Medical Care Network Research Articles

Interprofessional Collaboration and the Establishment of a Medical Care Network for the Dialysis Lifeline

<p>本院是位於台灣北部的醫學中心級醫院，建立了以透析生命線為核心的跨領域團隊療護，藉由個人化的透析生命線圖與優化的穿刺技術，搭配定期監測與系統化管理，提高透析生命線栓塞的及時搶救，設立周邊血管中心與透析血管通路訓練中心，以發展透析生命線療護網，並參與血管通路產業研發鏈，達成全面提升透析生命線療護品質的目標。</p> <p> </p><p>The present study established an interprofessional collaborative practice for dialysis lifelines at a hospital in northern Taiwan. This initiative improved treatment and care quality for patients requiring dialysis lifelines through the use of individualized mapping, optimized puncture techniques, surveillance, systematic management, and immediate salvage of thrombosed lifelines. A peripheral vascular center, a dialysis training center, and a dialysis lifeline care network were also established to improve vascular care and research.</p> <p> </p>

Healthcare 4.0: A Review of Phishing Attacks in Cyber Security

The rapidly developing scene of Healthcare 4.0, has turned into a fundamental concern. This paper dives into the multi-layered domain of medical care network safety, with specific emphasis on the persistent phishing assaults. We examine the motivation for cyberattacks and the challenges involved. In this paper we review the phishing attacks in medical care, talking about preventive measures to handle this danger. By embracing this through methodology, Healthcare organizations can sustain their protections, shield patient information, and maintain the trustworthiness of medical care frameworks, all while encouraging a culture of network safety status in the computerized age.

The Cybervillage created by a medical care network for older patients on peritoneal dialysis

The Cybervillage created by a medical care network for older patients on peritoneal dialysis

Report on a new remote collaborative medical care system -construction and operation of a remote collaborative medical care network for inflammatory bowel disease using information and communication technology in Hokkaido

Inflammatory bowel disease (IBD) comprises 2 major types-ulcerative colitis (UC) and Crohn's disease (CD). A remote collaborative medical care fee has been established for patients with suspected intractable diseases since 2020. Remote collaborative medical care is a type of telemedicine wherein a hospital specialist for intractable diseases, the patient, and an attending physician at a community hospital communicate via video calls. In IBD cases, however, treating patients who have already been diagnosed with severe or intractable diseases is difficult. As a part of the Hokkaido Intractable Disease Medical Care System Development Project, we have started providing free remote collaborative medical care services for all IBD patients, including those with a confirmed diagnosis and attending regional hospitals. We set up the telemedicine system using Microsoft365, a commercial cloud, and Nextcloud, a PaaS, to ensure robust security and enable rapid and massive sharing of medical details by information and communication technology. Since April 2021, we have examined 27 patients (36 times). Among these patients, 5 patients from regional hospitals were undiagnosed (1 patient of suspected CD, 3 patients of suspected IBD unclassified (IBD-U), and 1 patient of undiagnosed enteritis). Twenty-two patients from regional hospitals had a confirmed diagnosis (17 UC and 5 CD patients). Eight patients required a second time remote collaborative medical care, and 1 patient required a third time remote collaborative medical care. There was no equipment failure such as communication failure or system trouble, and all patients could be examined smoothly. The maintenance cost of the telemedicine system was 2500yen/month per hospital. Among all cases receiving remote collaborative medical care, 86% were consultations for refractory or severe active cases with a confirmed diagnosis of IBD. At present, the remote collaborative medical care fee for diagnosed patients is not permitted. Since remote collaborative medical care has the potential to correct regional disparities in medical standards, there is an urgent need to review the criteria for remote collaborative medical care fees.

Therapy of cardioneurosis with modern antidepressants in general medical care network

The clinical presentation of cardioneurosis is heterogeneous and includes anxiety-phobic, cenestalgic, and depressive symptoms. General practitioners, who most often see this category of patients, usually recommend to take «sedatives». Modern antidepressant, i. e. selective serotonin reuptake inhibitor, escitalopram demonstrated high efficiency and good tolerability in patients with cardoneurosis (neurocirculatory dystonia).

