Local Health Care Centers Research Articles

Impact of COVID on management of urological cases in a tertiary care non-COVID institute: A patient-centered study

Background: Health-care systems across the globe have been overwhelmed by coronavirus disease-19 (COVID 19). It has affected non-COVID patient management as well. While service, hospital-oriented data on effect of the pandemic on urological diseases have been published, there is scarce data on patient-centered issues in urology, particularly from India. Hence, we planned this study to determine the impact of COVID on management of urological cases.Materials and Methods: This is a prospective observational single-center study conducted at Indira Gandhi Institute of Medical Sciences, Patna, from April 2020 to November 2020. Consecutive non-COVID adult patients presenting to the indoor, outdoor, and telemedicine services of the urology department of our institute were included. Patients who were moribund, having altered sensorium, severe cardiorespiratory illness, unable to understand and respond, and those unwilling to participate were excluded from the study. A questionnaire-based data were collected. The same interviewer explained the questionnaire to patients in their own language (English/Hindi/Bhojpuri) either in person or telephonically and recorded the findings.Results: Two hundred consecutive patients were screened. One hundred and fifty were included in the study. Mean age of patients was 50 ± 3.2 years. One hundred and five patients were male. Thirty-eight patients had comorbid conditions. One hundred and thirty-seven patients reported delay to consult an urologist since development of the first urological symptom. The average delay was 68 ± 20 days. Thirty-two patients suffered COVID-19 disease during the urological illness. One hundred and twelve were advised for urology consultation after the first evaluation at a local health-care center. The reasons cited for delay by these patients (n = 112) were lock-down and reduced/unavailable public transport (n = 20) and fear of contacting corona infection (n = 10), both (n = 56), suffered COVID-19 (n = 18), and others (n = 8). The distance of patients' residence from the hospital was median 50 km, with interquartile range of 5–254 km. One hundred and three patients received definitive treatment and 47 were still undergoing delays due to various reasons. Sixty-two patients were advised surgery. 25 of these 62 were found to have complications due to delay.Conclusion: Delay in all aspects of management of urological illness, including consultation, work up, and definitive treatment was observed. Of all who were advised surgery, about 40% were found to have complications due to delay in surgery.

A case analysis of a mass treatment approach to control GI and water-related conditions in Sudan

BackgroundThe efficiency of mass chlorination in controlling diarrheal diseases during acute emergencies has been extensively reported in literature. However, long-term crises received unparallel attention. Researchers have previously carried out a trial that investigated the impact of using chemical means to treat water reservoirs of Um-Baddah Nevachah, a refugee camp located in the western outskirts of Khartoum, Sudan.A double-blind community experimental trial was carried out by randomly adding either chlorine or a placebo to the major water tanks in the area. Data were collected using a mixed-methods study design. The primary input was the quantitative data derived from total coliforms lab tests and records of the local primary healthcare center, while the embedded (nested) portion generated most of the qualitative data from direct face-to-face interviews.As a case analysis, this study aims to critically appraise the original trial. In the Background the authors discussed the context of the trial, approach used, and outcomes. Discussion section included three issues related to the trial: scientific importance, challenges and strategies.DiscussionImportance: There are two factors that contribute to the importance of this study: First, the integrated and systematic approach followed to resolve associated challenges. The study swiftly moved from investigating potential water contamination, to test whether it is related to an endogenous focus that auto-taints drinking water, and finally it explored the impact of tanks chlorination on public health. Second, the longstanding humanitarian context which remains largely underreported in literature. Challenges: funding limitations were among the first obstacles faced. During the fieldwork preparation phase, a lot of work was required to resolve logistical and security challenges. Keeping volunteers motivated was the biggest concern during the last phase of data collection. Strategies: The “Matrix Solutions Strategy” was developed and used to optimize scarce resources to simultaneously target multiple problems through a single intervention.ConclusionKey lessons learned from the whole experience were: persistence is paramount for the success of studies in precarious situations; lateral thinking generates alternative solutions that are novel, feasibility and practical in resources-limited settings; and finally respecting local culture and regulations is essential for building trust with both authorities and vulnerable societies.

