Areas Of Medical Care Research Articles

Rationalizing the Pediatric Emergency Department Workload: an Epidemiological Profile of Presentations Before and During the COVID-19 Pandemic

Background: Infectious respiratory disease in children provides a significant seasonal workload burden to paediatric emergency departments. Studies from the Southern hemisphere during the first wave of COVID-19 had shown a decrease in seasonal paediatric respiratory infections. During the COVID-19 pandemic, predicted drops in infectious disease circulating in children led to redeployment of junior doctors in paediatric services to adult services. Methods: We extracted data on children presenting to a tertiary emergency department with a respiratory illness, comparing winter 2019-2020 (pre-COVID-19) to winter 2020-2021 (post-COVID-19). We compiled demographic and epidemiological data and compared the two groups with regards to number and type of infectious respiratory presentations, admissions, days spent in hospital, and whether intensive or high dependency support was required. Results: We have found a reduction in respiratory disease presentations post-COVID-19 compared to pre-COVID-19. These patients were more likely to be admitted but their stay was reduced, and there was a trend towards a reduction in requirement for intensive or high dependency support during their admission. Conclusion: This work supports the redeployment of junior doctors in paediatric departments to adult departments given increased demand in other areas of medical care at that time. In view of the changing landscape, we suggest the introduction of a flexible staffing format to ensure adequate support to areas with higher demand.

A conceptual model for practice-based learning and improvement competency in medicine.

ABSTRACTIntroduction:Quality improvement and performance evaluation have become today’s mainstream medical issues, whereas in many areas of medical care, the quality of care services is less than desirable.Objective:To determine a conceptual model for practice-based learning and improvement (PBLI) competency in medicine.Methods:This study was conducted using Walker and Avant’s theoretical synthesis method. Articles related to the concept of PBLI were searched using the keywords of practice-based learning and improvement, quality improvement, core competency, medical education, practice-based learning in English, separately and combined in google, google scholar, and Pubmed databases. After identifying the theoretical blocks and variables of each block and communicating them, a visual model of PBLI was presented. After a focused search for each block, a total of 229 full papers were studied and the PBLI model was developed in six conceptual blocks.Results:The visual model that presented in this study shows the relation among six theoretical blocks of PBLI including: Block of approach to PBLI, PBLI process triggers block, gap bridging solutions, PBLI infrastructure block, PBLI sub-competencies block, PBLI academic development block.Conclusions:Nowadays, PBLI is one of the inevitable qualities of medicine that ensures the quality of medical practice, which, in addition to individual requirements, requires a series of technical, strategic, structural, and cultural infrastructures. By utilizing this capability, a physician will be able to discover the knowledge, skills, and performance gaps, and will be able to cope up with their appropriate approaches, thereby improving the quality of their medicine and the care provided and the patient’s safety. It can provide satisfaction and trust in society. The model presented in this paper makes it easy to understand the relationships between the various components of this competency.

Employability of the Machine Learning Algorithms in the Early Detection and Diagnosis of Multiple Diseases

The disease area models intend to bring the clinical and artificial intelligence (AI) fields together so that individuals can figure out how well AI and medication can cooperate. A few specialists have recently utilized AI-based ways to create independent disease detection systems. Early infection distinguishing proof might assist with reducing the number of individuals. To more readily comprehend the job of Artificial knowledge in the clinical field, we plan to lead a far-reaching concentrate on AI applications for the medical services area. To start, we'll audit the features and intentions for involving AI in the medical care industry. From top to bottom, we go over AI-based analyses for incorporating AI also the medical care area. Then, we initially go over AI's technical issues in the clinical industry and afterwards show how AI can help. We likewise investigate the effect of AI in the clinical field. Besides, we present a few eminent drives showing the significance of AI in medical care applications and administrations. At last, examine a few issues in disease distinguishing proof and recommend future innovative work regions that will prompt the utilization of AI in the medical services area.

Exploring Health Care Sector using AI with IoT

The new progressions in the Internet of Things (IoT) and Artificial Intelligence (AI) changed the traditional medical care framework into intelligent medical care. By consolidating key innovations, for example, IoT and AI, clinical benefits can be improved. The intermingling of IoT and AI offers various freedoms in the medical care area. the current survey article presents AI and IoT innovations in various fields. Like AI and IoT are utilized to recognize infections at introductory stages, keepa record of the relative activity of exercises, is extremely useful at the hours of crisis, deals with physical just as psychological wellness. It will likewise save a ton of cost and will be utilized for enormous scope.