Establishment of in-hospital clinical network for patients with neurofibromatosis type 1 in Nagoya University Hospital

Neurofibromatosis type 1 (NF1) is a genetic multisystem disorder. Clinicians must be aware of the diverse clinical features of this disorder in order to provide optimal care for it. We have set up an NF1 in-hospital medical care network of specialists regardless of patient age, launching a multidisciplinary approach to the disease for the first time in Japan. From January 2014 to December 2020, 246 patients were enrolled in the NF1 patient list and medical records. Mean age was 26.0 years ranging from 3 months to 80 years. The number of patients was higher as age at first visit was lower. There were 107 males (41%) and 139 females. After 2011, the number of patients has increased since the year when the medical care network was started. Regarding orthopedic signs, scoliosis was present in 60 cases (26%), and bone abnormalities in the upper arm, forearm, and tibia in 8 cases (3.5%). Neurofibromas other than cutaneous neurofibromas were present in 90 cases (39%), and MPNST in 17 cases (7.4%). We launched a multidisciplinary NF1 clinic system for the first time in Japan. For patients with NF1, which is a hereditary and systemic disease associated with a high incidence of malignant tumors, it will be of great benefit when the number of such clinics in Japan and the rest of Asia is increased.

COVID-related anxiety is prevalent and accurately reflects serious COVID risks in breast cancer patients.

12053 Background: A current cancer diagnosis is a risk factor for serious COVID-19 complications (CDC). In addition, the pandemic has caused major disruptions in medical care and support networks, resulting in treatment delays, limited access to doctors, worsening health disparities, social isolation; and driving higher utilization of telemedicine and online resources. Breastcancer.org has experienced a sustained surge of new and repeat users seeking urgent information and support. To better understand these unmet needs, we conducted a survey of the Breastcancer.org Community. Methods: Members of the Breastcancer.org Community were invited to complete a survey on the effects of the COVID-19 pandemic on their breast cancer care, including questions on demographics, comorbidities (including lung, heart, liver and kidney disease, asthma, diabetes, obesity, and other chronic health conditions); care delays, anxiety due to COVID-related care delays, use of telemedicine, and satisfaction with care during COVID. The survey was conducted between 4/27/2020-6/1/2020 using Survey Monkey. Results were tabulated and compared by chi square test. A p-value of 0.05 is considered significant. Data were analyzed using Stata 16.0 (Stata Corp., Inc, College Station, TX). Results: Our analysis included 568 breast cancer patients of whom 44% had ≥1 other comorbidities associated with serious COVID-19 complications (per CDC) and 37% had moderate to extreme anxiety about contracting COVID. This anxiety increased with the number of comorbidities (p=0.021), age (p=0.040), and with a current breast cancer diagnosis (p=0.011) (see table). Anxiety was significantly higher in those currently diagnosed, ≥65, or with ≥3 other comorbidities, compared to those diagnosed in the past, age <44, or without other comorbidities. Conclusions: Our survey reveals that COVID-related anxiety is prevalent at any age regardless of overall health status, but it increased with the number of other comorbidities, older age, and a current breast cancer diagnosis. Thus, reported anxiety is proportional to the risk of developing serious complications from COVID. Current breast cancer patients of all ages—especially with other comorbidities—require emotional support, safe access to their providers, and prioritization for vaccination.[Table: see text]

Practice Patterns and Outcomes of Online Hemodiafiltration: A Real-World Evidence Study in a Russian Dialysis Network

Background: Evidence suggests that online hemodiafiltration (OL-HDF) is associated with improved survival. Whether the dose-response relationship between convective volume and mortality may be confounded by selection bias or descends from practice patterns is not clear. We sought to evaluate the role of patients’ characteristics and practice patterns on OL-HDF dose and mortality in a large private dialysis network in the Republic of Russia. Methods: In this multicenter, historical cohort study, we included adult incident patients on OL-HDF with at least 90 days of survival on renal replacement therapy in centers belonging to the Russian Federation Fresenius Medical Care network (January 1, 2011, to December 31, 2016). We evaluated predictors and outcomes (survival) of substitution volume target achievement (Q_sub > 21 L/session). Results: Among 1,081 enrolled patients, the average Q_sub was 22.9 (±3.2) L/session; the mean ultrafiltration volume was 1.6 (±0.8) L/session. The mean age was 55.8 ± 13.2; 42% were woman. Most common comorbidities were congestive heart failure (39.7%) and peripheral vascular disease (21.7%). The average hemoglobin was 9.3 ± 1.3. The case-mix adjusted center effect accounted for 20% of variance in Q_sub. The top 10 most important variables associated with higher Q_sub were effective Q_b, serum protein, Charlson’s comorbidity index, hemoglobin, year of dialysis initiation (proxy of high Q_sub treatment policy in the clinic network), predialysis heart rate, serum bicarbonate, serum phosphate, age, serum sodium, and dry body weight. In addition, we found that the association of Q_b with Q_sub is moderated by year of enrollment, intradialytic weight gain, and coronary artery disease, whereas higher hemoglobin concentration moderated the relationship between treatment time and Q_sub. Finally, Q_sub between 21 and 25 L/session was associated with longer 5-year survival. Conclusions: Both center-dependent clinical practice standards and patient clinical conditions substantially contributed to the risk of low Q_sub. We confirmed previous evidence indicating better survival among patients with Q_sub ≥ 21 L/session.