Clinical Characteristics of Japanese Patients Who Visited a COVID-19 Aftercare Clinic for Post-Acute Sequelae of COVID-19/Long COVID.

IntroductionThe long-term clinical course, prognosis, and optimal management of symptoms and conditions after the acute phase of coronavirus disease 2019 (COVID-19) remain to be elucidated. The purpose of this study was to clarify the characteristics of patients referred to a COVID-19 aftercare (CAC) clinic established at a tertiary academic hospital in Japan.MethodsThis study was a descriptive case series study. All patients who visited the CAC clinic between February 15 and September 17 in 2021 were included. Patients’ background, chief complaints, and clinical courses after the onset of COVID-19 were described.ResultsA total of 87 Japanese patients (median age, 40.0 years; interquartile range [IQR], 26.5-53.0 years; 52.9% women) were referred to the CAC clinic. The median interval between the onset of COVID-19 and the visit to the clinic was 79.0 (IQR, 52.5-112.0) days. Referral sources were hospitals (36 patients), clinics (47 patients), a local healthcare center (3 patients), and other (1 patient). The most common chief complaint was general fatigue (50.4%) followed by dysosmia (28.7%), dysgeusia (26.4%), hair loss (18.4%), headache (17.2%), dyspnea (16.1%), and dyssomnia (13.1%). Respiratory symptoms were common in the early stages of the disease but were less common as the chief complaints when visiting the clinic. On the other hand, neurological, psychiatric, and extremity symptoms were predominant one month after the onset of COVID-19.ConclusionsRegardless of the severity in the acute phase, patients visiting our CAC clinic suffered from a variety of symptoms. General physicians skilled in using a comprehensive approach would be optimal to see patients with such complex symptoms.

Intra-diploic epidermoid cyst: An iceberg lesion

Introduction: Intraosseous epithelial inclusion cysts of the skull, presenting as lytic defects, constitute a very small percentage of the primary intracranial tumours. The case is presented by virtue of not only the rarity of the variant but also to highlight the importance of timely intervention by a neurosurgeon after adequate investigation and in a tertiary care setting. Case Report: A 45 year old female patient presented to the local Primary Healthcare Centre(PHC) with a small scalp swelling in the occipital region. . Intraoperative identification of intracranial extension was made by the surgeon as inferior margin of the swelling couldn’t be reached and also by palpation of the huge bone defect following which the procedure was abandoned midway and patient was referred to our centre for further management. Imaging: Contrast Enhanced Computerised Tomograhy(CECT) revealed a well defined, mixed density lesion with hypodense and an isodense component in right occipital region. Lesion was measuring 4.2(Cranio caudal) x 3.3(Antero posterior) x 3.6( transverse) cm. A sharp marginated bone defect was noted involving both the outer and inner tables of the occipital bone. Operative management: Lesion was approached through a right occipital craniotomy wherein the margins of bone defect were nibbled away to gain a wide access to the lesion. Pearly white, flaky contents of the lesion along with capsule were identified and excised completely. Discussuion: Intradiploic epidermoid cysts are very rare, accounting for <3% of all intracranial epidermoid cysts.(5) These cysts grow very slowly and usually present as painless bony swelling under the scalp. Conclusion: Cranial epidermoid is a fairly common entity and intradiploic variant of the same isnot uncommonly seen in neurosurgical practise. These lesions may present as a small scalp lesion which should not be judged based on its apparent size as these lesions are not infrequently known to have a bigger intracranial extension

Factors associated with patients bypassing primary healthcare centres in Qassim Region, KSA