Bridging the Gap: Investigating the Role of Social Workers in Supporting Metastatic Breast Cancer Patients in Nigeria

ABSTRACT Cancer is a disease common in every country around the globe with high incidences and deaths. Receiving a breast cancer diagnosis is often associated with a death sentence which makes the individual exhibit self-denial attributes, mixed negative emotions, depression, and anxiety. This study investigated the gap in supportive care and the role of social workers in the management of metastatic breast cancer patients in Nigeria. This study employed a qualitative method using Key Informant Interviews (KII). A total of 12 healthcare professionals in the area of medical social work, palliative care, and medical oncology were engaged in collecting the required information. The result revealed that social workers play significant roles in every aspect of the cancer care continuum – diagnosis, treatment, reintegration, or palliative care. Social workers help metastatic breast cancer patients in Nigeria, however, there are growing challenges to their roles. Most unskilled professionals often present themselves as social workers who do not meet professional standards or perform the best practice.

Prospects and Challenges of Developing Plant-Derived Snake Antivenin Natural Products: A Focus on West Africa.

Snakebite envenomation (SBE) is an important public health issue that is now receiving renewed attention following its reclassification as a Neglected Tropical Disease (NTD). Most incidences occur in rural areas of resource-limited countries, as such, timely and appropriate medical care for SBE is often inaccessible. The administration of anti-snake venom serum (ASV) is the only effective definitive treatment of SBE, but treatment failure to available ASVs is not uncommon. Emerging evidence highlights the potential of small-molecule compounds as inhibitors against toxins of snake venom. This presents an encouraging prospect to develop an alternative therapeutic option for the treatment SBE, that may be amenable for use at the point of care in resource-constraint settings. In view of the pivotal role of natural products in modern drug discovery programmes, there is considerable interest in ethno-pharmacological mining of medicinal plants and plant-derived medicinal compounds toward developing novel snake venom-neutralising therapeutics. In this review, we compile a collection of medicinal plants used in the treatment of SBE in West Africa and highlight their promise as potential botanical drugs or as sources of novel small-molecule compounds for the treatment of SBE. The challenges that must be surmounted to bring this to fruition including the need for (sub) regional collaboration have been discussed.

Are Public Oral Care Services Evenly Distributed?-Nation-Wide Assessment of the Provision of Oral Care in Japan Using the National Database of Health Insurance Claims.

The provision of oral health care services is one of the global challenges under the realization of universal health coverage in many countries. Despite the increasing importance of oral health care in an aging society, the disparities in the provision of oral care in Japan have not been clarified. Therefore, this study investigated the status of oral and dental care provision using the National Database of Health Insurance Claims and Specific Health Checkups (NDB) at the level of prefectures and secondary medical care areas. Additionally, a multiple regression model was applied to identify the influence of human resources in oral care services and economic factors on the standardized claims data ratio (SCR) of total dental receipts. The results showed that the total amount of oral care provided tended to be higher in metropolitan areas, with bimodal peaks in children aged 5–9 and adults in their 70s. The SCR for dental caries showed little difference nationally, but SCR for periodontal disease tended to be higher in prefectures including metropolitan areas. In a multiple regression model, the number of dentists and prefectural income per capita influenced the SCR of total dental receipts. In secondary medical care areas, some depopulated areas are supplemented by adjacent areas. These results suggest that oral health care services in the national health insurance system are generally well provided; however, they are likely to be influenced by human resources and economic disparities, and regional differences may occur in the care of periodontal diseases.