Challenges and Lessons Learned From Short-Term Medical Service Trips in Global Communities

The purpose of the article is to examine challenges and lessons learned from short-term medical service trips. Challenges and lessons learned in 3 countries included limited resources, language barriers, translation difficulties, and ethnic and cultural differences within communities. Local providers verbally expressed the meaningful changes to the care provided as they learned from the medical service team. After completion of the short-term medical trips, there were concerns related to the ongoing needs of the communities that the short-term medical trips were unable to address. Creating partnerships with local medical care networks for referrals for further testing and follow-up are needed.

Clinical target achievement is associated with better quality of life among dialysis patients: results from a continuous quality improvement program in a Portuguese healthcare network.

Patients with kidney failure have multifaced clinical needs. Continuous quality improvement (CQI) programs initiated by large healthcare provider networks bear the promise of improving guideline adherence and improving patient-centered outcome, including health-related quality of life (HRQOL). We aimed at evaluating the association between key performance indicators (KPI) adopted for our CQI and HRQOL in a large network of dialysis providers. We conducted a survey study in 39 centers belonging to the Portuguese Fresenius Medical Care (FME) network, in September 2017. For each participant, we retrospectively extracted clinical information during the 6-month period preceding survey administration. We used this information to calculate KPI as defined by the FME-CQI policy. Those KPI were selected in the FME-CQI policy as modifiable intermediate endpoints for which previous evidence suggested a causal relationship with patients' morbidity and mortality. HRQOL was assessed by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaire. Among 4691 eligible patients who were invited to participate in the survey, 2263 (48.2%) answered the self-administered survey. Based on KPI standards, patients had 1.5 (± 1.2) off-target clinical parameters on average. KDQOL-36 score were generally higher than those observed in European reference population. We found a significant linear association between KPI parameters and HRQOL. This pattern was robust to adjustment for satisfaction scores. Our data demonstrated a graded, monotonic, dose-response relationship between the number of off-target KPIs and HRQOL. Such relationship was not mediated by patients' satisfaction and may be attributed to amelioration of disease-specific symptoms and functional capacity.

Long-term mortality risk associated with citric acid- and acetic acid-based bicarbonate haemodialysis: a historical cohort propensity score-matched study in a large, multicentre, population-based study.

Citric acid-based bicarbonate dialysate (CiD) is increasingly used in haemodialysis (HD) to improve haemodynamic tolerance and haemocompatibility associated with acetic acid-based bicarbonate dialysate. Safety concerns over CiD have been raised recently after a French ecological study reported higher mortality hazard in HD clinics with high CiD consumption. Therefore, we evaluated the mortality risk associated with various acidifiers (AcD, CiD) of bicarbonate dialysate. In this multicentre, historical cohort study, we included adult incident HD patients (European, Middle-East and Africa Fresenius Medical Care network; 1 January 2014 to 31 October 2018). We recorded acidifiers of bicarbonate dialysis and dialysate composition for each dialysis session. In the primary intention-to-treat analysis, patients were assigned to the exposed group if they received CiD in >70% of sessions during the first 3 months (CiD70%), whereas the non-exposed group received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow-up. We enrolled 10 121 incident patients during the study period. Of them, 371 met the criteria for inclusion in CiD70%. After propensity score matching, mortality was 11.43 [95% confidence interval (CI) 8.86-14.75] and 12.04 (95% CI 9.44-15.35) deaths/100 person-years in the CiD0% and CiD70% groups, respectively (P = 0.80). A similar association trend was observed in the secondary analysis. We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite the fact that physicians were more inclined to prescribe CiD to subjects with worse medical conditions.