ObjectiveThis study investigates the reasons for bypassing local primary healthcare centres (PHCs) by patients with minor illnesses in Qassim Region, KSA. MethodsA cross-sectional study was performed on 266 patients that visited emergency departments in public hospitals in Qassim Region. The patients were randomly selected and categorised as level five patients (LFPs) using the Canadian Triage and Acuity Scale (CTAS) for patient characterisation. ResultsOf the 266 patients, 85.7% had previous experience of visiting PHC facilities. The majority of these patients were not satisfied with their treatment in PHCs. Approximately 52.9% of the patients reported that the working hours at PHCs were not sufficient, 38.1% mentioned a lack of experienced staff, and 31.7% believed that PHCs were insufficient for diagnostic tests. Another 13.8% of the patients reported the unavailability of prescribed medicines. Interestingly, 17.7% of the patients reported that they never bypassed PHCs. In general, the data demonstrate that patients’ gender, employment, and marital status have no significant role in their decision to skip PHCs in favor of emergency departments of public hospitals (p > 0.05). ConclusionsPatients bypassing PHCs without a referral form is a serious concern that have a deleterious effect on the healthcare system, particularly emergency departments. If bypassing continues, it will increase the burden on emergency departments, particularly on healthcare services for the general population.

Socio-cultural factors for breastfeeding cessation and their relationship with child diarrhoea in the rural high-altitude Peruvian Andes \u2013 a qualitative study

BackgroundIn some areas of the world, breast milk is seen as a potential source of child diarrhoea. While this belief has been explored in African and Southeast Asian countries, it remains vastly understudied in Latin American contexts. We investigate socio-cultural factors contributing to breastfeeding cessation in rural high-altitude populations of the Peruvian Andes. The role of socio- cultural factors in the local explanatory model of child diarrhoea, and whether these perceptions were integrated in the local healthcare system were assessed.MethodsWithin the framework of a randomised controlled trial, we conducted semi-structured interviews with 40 mothers and 15 health personnel from local healthcare centres involved in the trial.ResultsCultural beliefs on breastfeeding cessation included the perception that breast milk turned into “blood” after six months and that breastfeeding caused child diarrhoea. We identified eight local types of child diarrhoea, and women linked six of them with breastfeeding practices. “Infection” was the only diarrhoea mothers linked to hygiene and the germ disease concept and perceived as treatable through drug therapy. Women believed that other types of diarrhoea could not be treated within the formal healthcare sector. Interviews with health personnel revealed no protocol for, or consensus about, the integration of the local explanatory model of child diarrhoea in local healthcare and service provision.ConclusionsThe local explanatory model in rural Andean Peru connected breastfeeding with child diarrhoeas. Cultural beliefs regarding diarrhoea management may increase home treatments, even in cases of severe diarrhoeal episodes. Future national breastfeeding support programmes should promote peer-counselling approaches to reduce negative attitudes towards breastfeeding and health practitioners. Local explanatory models should be incorporated into provincial and regional strategies for child diarrhoea management to promote equity in health and improve provider-patient relationships.

The inappropriate use of proton pump inhibitors and its associated factors among community-dwelling older adults

ObjectivesLittle is known about the inappropriate use of proton pump inhibitors (PPIs) and how mild cognitive impairment (MCI) and high comorbid burden relate to the inappropriate prescribing of PPIs. Therefore, the current study aimed to examine these associations among community-dwelling older adults in Jordan. MethodThis cross-sectional study was conducted on 215 community-dwelling older adults from three local healthcare centers located in Irbid, Jordan. Data about PPI use, including the name of medication, dose, frequency, duration, and indication, were collected retrospectively from a review of the participating older adults’ medication cards for November and December 2019. The collected data were evaluated based on the Food and Drug Administration (FDA) guidelines. MCI was measured using the Arabic version of the Montreal Cognitive Assessment, and comorbid burden was measured using the Cumulative Illness Rating Scale for Geriatrics. ResultsForty-seven percent of the participants were found to have taken a PPI, with 68 % having taken one for a longer period than recommended by the FDA. Older adults with MCI or high comorbid burden were found to be more susceptible than other older adults to the long-term use of PPIs. The logistic regression revealed that MCI is a statistically significant predictor of inappropriate PPI use (p < 0.001). ConclusionInappropriate PPI use is common among community-dwelling older adults in Jordan, with a significantly higher prevalence of inappropriate PPI use in people with MCI than in people with normal cognitive abilities. Future intervention studies are highly recommended to encourage optimal prescribing of PPIs for community-dwelling older adults.

