Large Health Center Research Articles

To What Extent Can Digital Health Technologies Comply With the Principles of Responsible Innovation? Practice-and Policy-Oriented Research Insights Regarding an Organisational and Systemic Issue

Background: Digital health technologies (DHTs) have expanded exponentially since the COVID-19 crisis and have prompted questions about their impact across all levels of health systems. Because health organisations and systems play a central role in the success or failure of the transition to more equitable and sustainable societies, the concept of Responsible Innovation in Health (RIH), focused on aligning the processes and outcomes of innovation with societal values, is gaining interest in research, policy, and practice. This study aims to explore enablers and constraints to the development, procurement and/or utilisation of responsible DHTs in health organisations. Methods: Semi-structured interviews were conducted with 29 stakeholders concerned with the development, procurement, and/or utilisation of DHTs in a large Canadian academic health centre. Data were thematically analysed through a mixed deductive-inductive process using the RIH framework. Results: Our findings highlight that the consideration of RIH principles in the development, procurement, and/or utilisation of DHTs depends mainly on organisational and systemic factors and conditions, namely: (1) the presence of an organisational culture that promotes RIH in its innovation-related practices and processes; (2) availability of material and financial resources as well as expertise in certain fields (eg, environmental sustainability); (3) the evolution of health technology assessment (HTA) practices to include other dimensions beyond effectiveness, safety, and costs; (4) the scope of the regulatory and legal frameworks that govern the approval and use of DHTs; and (5) the role of the market (eg, venture capital) in the design of federal and provincial innovation policies. Conclusion: This study provides insights on practice, policy, and political issues that health organisations may face in the development, procurement, and/or utilisation of responsible DHTs. It can help scholars, practitioners, decision-makers, and industry to create the conditions for a better integration of RIH principles into health organisations and systems.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

O-107 The contribution of women's modes of conception, self-mastery, perceived stress, and cognitive appraisal to personal growth in two phases during pregnancy

Abstract Study question How do women’s modes of conception, self-mastery, perceived stress, and cognitive appraisal contribute to personal growth during two phases of pregnancy? Summary answer Women who conceive through IVF experience the highest level of personal growth; Higher challenge appraisal is associated with higher personal growth in both study phases. What is known already Pregnancy can be experienced as a complex and stressful period, especially for women who conceive through fertility treatments. However, stress also constitutes an opportunity to experience personal growth, as shown by a few studies that examined women once during pregnancy. One study focused on cognitive appraisal and found that as women appraise their pregnancy as more challenging, they experience a higher level of growth during the third trimester of pregnancy. Additionally, scarce evidence indicates that personal growth increases from the third trimester to the postpartum period. Study design, size, duration The current study consists of three groups that differ in their modes of conception: spontaneous; first-line fertility treatments, such as intrauterine insemination (IUI); and in-vitro fertilization (IVF). A prospective design was employed in two phases during pregnancy: the first or second trimester (Phase 1; n = 400) and the third trimester (Phase 2; n = 268). Participants/materials, setting, methods Israeli pregnant women (age M = 32, SD = 4.5) were recruited by gynecologists and fertility specialists via several large women's health centers in Israel. Women completed five self-report questionnaires: Posttraumatic growth, self-mastery, perceived stress, cognitive appraisal, and questions relating to background and pregnancy-related details. Main results and the role of chance The findings indicate that women who conceived spontaneously have a higher sense of self-mastery than women who conceived through IVF. Whereas no differences were found between the study groups in perceived stress, the IVF group experienced higher personal growth than the spontaneous group during early pregnancy, but not during advanced pregnancy. The hierarchical regressions conducted to examine the contribution of the study variables to personal growth revealed that they accounted for 30.6% of its variance in the early phase of pregnancy and 23.6% in the advanced phase. In the early phase, lower self-mastery, a lower appraisal of the pregnancy as a threat, and a higher appraisal of the pregnancy as a challenge were associated with higher personal growth. In the advanced phase of pregnancy, only being first-time expecting mothers and higher challenge appraisal predicted personal growth. Finally, personal growth was greater in advanced pregnancy than in the earlier stage. Limitations, reasons for caution The findings rely on self-report measures, which may be biased. Also, the study was conducted in Israel, in which women who want to have children are eligible to receive fertility treatments sponsored by the health insurance fund up to the age of 44, thus should be considered in this context. Wider implications of the findings Women may experience positive implications following challenging conceiving circumstances. This can be translated to interventions aimed at strengthening women's internal resources and positive perceptions, as well as to raising awareness among professionals in fertility units that, alongside difficulties entailed in the process, it can also constitute an opportunity for growth. Trial registration number not applicable

Evaluation of a web-based, interactive guide to enhance patient-clinician electronic communication.