P1548THE VALUE OF BEING A NETWORK: CLINICAL GOVERNANCE AND DIALYSIS CLINIC PERFORMANCE MANAGEMENT IS ASSOCIATED WITH IMPROVED PATIENTS SURVIVAL

Abstract Introduction. In order to help facilitate the uptake of best clinical practices, improve outcomes, enhance efficiency and reduce costs, few healthcare organizations have introduced Continuous Quality Improvement (CQI) programs. Since September 2014, dialysis centers belonging to the EMEA Fresenius Medical Care (FME) network have introduced a CQI policy called Medical Peer Review (MPR) based on key performance indicators (KPI) related to patient’s clinical status. We exploit the quasi-experimental setting generated by the introduction of FMC CQI policy, to evaluate the association between improvement in intermediate outcomes (key performance indicators) and prolonged survival among dialysis patients registered in the EMEA FME network. Methods. We conducted a historical cohort study. We included adult patients on chronic dialysis with less than 90 days between renal replacement therapy (RRT) initiation date and first treatment date in FME clinics. We compared KPI target achievement (P-BSC score) and 2-year mortality for patients enrolled prior to MPR-CQI policy onset (Cohort A) and a cohort of patients enrolled after MPR-CQI policy onset (Cohort B). Structural Equation model was adopted to estimate the association of MPR-CQI policy on patients’ survival through changes in intermediate outcomes (P-BSC score). Results. The Cohort A and Cohort B consisted of 2397 and 1873 patients, respectively. We observed no difference across groups concerning the distribution of age (63.1 vs 62.8 years), gender (59% vs 60% males) and body mass index (27.6 vs 26.4 kg/m2); Cohort A showed lower Charlson’s comorbidity index (3.3±1.5 vs 3.8±1.9, p<0.01) and higher dialysis vintage (32.9±27.0 vs 21.3±22.2 days, p-value<0.01) compared to Cohort B. P-BSC scores over the 6-month ascertainment period was 5.25±1.47 in the pre CQI-MPR policy cohort, while it was significantly higher (6.67±1.63) in the post CQI-MPR policy cohort. Mediation analysis demonstrated a strong indirect effect of CQI-MPR implementation on mortality trough improvement of P-BSC rating score occurring in the post-implementation era (OR=0.70, p<0.001) Conclusion. We showed that, after discounting for potential unmodifiable confounding factors and potential unmeasured selection/chronological bias, improvement of intermediate outcomes and performance indicators occurred after MPR-CQI policy implementation, was associated to a strong improvement in survival. Figure:

P1449MORTALITY RISK ASSOCIATED WITH ACETIC ACID BASED AND CITRIC ACID BASED BICARBONATE HEMODIALYSIS: A HISTORICAL COHORT STUDY

Abstract Background Citric Acid Based Bicarbonate Dialysate (CiD) is increasingly used in hemodialysis to improve hemodynamic tolerance and hemocompatibility associated with Acetic Acid Based Bicarbonate dialysis (AcD). We sought to evaluate the mortality risk associated with different dialysate acidifiers. Methods We conducted a multicenter, historical cohort study; all adult incident hemodialysis patients registered in EMEA Fresenius Medical Care network since January 1st 2014 to October 31st 2018 were enrolled. We recorded dialysate acidifier composition for each dialysis session. In the primary analysis (intention-to-treat population), patients were assigned to the exposed group if they received CiD in more than 70% of sessions during the first three months (CiD70%), whereas non-exposed received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow up. Results We enrolled 10,121 incident patients during the study period. Of them, 371 met criteria for inclusion in CiD70%. After propensity score matching mortality was 11.43 (95%CI: 8.86 - 14.75) and 12.04 (95%CI: 9.44 - 15.35) deaths/100 person-years, in the CiD0% and CiD70% groups respectively (p=0.80). A similar association trend was observed in the secondary analysis. Conclusions We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite physicians were more inclined to prescribe CiD to subjects with worse medical conditions.

Consent management and workflows for cross-sectoral patient records and teleconsultations

Cross-enterprise electronic patient records are akey element in the design of interoperable medical care networks and process chains. However, the different requirements concerning type, performance and quality assurance of available communication services within the different healthcare sectors still require that the hospitals participate in various secure communication networks which have to be bridged for cross-sectoral communication. Cross-institutional pathways for telemedicine, however, can be mapped both within and across sectoral boundaries via automated process chains using the IHE (Integrating the Healthcare Enterprise) defined integration profile CrossEnterprise Document Sharing (XDS) and associated integration profiles. The provision of medical documents in across-institutional patient record outside of defined medical pathways requires differentiated authorization management. In this respect, consent documents according to the IHE APPC (Advanced Patient Privacy Consents) profile enable the documentation of the patient's consent, including information about planned authorized people, document types, period and type of document access allowed. Providing access control to medical documentation by the patients themselves is an essential part of the required focusing of medical services on patients. New interoperability standards optimized for use on mobile devices, such as FHIR (Fast Healthcare Interoperability Resources), will enable simplified delivery of patient-centered health records and other medical services on mobile platforms in the future.