The Impact of Financial Incentives on Behavior and Self-Management of Uncontrolled Type 2 Diabetes: Pre- and Post-Quasiexperimental Study.

Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population. This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018. The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels (p = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure (p = 0.04, < 0.001, 0.019 respectively). Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.

Effects of mobile messenger counseling on case management success for individuals engaging in self-harm or suicide attempts who were discharged from emergency departments

ObjectivePostdischarge case management for self-harm or suicide attempters often fails; therefore, this study aimed to investigate the effects of mobile messenger counseling (MMC) on the postdischarge case management results among this patient group.MethodsA retrospective analysis was done with data collected from March 2015 to February 2020 that included self-harm or suicide attempters who had visited a Korean emergency department and were discharged. If patients consented, postdischarge case management and MMC were conducted from March 2017. The primary outcome was the rate of successful case management, which reflects the patients either connecting to a local psychiatric healthcare center or undergoing a follow-up at a neuropsychiatric outpatient department at least once following discharge. Using univariate and multivariate logistic regression analyses, we evaluated MMC’s effects on these patients’ postdischarge case management.ResultsOf 913 patients, 604 participated in this study. In terms of successful case management, the MMC group showed a significantly higher rate than the non-MMC one (28.3% vs. 16.1%, P=0.001). A multivariate analysis demonstrated that access to postdischarge MMC (odds ratio, 2.149; 95% confidence interval, 1.357–3.403; P=0.001) and giving consent for case management while in the emergency department were significantly associated with successful case management (odds ratio, 8.917; 95% confidence interval, 5.610–14.173; P<0.001).ConclusionThe use of MMC for self-harm or suicide attempters is associated with higher case management success rates by increasing their chances of connecting to a psychiatric healthcare center or a neuropsychiatric outpatient department.

Point-of-Care Digital Cytology With Artificial Intelligence for Cervical Cancer Screening in a Resource-Limited Setting

Cervical cancer is highly preventable but remains a common and deadly cancer in areas without screening programs. The creation of a diagnostic system to digitize Papanicolaou test samples and analyze them using a cloud-based deep learning system (DLS) may provide needed cervical cancer screening to resource-limited areas. To determine whether artificial intelligence-supported digital microscopy diagnostics can be implemented in a resource-limited setting and used for analysis of Papanicolaou tests. In this diagnostic study, cervical smears from 740 HIV-positive women aged between 18 and 64 years were collected between September 1, 2018, and September 30, 2019. The smears were digitized with a portable slide scanner, uploaded to a cloud server using mobile networks, and used to train and validate a DLS for the detection of atypical cervical cells. This single-center study was conducted at a local health care center in rural Kenya. Detection of squamous cell atypia in the digital samples by analysis with the DLS. The accuracy of the DLS in the detection of low- and high-grade squamous intraepithelial lesions in Papanicolaou test whole-slide images. Papanicolaou test results from 740 HIV-positive women (mean [SD] age, 41.8 [10.3] years) were collected. The DLS was trained using 350 whole-slide images and validated on 361 whole-slide images (average size, 100 387 × 47 560 pixels). For detection of cervical cellular atypia, sensitivities were 95.7% (95% CI, 85.5%-99.5%) and 100% (95% CI, 82.4%-100%), and specificities were 84.7% (95% CI, 80.2%-88.5%) and 78.4% (95% CI, 73.6%-82.4%), compared with the pathologist assessment of digital and physical slides, respectively. Areas under the receiver operating characteristic curve were 0.94 and 0.96, respectively. Negative predictive values were high (99%-100%), and accuracy was high, particularly for the detection of high-grade lesions. Interrater agreement was substantial compared with the pathologist assessment of digital slides (κ = 0.72) and fair compared with the assessment of glass slides (κ = 0.36). No samples that were classified as high grade by manual sample analysis had false-negative assessments by the DLS. In this study, digital microscopy with artificial intelligence was implemented at a rural clinic and used to detect atypical cervical smears with a high sensitivity compared with visual sample analysis.