Health system efficiency in OECD countries: dynamic network DEA approach

BackgroundIn recent years, measuring and evaluating the efficiency of health systems has been explored in the context of seeking resources to ensure the sustainability of ‘countries’ health and social systems and addressing various crises in the health sector. The study aims to quantify and compare the efficiency of OECD health systems in 2000, 2008, and 2016. The contribution to research in the field of efficiency in the healthcare system can be seen in the application of Dynamic Network Data Envelopment Analysis (DNDEA), which help us to analyse not only the overall efficiency of the healthcare system but analyse the overall efficiency as the result of the efficiencies of individual interconnected areas (public and medical care area). By applying the DNDEA model, we can realise the analysis not only within one year, but we can find out if the measures and improvements taken in the healthcare sector have a positive impact on its efficiency in a later period (eight-year interval).MethodsThe analysis focuses on assessing the efficiency of the health systems of OECD countries over three periods: 2000, 2008, and 2016. Data for this study were derived from the existing OECD database, which provides aggregated data on OECD countries on a comparable basis. In this way, it was possible to compare different countries whose national health statistics may have their characteristics. The input-oriented Dynamic Network Data Envelopment Analysis model was used for data processing. The efficiency of OECD health systems has been analysed and evaluated comprehensively and also separately in two divisions: public health sub-division and medical care sub-division. The analysis combines the application of conventional and unconventional methods of measuring efficiency in the health sector.ResultsThe results for the public health sub-division, medical care sub-division and overall health system for OECD countries under the assumption of constant returns to scale indicate that the average overall efficiency was 0.8801 in 2000, 0.8807 in 2008 and 0.8472 in 2016. The results of the input-oriented model with the assumption of constant returns to scale point to the overall average efficiency of health systems at the level of 0.8693 during the period. According to the Malmquist Index results, the OECD countries improved the efficiency over the years, with performance improvements of 19% in the public health division and 8% in the medical care division.ConclusionsThe results of the study are beneficial for health policymakers to assess and compare health systems in countries and to develop strategic national and regional health plans. Similarly, the result will support the development of international benchmarks in this area. The issue of health efficiency is an intriguing one that could be usefully explored in further research. A greater focus on combining non-parametric and parametric models could produce interesting findings for further research. The consistency in the publication and updating of the data on health statistics would help us establish a greater degree of accuracy.

Elucidating variations in outcomes among older end-stage renal disease patients on hemodialysis in Fukuoka Prefecture, Japan.

Variations in health care outcomes and services potentially indicate resource allocation inefficiency. Therefore, this study was conducted to examine variations in mortality and hospitalization cases among end-stage renal disease (ESRD) patients receiving hemodialysis (HD) care from medical facilities located in 13 secondary medical care areas (SMAs) of Fukuoka prefecture, Japan. The research was designed as a retrospective, cross-sectional study using insurance claims data. The subjects of the study were older patients (over 65 years old) insured by the Fukuoka prefecture's Latter-Stage Elderly Healthcare Insurance. Using an electronic claims database, we identified patients with chronic kidney disease (CKD) who had received HD care from April 1, 2017 to March 31, 2018. The CKD status was identified using International Classification of Disease, 10th revision code, and HD maintenance status was ascertained using specific insurance procedure codes. A total of 5,243 patients met our inclusion criteria and their records were subsequently reviewed. About 73% (n = 3,809) of patients had admission records during the period studied. Thus, the data regarding hospital length of stay (LOS) and admission costs were analyzed separately. Significant differences in terms of increased risks in hospitalization were evident in a number of SMAs. An increase in mortality risk due to heart failure and malignancy was observed in two separate SMAs. Also, analyzed LOS, total hospitalization cost, and cost per day according to SMAs showed statistically significant variations. The findings highlight the magnitude of the burden of CKD and ESRD in the community. The high prevalence of ESRD, associated mortality, and hospitalized HD patients signal the need for clinicians to assume broader roles in measures against chronic kidney disease through involvement in community awareness programs. To improve patient outcomes, improvement of regional health care provision, the level of medical care, and the development of existing human resources are needed.

Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes.

The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ22 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.

Long-term care facilities during the COVID-19 pandemic : Considerations on the way back to normality

Langzeitpflegeeinrichtungen (LPE) waren und sind von der COVID-19-Pandemie besonders betroffen. Die Dimension der Ausbrüche und die hohe Letalität unter den Bewohner(innen) (BW) führten zu massiven Einschränkungen, v. a. im Bereich der sozialen Kontakte und Aktivitäten, aber auch in Bereichen der medizinischen Versorgung. Mit dem Start der Impfungen und den verbesserten Testmöglichkeiten haben sich nun aber die Voraussetzungen geändert, und bestehende Beschränkungen müssen auf ihre Zweckmäßigkeit evaluiert werden. In einer interprofessionellen und interdisziplinären Expertengruppe wurden Überlegungen erstellt, wie ein Weg zurück in die Normalität für LPE ausehen kann.

Chatbot como herramienta comunicativa durante la crisis sanitaria COVID-19 en España