Effective Self-Efficacy Factors in Empowerment of Health Care Networks Managers in East Azerbaijan, West Azerbaijan and Ardebil Provinces, Iran

Introduction: Empowerment has determinant role in developing the ability of individuals in order to achieve sustainable improvement in efficiency of the health care organizations. This study was carried out to identify the variables and effective self-efficacy components affecting the manager’s empowerment in Health­ Care Networks during 2018-19. Methods: This is an applied and exploratory study. At first, the variables involving in the empowerment of human resources were extracted by reviewing the literature as well as interviewing with the specialists. Then, the conceptual model was designed, the questionnaire compiled and its validity and reliability confirmed. The data were collected through the completing of the questionnaire by 416 managers who were chosen via stratified random sampling method and analyzed using exploratory and confirmatory factor analysis. Results: According to the results of the exploratory factor analysis, the variable “continuous training” with the factor loading of 0.84 was found the most important variable. Concerning the standard coefficients of confirmatory factor analysis, variables of all the three components of self-efficacy were significant (p<0.001) and the component “Believe in responsibly ability and skill in work” (factor loading = 0.96) had the higher effect on self-efficacy. The impact rate of self-efficacy in empowerment with 0.96 and the variables “having job skills” and "emotional arousal" with 0.79 factor loading are considered as the most significant variables. Conclusion: The Universities of Medical Sciences and Health Care Networks can improve the ability of the managers through continuous training, promotion of professional skills, responsibility and presenting the successful models and experiences.

Visiting Rate of Dental Clinic by the Recommendation Based on the Periodontal Screening Tests for DM Patients

Aim: To investigate the dental visit status of DM patients who needed to treatment of periodontitis screened by Perioscreen test in the medical and dental clinic cooperation at community base. Material and Method: The study population was DM patient undergone perio dontal screening tests by diabetologist . In total, 100 subjects (65 male and 35 female) were selected. The dental visit status of DM patients with positive results was investigated according to correspondence between the medical and dental information including intraoral clinical examination: number of remaining teeth, maximum value of the periodontal pocket and percent of bleeding on probing, and type of periodontal treatment. Result: 57 patients were positive for Perioscreen test. Among the patients with positive results, 34 patients (59.6%) visited one of three partnership dental offices and all received periodontal treatment. 26 patients (45.6%) were finished their periodontal treatment within 6 months. For the patients who finished dental treatment, parameters of periodontal diseases were improved. Conclusion: About 60% DM patients who regularly attend the medical clinic were positive for periodontitis by Perioscreen test. Among them, about 60% patients attended for dental clinic by the recommendation by family doctor. These results may provide the basic information to medical and dental clinic cooperation and community medical care networks. Disclosure N. Kato: None.

Abstract #611 Real World Treatment of Obesity with Liraglutide in Mexican Patients of a Medical Care Network

Abstract #611 Real World Treatment of Obesity with Liraglutide in Mexican Patients of a Medical Care Network

Allergy medical care network: A new model of care for specialties

In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005–2010 was designed.The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. Material and methodsDescriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. ResultsThe indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. ConclusionsAfter application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs.

Life satisfaction and its determinants: a survey on Iranian nurses population

Evaluation of life dissatisfaction should be one of the main components of managers’ efforts to perform appropriate policies for promoting quality of work life and improving productivity of nurses. Thus the aim of the present study was to examine life satisfaction level and its determinants among a sample of Iranian nurses.In this descriptive study, 309 nurses qualifying in medical care network, randomly selected from eight medical centers using stratified random sampling method were included. Information of different aspects of living and working situations were collected by a questionnaire and life satisfaction was also measured by the Life Satisfaction Index A (LSIA).Data were analyzed by descriptive and stepwise logistic regression model at p < 0.05 using SPSS 19. Mean score of the LSIA questionnaire was 25.47 ± 6.51; 253 (81.9%) nursing staffs reported were satisfied and only 56 (18.1%) dissatisfied. The satisfaction rate was higher in men compared with women (95.7% versus 80.8%). All nurses working in surgery and psychiatry wards satisfied in lives; whereas dissatisfaction rate was the highest among emergency ward (23.7%) and operating room (23.1%) nurses. There was a positive correlation between life satisfaction score and nurse’s income (R = 0.173, p = 0.002). In married ones, multivariable stepwise regression analysis showed that male gender was a main determinant of higher life satisfaction score (p = 0.027). Among single nurses, only higher workload as having a second job had an adverse correlation with life satisfactions score (p < 0.001). Life satisfaction among nurses can be potentially influenced by gender and high work load indicators as well as level of their income. The results also provide empirical support for a positive relationship between work condition and nurses life satisfaction.

Improved Particle Swarm Optimization Algorithm for Android Medical Care IOT using Modified Parameters

This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.