H\u0101 Ora: secondary care barriers and enablers to early diagnosis of lung cancer for M\u0101ori communities

BackgroundLung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities.MethodsThis project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed.ResultsBarriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau.ConclusionsThe study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations.

Reception of Dietary and Other Health-Related Lifestyle Advice to Address Non-communicable Diseases in a Primary Care Context: A Mixed-Method Study in Central Argentina.

An effective way to address risk factors for non-communicable chronic diseases (NCD) and reduce healthcare costs is by using sound health-related advice (HRA) to promote healthy lifestyle habits. In Argentina, however, few studies have examined the context in which HRA is communicated and undertaken by patients at the primary care level. In this study, we assessed the reception of HRA using a mixed-method approach in a central area of Argentina. A total of 1,044 participants from the community were contacted and sociodemographic characteristics, health-related lifestyle factors, and medical history were collected. A calendar with health messages was provided to participants and its usage was assessed after 1 year. Additionally, semi-structured interviews were conducted with 34 patients attending a local primary healthcare center. The results show that HRA was given more frequently to individuals with higher mean age, lower educational level, and to females. Participants with a chronic health condition are at a higher chance of receiving advice to reduce salt intake and maintain a healthy weight. Dietary advice is offered along with other lifestyle recommendations. The use of alcohol and tobacco is usually addressed together. HRA was primarily received in the context of an NCD diagnosis and advice was directed, especially, to risky behaviors. The HRA to increase the intake of fruits and vegetables was mentioned less frequently. Patients at the healthcare center greatly appreciated receiving an HRA, especially when given in a tailored, written, and detailed form, and acknowledged its importance to prevent or control a chronic health condition as part of the medical treatment but showed concern regarding the ability to fully incorporate the advice. Lifestyle recommendations are highly appreciated by patients but are still underutilized since they are offered mostly in the context of illness. The health calendar was shown to be useful to complement health intervention programs at the community level. The findings of our study underscore the acknowledged value of HRA by participants to tackle the risk factors of chronic diseases. If properly used HRA constitutes a simple and highly valued tool to help address patient's needs to prevent and control NCD in Argentina.

The Impact of Stria Gravidarum On Quality-of-Life Issues

Background: Striae gravidarum is a commonly occurred physiological change among women with pregnancy. Although these changes are accepted as physiological, the lack of therapeutica and preventive techniques led to impaired quality of life of women. Objective: To assess the quality-of-life affection as regards emotions, symptoms and functioning by presence of stria gravidarum in pregnant females. Patients and Methods: This cross sectional study was carried on three hundred twenty-three pregnant female patients with stria gravidarum over the age of eighteen years. They were enrolled in the study from the Obstetrics & Gynecology Department, Faculty of Medicine Menoufia University, Shebin El Kom University Hospital and Local Health Care Centers. This study was conducted between April 2020 and October 2020. Results: Severe striae gravidarum, score (3-8) was observed in 20.6% of primiparae cases and 54.9 % of multiparae cases. Mild stria gravidarum, score (1-2) was observed in 79.4 % of primiparae cases and 45.1 % of multiparae cases. There was significant difference in Dermatology life quality index (DLQI) mean value between different davey’s score scale as (p < 0.001), mild cases with SG had mean value 15.24 ± 1.42 and severe cases. There is significant difference regarding DLQI of pregnant women who did or did not take preventive steps (p < 0.001). There is significant difference regarding association between Parity and DLQI (p=0.01). Conclusion: Women suffer from striae should be examined in detail to prevent the development or progression of striae, particularly in women encountered for the first time or primiparae with severe striae those might be intensely affected.