e13659 Background: Secure messaging (SM) enables patients to ask clinicians questions asynchronously. Benefits include enhancing patient engagement, contributing to oral chemotherapy adherence, and lowering symptom distress. However, patients are unsure how to address concerns effectively, and clinicians find it challenging to decipher patients’ needs within messages. Coupled with clinicians not having adequate time to respond to messages, breakdowns in communication are common. We developed an interactive guide to help patients with cancer craft effective secure messages. It featured an oncologist providing strategies to write messages with specificity, expressing concerns, stating needs, being direct, and included a downloadable tip sheet. Methods: Patients 18+ with a current cancer diagnosis who were enrolled in the portal at a large health center were recruited. Between October 2023 and January 2024, participants were sent a link to interact with the guide, followed by a survey. The survey included several measures: 1) Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer); 2) Digital Behavior Change Intervention (DBCI) Engagement Scale; 3) Website User Satisfaction questionnaire (WUS); 4) Acceptability of Intervention Measure (AIM); 5) Intervention Appropriateness Measure (IAM). We used R version 4.3.2 for the descriptive analysis. The Wilcoxon rank-sum test compared groups by demographic categories. The local IRB approved this study. Results: One hundred patients participated. Median age was 64 years (range=21-86), 54% male, 83% white, 35% diagnosed with prostate cancer, 35% lung cancer, and 23% hematologic cancer. Respondents reported high levels of self-efficacy based on CASE-cancer (mean 43.3 of 48). Respondents averaged 15 minutes using the guide. 96% thought the guide’s content was presented clearly, 95% found it easy to understand, 90% enjoyed using it, 89% thought the guide was suitable, and 88% could rely on its information. Results by demographic categories found that non-white respondents (M = 43.0) were significantly more engaged than white respondents (M = 28.4), P = 0.038 , and those with a bachelor’s degree+ (M = 96.5) had higher satisfaction than those without (M = 91.6), P = 0.025. Conclusions: Patients with cancer embraced an interactive guide that provided strategies to craft secure messages. They found it engaging, satisfying, acceptable, and appropriate, with racially minoritized patients being most engaged. As SM is a widely used tool for patient-clinician communication, it is crucial to concentrate on the way messages are constructed. We found potential to improve patients’ message-writing techniques, which could result in clinicians writing more complete answers to questions. Additionally, there is the possibility to enhance underserved patients’ communication skills and make them more engaged in their care.

#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in > 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr >150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

The Strategies Used to Balance Health and Work Across the Solid Organ Transplantation Trajectory.

Introduction: Workers who undergo solid organ transplantation report frequent conflicts between the unpredictable demands of their health condition and the rigid requirements of their employer and of health services. The present study aimed to describe the self-management strategies adopted by workers while staying at work before transplantation and during sustainable return-to-work posttransplantation. Methods: Fifteen employed kidney, liver, and lung transplant recipients were recruited from 2 large urban university health centers in Montreal, Canada. Three focus groups were held, and thematic analysis was performed. Findings: Seven strategies were identified: responding promptly and consistently to fatigue-related needs, planning ahead with immediate supervisors while remaining strategic about when to disclose transplantation, requesting work accommodations, requesting flexibility in healthcare provision, consulting physicians about work-related issues, informing co-workers about work limitations and immunosuppression and asking not to be treated differently in the workplace. Conclusion: Access to work accommodations, support from physicians and flexibility in treatment and appointment schedules supported workers' ability to manage their health while staying at work before and after undergoing solid organ transplantation. In light of findings, it may be useful for healthcare professionals to address workers' concerns about work limitations and work accommodation implementation, especially when the illness-management burden increases before transplantation and during posttransplantation sick leave. Future studies could describe the strategies used by other important stakeholders when attempting to provide support to workers.

Risk factors and prevalence of human papillomavirus-related secondary oral and oropharyngeal squamous cell carcinoma in patients following allogeneic stem cell transplant for hematological malignancies

ObjectiveAllogeneic hematopoietic stem cell transplants are associated with a greater susceptibility to secondary malignancies. The present study examines the prevalence and risk factors of developing secondary oral and oropharyngeal cancer. Material and methodsThis was a chart review of 286 allogeneic stem cell transplant recipients treated at a large Health Center, with a mean follow-up time of 5 years. The eligibility included adults who underwent allogeneic hematopoietic stem cell transplants between October 2016 and June 2021. ResultsTwo hundred eighty-six charts were reviewed of them: leukemia (65%), aplastic anemia (10%), and lymphoma (9%). 57 (20%) developed secondary cancers Five cases of the secondary cancers (8.8%) were oral squamous cell carcinoma, and three were human papillomavirus-related. Graft versus host disease occurred in 77.1% and 100% of oral/oropharyngeal cancers. About 50% across the groups had a history of smoking. graft versus host disease, immunosuppression, and smoking. The risk factors for secondary oral/oropharyngeal cancer; chronic graft versus host disease, immunosuppression, and smoking were not statistically significant. ConclusionsThese findings support the recommendation for increased follow-up time and close monitoring of hematopoietic stem cell transplant recipients for secondary oral/oropharyngeal malignancies. The involvement of the human papillomavirus in these cases should be further investigated.