La expansión de la Covid-19 a nivel mundial desembocó en un colapso de las redes sanitarias en la mayoría de los países. En esta situación, las nuevas tecnologías adquirieron un papel relevante, especialmente en la gestión de la comunicación, gracias a su inmediatez y posibilidades de cobertura. El confinamiento establecido en España, como consecuencia del estado de alarma decretado en marzo de 2020, aceleró la adopción de diversos recursos tecnológicos en el área de la atención médica a distancia. En este contexto, las plataformas conversacionales se han ido convirtiendo en una de las herramientas más utilizadas por las instituciones para aliviar la falta de recursos en atención telefónica y presencial a la hora de atender las primeras consultas realizadas por los ciudadanos aquejados de síntomas, o por aquellos que solicitaban algún otro tipo de información urgente relacionada con la enfermedad. Esta demanda de agilidad vino a ser atendida por diferentes empresas que ofrecieron el desarrollo de servicios de bot en tiempo record. “Los chatbots son una solución que permite de forma rápida implementar un medio de respuesta inmediato a los usuarios” (Aguilar et al., 2020). El presente artículo analiza el grado de alcance que estas plataformas de respuesta en línea tuvieron –y aún tienen– en la descongestión de los servicios sanitarios en España y si su disponibilidad ha sido de algún modo útil para los ciudadanos. Para ello, se ha tomado una muestra de las cinco principales plataformas conversacionales y, utilizando un estudio de caso, se han revisado sus características particulares. Además se han aportado los datos obtenidos a través de un cuestionario realizado a usuarios y los extraídos de una serie de entrevistas a expertos. El resultado de esta investigación pone de manifiesto que el nivel de uso de los chatbots sanitarios específicos para la Covid-19 en la actualidad alcanza al 30% de la muestra analizada y que los que han empleado este tipo de asistentes lo han hecho fundamentalmente con fines informativos, siendo los meses de abril y octubre los que han reflejado mayor actividad en este sentido.

Russian healthcare in the development of medical tourism

The authors consider the possibilities of national health care in the context of the export of medical services. The methodology of the work is based on an approach based on different specifics of medical and healthcare tourism and their correlation. The forms of state support are described in the article. The assessment of the plan for the development of the export of medical services and the ways of its implementation are given. The following pointes are highlighted: trends in the commercialization of medical tourism, business strategy, social, economic and technological risks in the development of medical tourism, and the prospects of development. The most attractive areas of medical care in Russia for foreigners are explicated. The financial benefits of exporting medical services and the issue of Russia’s international cooperation in this area are considered.. It is done for a comparative analysis of the achievements in different countries in the medical and tourism industry. The forms of cooperation with the Joint Commission International (JCI) in promoting the export of medical services in Russia were noted. The article also deals with the problems and barriers to the development of the export of medical services and possible ways to solve them.

Impact of SARS-CoV-2 pandemic on bariatric care in Poland: results of national survey

BackgroundThe SARS-CoV-2 pandemic has reached Poland on March 4th, 2020 and undoubtedly affected all areas of life and medical care, including bariatric care. The study was planned to identify the impact of the SARS-CoV-2 pandemic on bariatric care in Poland.MethodsThe online survey was designed and distributed to bariatric surgeons. The questionnaire was divided into three parts: demographic characteristics of participants and their bariatric centers, examining the impact of the pandemic on the bariatric care and last part with questions about planned care after the pandemic.Results49 surgeons participated in the survey. 27 (55%) participants worked in hospitals transformed into COVID-dedicated units. Only 9 (18%) respondents declared uninterrupted bariatric surgery during a pandemic. 91% of surgeons declared continuation of bariatric care with telemedicine techniques. All participants declared a high willingness to resume bariatric surgery after the SARS-CoV-2 pandemic and responded that bariatric procedures should resume immediately when World Health Organisation (WHO) announces the end of a pandemic regardless of oncological treatment. 90% of respondents believe that the pandemic will not affect the safety of bariatric procedures in the future.ConclusionsAccess to bariatric care during the pandemic is limited and redirected to telemedicine. Surgeons are ready to resume bariatric operations immediately after the pandemic, but its end is difficult to determine. In surgeons’ opinion pandemic will not affect the safety of bariatric surgery in the future. The extended waiting list and financial aspects will be the main issues after the pandemic.

SURGICAL ASPECTS OF DIAGNOSIS AND TREATMENT OF CHEST PATHOLOGY CAUSED BY CORONAVIRUS DISEASE COVID-19, ANALYSIS OF CLINICAL CASE