The Impact of Stria Gravidarum On Quality-of-Life Issues

Background: Striae gravidarum is a commonly occurred physiological change among women with pregnancy. Although these changes are accepted as physiological, the lack of therapeutica and preventive techniques led to impaired quality of life of women. Objective: To assess the quality-of-life affection as regards emotions, symptoms and functioning by presence of stria gravidarum in pregnant females. Patients and Methods: This cross sectional study was carried on three hundred twenty-three pregnant female patients with stria gravidarum over the age of eighteen years. They were enrolled in the study from the Obstetrics & Gynecology Department, Faculty of Medicine Menoufia University, Shebin El Kom University Hospital and Local Health Care Centers. This study was conducted between April 2020 and October 2020. Results: Severe striae gravidarum, score (3-8) was observed in 20.6% of primiparae cases and 54.9 % of multiparae cases. Mild stria gravidarum, score (1-2) was observed in 79.4 % of primiparae cases and 45.1 % of multiparae cases. There was significant difference in Dermatology life quality index (DLQI) mean value between different davey’s score scale as (p < 0.001), mild cases with SG had mean value 15.24 ± 1.42 and severe cases. There is significant difference regarding DLQI of pregnant women who did or did not take preventive steps (p < 0.001). There is significant difference regarding association between Parity and DLQI (p=0.01). Conclusion: Women suffer from striae should be examined in detail to prevent the development or progression of striae, particularly in women encountered for the first time or primiparae with severe striae those might be intensely affected.

Older Adult Refugees’ Roles in Creating Partnerships for Culturally Responsive Healthcare

The aim of this presentation is to reveal the importance of engaging older refugee community members in creating partnerships with local healthcare providers to implement culturally responsive interventions. Such engagement invites older refugees’ participation and encourages continued connection to country of origin beliefs and culture, particularly within the sphere of healthcare and medical family therapy. Cambodian and Laotian refugee families in coastal Alabama were interviewed via qualitative community-based participatory research and ethnographic, in-depth interviews focused on familial and communal processes. Local healthcare providers engaged in focus group discussions regarding cultural processes associated with health beliefs and behaviors and in periodic outreach through culturally responsive health fairs. We found that older adults play important roles in refugee populations as community leaders, problem-solvers, and legacy-carriers upholding traditional values and cultural continuity. They also maintain and promote continuity by employing traditional, complementary, or alternative medicine (TCAM). Recursive processes also emerged as older individuals sought care from younger community members in times of sickness, including having younger generations provide language translation and transportation to local healthcare centers and hospitals and in navigating the United States healthcare system. In addition, community members joined with local healthcare providers to aide in health and healthcare literacy among refugees and to educate local physicians on culturally responsive interventions. Implications include the inclusion of older adults in health decisions and the promotion and maintenance of community partnerships with health agencies that both encourage TCAM utilization and also allow for access to ongoing, appropriate treatment within the US healthcare system.

Hā Ora: Barriers and enablers to early diagnosis of lung cancer in primary healthcare for Māori communities.

The objective of this research was to document the barriers to early presentation and diagnosis of lung cancer within primary healthcare, identified by Māori whānau (families) and primary healthcare providers in the Midland region of Aotearoa New Zealand. This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Each community hui included cancer patients, whānau, and other community members. Each healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Barriers and enablers to early diagnosis of lung cancer were categorised into three key themes: GP relationship and position in the community, health literacy and pathways to diagnosis. This study demonstrates that culturally responsive, patient-centred healthcare, and positive GP-patient relationships are significant factors for Māori patients and whānau serving as barriers and enablers to early diagnosis of lung cancer.

Community-dwelling older adults\u2019 awareness of the inappropriate use of proton pump inhibitors

BackgroundProton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux, peptic ulcers, and esophagitis. However, the long-term use of PPIs by older adults is associated with adverse health outcomes. There is limited evidence about older adults’ awareness of long-term PPI use and its associated adverse effects. This study aimed to assess older adults’ awareness of the adverse effects of the long-term use of PPIs, and their willingness to stop PPI use given of the risks and benefits of PPI use.Methodsthis cross-sectional study was conducted on a convenience sample of 120 older adults from three local healthcare centers located in Irbid, Jordan. Older adults’ awareness of PPI use was measured using the Patients’ Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation Survey.Resultsthe majority of the participating older adults were not familiar with any reports linking long-term PPI use with adverse effects, reported no concerns related to the chronic use of PPIs, and reported that they had not discussed the benefits and risks of PPI use with their primary care providers (PCPs). Although the majority of the participants had not previously attempted to stop using PPIs, the majority expressed a willingness to stop PPIs due to their adverse effects, especially if advised to do so by a PCP. The factors associated with the long-term use of PPIs included age, indications for gastrointestinal reflux disease (GERD), improvement of GERD symptoms, and the willingness to reduce or stop PPIs. Being advised by a PCP to stop PPIs (p = 0.049) and having increased concerns about the adverse effects of long-term PPI use (p < 0.0001) were the only two statistically significant predictors of previous attempts to stop PPIs.Conclusionsconcerns regarding the adverse effects of long-term PPI use were associated with attempts to stop PPIs, especially in cases where this was recommended by a PCP. Discussions between PCPs and patients regarding the risks and benefits of PPIs are necessary in order to ensure that patients do not make inappropriate decisions regarding ongoing PPI therapy. Careful evaluation of the long-term use of PPIs among older adults is required.