Risk psychosocial factors associated with postpartum depression trajectories from birth to six months.

The purpose of this study was to assess the trajectory of women's depressive symptoms during the first six months postpartum, identify risk factors (sociodemographic, obstetric and personality) associated with classes, and examine associations between classes and postpartum PTSD at two months and bonding at six months. The final sample included 212 women who gave birth in the maternity wards of a large tertiary health center that were approached at 1-3days, two months, and six months postpartum and completed a demographic questionnaire and measures of neuroticism (BFI) and postpartum depression (EPDS), postpartum PTSD (City Birth Trauma Scale) and bonding (PBQ). Obstetric data were taken from the medical files. Cluster analysis revealed three distinctive clusters: "stable-low" (64.2%), "transient-decreasing" (25.9%), and "stable-high" (9.9%). Neuroticism, general-related PTSD symptoms, and bonding were associated with differences between all trajectories. Birth-related PTSD symptoms were associated with differences between both stable-high and transient-decreasing trajectories and the stable-low trajectory. No obstetric or demographic variables were associated with differences between trajectories. We suggest that screening women for vulnerabilities such as high levels of neuroticism and offering treatment can alleviate the possible deleterious effects of high-symptom depression trajectories that may be associated with their vulnerability.

An Electronic Health Record-Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study.

In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician's schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. We evaluated an electronic health record (EHR)-based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access.

Hebrew validation of the postpartum bonding questionnaire: a study of mothers and fathers

ABSTRACT Objective The Postpartum Bonding Questionnaire (PBQ) is a self-report questionnaire designed to screen disorders of the mother–infant relationship. The PBQ was adapted to several countries, though there is no agreement on the accepted number of items and factors. This study aimed to assess the validity and reliability of the Hebrew version for both mothers and fathers. Methods Participants (602 mothers and 144 fathers) from two separate samples were randomly recruited in the maternity ward of a large tertiary health centre. The mothers’ samples were combined and redivided to form subsamples A and B. At T1 (1–4 days postpartum), the participants completed demographic questionnaire in person the PBQ and the Edinburgh Postpartum Depression Scale (EPDS) were administered online at T2 (8–12 weeks postpartum). The PBQ was also administrated at T3 (six-months). Results EFA on subsample A resulted in a two-factor structure, which was tested using CFA on subsample B. The model’s fit was very good; χ(35)2 = 83.68, p < .001, CFI = .97, TLI = .91, RMSEA = .07, SRMR = .03. Additional reliability and validity analyses showed a very good fit for mothers. Scalar measurement invariance across mothers and fathers yielded satisfactory results. CFA among fathers, revealed adequate goodness of fit; χ2/df = 87.65/46, p < .001, CFI = .95, TLI = .89, RMSEA = .08, SRMR = .05. Conclusions The Hebrew version of the PBQ demonstrated satisfactory validity for both mothers and fathers. The revised version, with 14 items, measures bonding as a continuum rather than measuring bonding disorders like the original version. These findings emphasise the importance of validating the scale in different cultural contexts.

Patients With a History of Spine Surgery Receiving Chiropractic Spinal Manipulation in US Academic Health Centers: A Cross-Sectional Cohort Study.

The number and characteristics of patients with previous spine surgery receiving chiropractic spinal manipulation (CSM) are largely unknown. This study aimed to explore the proportion of patients receiving CSM with a history of spine surgery, the characteristics of these patients, and the treatments received compared to a broader population of patients receiving CSM. We queried a 110-million-patient United States (US) network of aggregated records and claims data from patients attending integrated academic health centers (TriNetX, Inc.) on March 6, 2023, yielding data spanning 2013-2023. We identified two patient groups: (1) those receiving CSM and (2) a subset receiving CSM with prior spine surgery. We compared baseline characteristics and treatments received over a one-year follow-up after CSM. Of the 81,291 patients receiving CSM, 8,808 (10.8%) had at least one prior spine surgery. Patients with prior spine surgery receiving CSM were older, more often female, more often non-Hispanic/Latino and White, less often Black, had a greater body mass index, and had a higher prevalence of low back and neck pain compared to the broader CSM cohort (p<0.0001 for each). Those with prior spine surgery were also more likely to receive multiple medications, physiotherapy procedures, and spinal injections (p<0.0001 for each). Patients receiving CSM with a history of spine surgery comprise a substantial proportion of CSM patients in large US academic health centers. This subset of patients differs characteristically from the broader CSM population and more often receives medications, physiotherapy, and spinal injections. Further research is needed to examine the safety and efficacy of CSM in this population, given the high proportion of patients and limited research on this topic.