The COVID-19 pandemic has generated many challenges both for humanity in general, and for the systems of organizing medical care and many areas of specialized treatment, in particular surgical. The very dynamics of the pandemic, the lack of available specific treatment, various approaches to assessing statistical and clinical data in various countries today do not allow generally accepted conclusions to be drawn. Numerous publications on this topic, as a rule, contain information about personal experience of research, diagnosis, treatment and a review of the current literature. We analyzed 68 cases of chest diseases caused by COVID-19 in patients who received consultative, specialized surgical thoracic care in basic medical institutions of Chernivtsi region for the period January-September 2020. Bilateral lung lesions predominated – 70.6 % in older patients 42 years (66.2 %). Surgical interventions were performed in 65 (95.6 %) patients. The most common complication in the acute period was pneumothorax on the background of active viral pneumonia – 40 (58.8 %) patients, 6 (8.8 %) – patients with heart and pericardial lesions, 7 (10.3 %) – hemorrhagic, serous-fibrinous pleurisy. Based on own data in comparison with the histological and pathophysiological researches resulted in the available literature, surgical tactics, separate surgical receptions at patients with virus-induced complications, in particular: drainage of a pleural cavity, pericardium, videothoracoscopic techniques are proved. The algorithm of examinations and treatment tactics in the formation of intrapulmonary pseudocysts after coronavirus disease are presented. We analyzed 5 (7.4 %) cases in which there were complications of major diseases (cancer, nonspecific purulent-septic diseases) caused by COVID-19. Study of the effectiveness of the use of videothoracoscopic electric welding technologies in the destruction of the lung parenchyma caused by viral infections.

Absences from work among healthcare workers: are they related to influenza shot adherence?

BackgroundThe coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017–2018 influenza season.MethodsWe performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test.ResultsInfluenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p < 0.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak.ConclusionsFactors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals.

Całkowicie prywatna opieka medyczna — próba zarysu

In this paper, we explore what the market for medical services and products could look like if the state completely withdrew from the area of medical care. In section 1, we demonstrate that medical services would be purchased mainly through direct payments and medical insurance. We analyse two models of medical insurance: guaranteed renewable insurance and health-status insurance. Other types of insurance that may emerge on the market are also discussed. In section 2, we exam-ine how the privatisation of the health-care system would affect the prices of medical services. We analyse fundamental problems of the state-run health care and discuss how they contribute to small-er supply and higher prices of medical services. We then describe how the introduction of market mechanisms would allow to solve many of these problems. We argue that internalisation of the costs of medical care in a free market order would create strong economic incentives for individuals to take better care of their health, and we contrast this with the state-run health care in which these costs are externalised. In section 3, we explore how medical services could be obtained by individuals without sufficient funds. In section 4, we discuss how the quality of medical care could be ensured without the help of the state. We argue that competition between service providers would be the main guarantor of quality. We also identify mechanisms that would lead to spontaneous emergence of a system of private medical licencing.

Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals

The purpose of this narrative review is to expand routine prepregnancy counseling and anticipatory guidance to include people of all genders. Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine prepregnancy counseling. In addition to the topics covered in routine prepregnancy counseling, there are several unique considerations for prepregnancy care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Research in the area of TGNB medical care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and prepregnancy-related care. Therefore, we present prepregnancy medical, surgical, social, and practice of care considerations for TGNB populations in light of other known health and healthcare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive prepregnancy care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them.

Implementation of Family Medicine in Central and Eastern Europe: Experience and Lessons for Ukraine

The reform of the healthcare system in Ukraine is a prime necessity, which is due to the lack of clear structural transformations since independence. However, today the implementation of reform measures generates a number of negative reviews in the society related to the lack of awareness of citizens with the main vectors of change. In addition, the closure of hospitals leaves the population without proper medical care, while the general introduction of family medicine is met with caution as the special field “family medicine” is new and unpopular for Ukraine. Lack of sufficient knowledge about the basic principles of the functioning of family medicine and the absence of professional family doctors gives rise to further distrust of the people in the primary healthcare unit. Therefore, the medical reform instead of separating powers between all levels and areas of medical care and achieving global goals and results for the whole society and socio-economic development of the country is failing.In our study, we defined the concept of family medicine in its theoretical and practical application, proving that family medicine is the basis of the general well-being of society. And its development, modernization and popularization can become the first element in the general system of healthcare. An example of Central and Eastern European countries has shown that the phased introduction of family medicine is positively reflected in indicators of welfare and mortality rates, as well as on indicators of social and economic development of countries, etc. However, the lack of sufficient knowledge and the corresponding level of government interest in reforming the primary healthcare unit generates a zero effect from all actions taken. At the same time, non-professional family doctors invalidate the importance of the primary unit in the healthcare system.Within the framework of the study special attention was paid to the problems encountered by Ukraine on the way of implementation of medical reform. The basic components of such a problem, which originated in the absence of a clear and coordinated work of state authorities and local self-government was analyzed. Based on the foregoing, and on the experience of foreign countries, we have been offered ways to solve such problems and improve the general mechanism of primary healthcare.

The reality and potential medical economic evaluation by avoiding adverse events of pharmacist intervention in emergency medical care and intensive care area

The reality and potential medical economic evaluation by avoiding adverse events of pharmacist intervention in emergency medical care and intensive care area