Sustainable Innovations in Small Enterprises for the Transformation of the Primary Healthcare Sector

Small enterprises face multiple and complex challenges when developing digital technologies. The aim of this article is to explore the role of sustainable innovation in small enterprises in relation to the ongoing transformation of the primary healthcare sector. The purpose is to gain understanding of innovation processes within the framework of sustainable development, applied to a local primary healthcare center. Data were collected through seven semi-structured interviews. A qualitative thematic analysis was conducted. Five themes appeared in relation to the ongoing transformation of the primary healthcare sector: (1) The process of sustainable innovation in a long-term perspective; (2) the companies’ views on innovations in healthcare; (3) effects of innovations in healthcare; (4) sustainable product or service development, and (5) the role of collaboration in the innovation process. The companies expressed a positive attitude to new innovations, as a natural part of developing the companies. The article concludes that incremental development of tools in small businesses supports the transformation of processes and services in the primary healthcare sector. Cross-disciplinary teams in collaboration facilitates the necessary learning and the required creation and sharing of knowledge.

Coarctation of the aorta: a rare cause of severe hypertension in pregnancy

A 24-week pregnant 18-year-old woman was seen at her local health-care centre where she was found to have a respiratory rate of 38 breaths per min, a blood pressure of 250/90 mm Hg, and a heart rate of 39 beats per min. She collapsed and required intubation and ventilation. A chest x-ray showed bilateral infiltrates—pulmonary oedema—and she was treated with furosemide and nitroglycerin and transferred to our intensive care unit.

ERx – A technological advance to speed-up TB diagnostics

Abstract In 2016 an interdisciplinary collaborative research team started an ambitious project to assist the diagnosis of tuberculosis (TB) in areas with over-burdened and poor healthcare infrastructure in the outskirts of Lima, capital of Peru. Currently we have implemented an integrated system which connects nurses, physicians and scientists, in a network of cooperation to identify and report suspicious cases of pulmonary TB. Our Electronic Mobile system (called ‘eRx’) is a Computer Automated Diagnosis (CAD) tool that can be used by local TB nurses allowing them to send X-rays along with additional prospect patient information, directly to be remotely evaluated by a physician. The physician accesses a web-based system using a computer or a tablet which allows him/her to evaluate the data coming from the distinct healthcare centers. The physician may also be assisted by a Beta version of an automatic diagnostic software which uses Deep Learning to identify the presence of lung abnormalities as well as the possible manifestations for TB. The goal of our research is to increase the speed at which a diagnosis can be made by providing a CAD tool to health care providers to improve quality and efficiency of TB diagnosis. To support future developments of the automatic diagnostic software, we rely on another web-based platform which contains over 10,000 X-rays images which are being annotated by a specialist who provides the regions where the TB manifestations can be found, which will be used later to train a Region-Based Convolution Neural Network. The software for the eRx system covers the obtaining of high-quality data, artificial intelligence support and mobile technologies directly in hands of the healthcare professionals, each software has already been validated individually, and will be evaluated together during a pilot study working directly with local healthcare centers, physicians and nurses. Our study has approval from the the IRB Boards at the University of Massachusetts Lowell IRB, and the School of Medicine at the Peruvian University Cayetano Heredia.