Symptoms and signs of lung cancer prior to diagnosis: case–control study using electronic health records from ambulatory care within a large US-based tertiary care centre

ObjectiveLung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs...

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

ObjectivesHepatitis C virus (HCV) poses a global public health threat. Prisons are a focus of prevention efforts due to high infection burdens. Expedition of treatment for incarcerated people is critical,...

Rural implementation of the perioperative surgical home: A case-control study.

Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study. The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer's exact test were performed for categorical variables and Mann-Whitney test or Student's t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models. The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital. Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.

Experiences of seeking and accessing medical care among persons with major depression: A qualitative descriptive study of persons with depression in China.

A large number of people in China are affected by depression, yet tend to delay seeking treatment. This study aims to explore persons living with depression and their journey of diagnoses and seeking professional medical help in China. Semi-structured interviews were conducted with 20 persons who visiting physicians to be diagnosed and receive professional help from a large mental health center in Guangzhou, Guangdong province, China. Individual interviews were conducted and data were analyzed using content analysis. Three themes were identified from the findings: (1) "noticed something was wrong"; (2) negotiated decisions with their own narratives and the personal suggestions of others; and (3) gave new meaning to their experiences of depression, whereby they sought medical treatment. The findings of the study indicated that the impact of progressive depressive symptoms on the participants' daily lives was a strong motivation for them to seek professional help. The obligation to care for and support their family prevented them from initially disclosing their depressive symptoms to family members, but eventually prompted them to seek professional help and persist in follow-up treatment. Some participants experienced unexpected benefits (e.g., relief at no longer feeling "alone") during their first visit to the hospital for depression or when they were diagnosed with depression. The results suggest a need to continue to actively screen for depression and provide more public education to prevent negative assumptions and reduce public and personal stigmatization of those with mental health problems.

LBSS: A Lightweight Blockchain-Based Security Scheme for IoT-Enabled Healthcare Environment.

Recently, global healthcare has made great progress with the use of Internet of Things technology. However, for there to be excellent patient care, there must be a high degree of safety for the IoT health system. There has been a massive increase in hacking systems and the theft of sensitive and highly confidential information from large health centers and hospitals. That is why establishing a highly secure and reliable healthcare system has become a top priority. In this paper, a security scheme for the IoT-enabled healthcare environment, LBSS, is proposed. This security scheme comprises three security mechanisms. The first mechanism is based on the blockchain technology and is used for transaction integrity. The second mechanism is used to store the healthcare system data in a secure manner through the distribution of its data records among multiple servers. The third mechanism is used to access the healthcare data after applying a proposed authorization test. To minimize the security overhead, the healthcare data is prioritized in regard to its importance. Therefore, each security mechanism has specific steps for each level of data importance. Finally, the NS3 package is used to construct a simulation environment for IoT-enabled healthcare systems to measure the proposed security scheme performance. The simulation results proved that the proposed healthcare security scheme outperformed the traditional models in regard to the performance metrics.

S1481 Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County + University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Methods: A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Results: Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placing monitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). Endoscopy Unit staffing remained unchanged throughout the study period. Conclusion: Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. Table 1. - Core Productivity and Efficiency Parameters of LAC+USC Endoscopy Unit Phase 1 FIRST INTERVENTION 12/1/2021: pre-anesthesia visit Phase 2 SECOND INTERVENTION 3/15/2022:First patient prepared in-room and streamlined inter-procedure processes Phase 3 Sep-2021 Oct-2021 Nov-2021 Dec-2021 Jan-2022 Feb-2022 Mar-2022 Apr-2022 May-2022 Total Procedures 539 556 450 511 467 501 504 647 612 Moderate Sedation 515 539 426 488 432 468 465 608 573 Anesthesia Supported 24 17 24 23 35 33 39 39 39 Mean Room Turnover Time (minutes - for anesthesia room) 45 (±40) 31 (±40) 30 (±24) First-Case On Time Start % (moderate sedation) 75.7% 78.3% 87.5% First-Case On Time Start % (anesthesia supported) 0% 0% 92.5% Anesthesia Room Throughput (mean # of procedures per day) 4.5 7.0 9.0

A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value &lt; 0.01), discharge disposition (P-value &lt; 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.

Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital

Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital. This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017, and July 31, 2021 (excluding January 1, 2020- May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation, and hospital ward. The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% in closed wards, 0.75% in open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorders, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use, and mood stabilizer use. HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors, or mood stabilizers.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD.

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1–4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8–10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.