts induced relaxation in the precontracted isolated gastric fundus GRAPHICAL ABSTRACT

Addressing Challenges and Promoting Development: Strategies for Health and Wellness Industry in Ethnic Regions

China has entered an aging society. In order to respond to the aging society, government departments have successively introduced various pension policies since 2013 with an attempt to mitigate the impact of the aging society. Under this context, the health and wellness industry came into being. However, the documents of the central department for the health and wellness industry are still lacking, the health care issues in ethnic region have received less attention, and there is no specific legal source for local governments and enterprises to follow. The purpose of this paper is to clarify the development of the health and wellness industry in ethnic region through literature analysis, to study the feasible path of the development of the health and wellness industry in ethnic region, and to provide suggestions. This study finds 40 representative papers on rural revitalization and health and wellness industry in the past three years through literature retrieval. We summarize the questions raised in the papers, analyzes and evaluates them, and finally proposes a conclusion. Findings show that the development of health and wellness industry in ethnic region lacks national level policies, and the details of local implementation are relatively weak. Moreover, in terms of the development path of the health and wellness industry in ethnic region, the integration model of health care, sports, culture and tourism seems to be a feasible direction. In addition, the development of health and wellness industry in ethnic region has a positive impact on rural revitalization. In other words, the development of health and wellness industry in ethnic region may have a high coupling effect with regional economy. Finally, this study provides some useful suggestions for government departments and subsequent research.

Poor Maternal Sleep Health Adversely Affects Neonatal and Pregnancy Outcomes: An Important Ignored Health Issue in Prenatal Care

Poor Maternal Sleep Health Adversely Affects Neonatal and Pregnancy Outcomes: An Important Ignored Health Issue in Prenatal Care

Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area.

Proper coding of heart failure (HF) in electronic health records (EHRs) is an important prerequisite for adequate care and research towards this vulnerable patient population. We set out to evaluate the accuracy of registration of HF diagnoses in primary care EHRs. In a routine primary care database covering the Amsterdam Metropolitan Area, we identified all episodes of care with International Classification of Primary Care (ICPC) codes K77 (decompensatio cordis) or K84.03 (cardiomyopathy) up to 31/12/2021. We also performed two text-based searches toidentify HF episodes without an appropriate ICPC-code. Anexpert panel evaluated all ICPC and text matches for congruence between the assigned codes and notes. From a database of 968,433 records we identified 19,106 patients (2.0 %) with a total of 24,011 ICPC-coded HF episodes. Removal of 1,324 episodes found to concern other or uncertain diagnoses and inclusion of 4,582 validated HF episodes identified through text search led to exclusion of 909 (overregistration: 4.8 %) and inclusion of 2,266 additional patients (underregistration: 11.1 %). The inclusion of miscoded HF episodes advanced the first known date of HFdiagnosis in 3.9 % of records, with a median shift of 3.45 years. Episode-level underregistration decreased significantly over time, from 23.8 % in 2006 to 10.0 % in 2021. While there is improvement over time, there are still substantial levels of over- and underregistration ofHF, emphasizing the need for cautious interpretation ofICPC-coded data. The findings contribute to the understanding of HF registration issues in primary care and provide insights for improving registration practices.