Multidisciplinary System Research Articles

A survey of availability and affordability of polypills for primary and secondary prevention of cardiovascular diseases in selected countries

Abstract Background/Introduction The recent inclusion of polypills—fixed-dose combinations of two or more antihypertensive drugs and statin with or without aspirin—in the World Health Organization’s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for primary or secondary prevention of cardiovascular diseases (CVDs). Although there exists extensive evidence on efficacy, safety, and acceptability of polypills, there is no research to-date assessing the "real world" availability and affordability of polypills globally. Purpose We conducted a cross-sectional survey of public and private sector facilities in 13 countries from around the world to evaluate the availability and affordability of polypills. Methods In the surveyed countries, we first ascertained whether any polypill was authorized for marketing and/or included in the national EMLs and clinical guidelines. The facility survey employed a modified WHO/Health Action International methodology. In each country, we collected retail and price data for polypills from at least one public sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable in a given country if the lowest paid worker spends more than a days’ wage to purchase monthly supply. Results Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius, and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. Further, none of the surveyed public pharmacies in any of the four countries stocked any polypills. Among the surveyed private sector facilities, availability ranged from 0% in India (out-of-stock on the survey day but listed for sale) to 100% in Argentina and Spain. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Although not in stock, India had a wider range of various combinations (n=5). Many combinations (63%) found in this survey were affordable in the local context, but these were limited to India and Spain. A lowest paid government worker would spend between 0.2 (India)–2.8 (Mauritius) days’ wages to pay the price for one month’s supply of the polypills. Polypills were likely to be affordable in countries that locally manufactured them. Further, two-pill combinations (one antihypertensive and a statin) were stocked by private pharmacies in Argentina, Bangladesh, Cameroon, India, Nepal, and Spain, with affordability ranging from 0.2 (India)–7.1 (Cameroon) days’ wages. Conclusion Low availability and affordability of polypills in both public and private sectors suggest that the implementation and overall uptake of polypills remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Neuroprognostication, withdrawal of care and long-term outcomes after cardiopulmonary resuscitation.

Survivors of cardiac arrest often have increased long-term risks of mortality and disability that are primarily associated with hypoxic-ischemic brain injury (HIBI). This review aims to examine health-related long-term outcomes after cardiac arrest. A notable portion of cardiac arrest survivors face a decline in their quality of life, encountering persistent physical, cognitive, and mental health challenges emerging years after the initial event. Within the first-year postarrest, survivors are at elevated risk for stroke, epilepsy, and psychiatric conditions, along with a heightened susceptibility to developing dementia. Addressing these challenges necessitates establishing comprehensive, multidisciplinary care systems tailored to the needs of these individuals. HIBI remains the leading cause of disability among cardiac arrest survivors. No single strategy is likely to improve long term outcomes after cardiac arrest. A multimodal neuroprognostication approach (clinical examination, imaging, neurophysiology, and biomarkers) is recommended by guidelines, but fails to predict long-term outcomes. Cardiac arrest survivors often experience long-term disabilities that negatively impact their quality of life. The likelihood of such outcomes implements a multidisciplinary care an integral part of long-term recovery.

Extracorporeal Cardiopulmonary Resuscitation: CME Review.

Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly being used for refractory cardiac arrest for both in-hospital and out-of-hospital cardiac arrests. The term eCPR refers to cannulating a patient to an extracorporeal membrane oxygenation (ECMO) circuit to provide perfusion after cardiac arrest refractory to standard cardiopulmonary resuscitation. Extracorporeal cardiopulmonary resuscitation has been shown to offer increased survival benefit among a select group of adult and pediatric patients experiencing refractory cardiac arrests, both in hospital and out of hospital. Extracorporeal cardiopulmonary resuscitation should be considered when (1) the cardiac arrest is witnessed, (2) the patient receives high-quality cardiopulmonary resuscitation, (3) the patient is at or in close proximity to an ECMO center, (4) there is a reversible cause for the cardiac arrest where the perfusion from the ECMO circuit serves as a bridge to recovery, and (5) the treating facility has a robust multidisciplinary system in place to facilitate rapidly moving patients from site of arrest to site of cannulation to intensive care unit. To develop an eCPR system of care, a multidisciplinary team consisting of prehospital, emergency medicine, in-hospital, proceduralist, perfusionist, and intensive care medical professionals must be established who support the use of eCPR for refractory cardiac arrest. The future of eCPR is the development of systems of care that use eCPR for a narrow subset of pediatric out-of-hospital cardiac arrests.

Agro-Silvo-Pastoral Heritage Conservation and Valorization—A Comparative Analysis of the Chinese Nationally Important Agricultural Heritage Systems and of the Italian Register of Historical Rural Landscapes

Agricultural heritage systems are receiving increasing attention due to their multifunctional role, their capability to provide ecosystem services, and for representing sustainable development models for rural areas. At the international level, the Food and Agriculture Organization (FAO) of the United Nations launched in 2002 the Globally Important Agricultural Heritage Systems (GIAHS) Program to identify and safeguard traditional agro-silvo-pastoral systems that are the result of the adaptation of rural communities to the surrounding environments. Following this approach, similar national programs have been developed, among which the Italian National Register of Historical Rural Landscapes and the China Nationally Important Agricultural Heritage Systems (China-NIAHS) initiative stand out. This research compares the China-NIAHS initiative and the Italian Register of Historical Rural Landscapes, highlighting similarities and differences and identifying strengths and weaknesses, to contribute to the development of proper tools for the conservation and valorization of agricultural heritage systems. Both initiatives were established in 2012 and share similar aims and inscription criteria, including historical and current significance, knowledge system and social structure, economic and productive framework, and causes of vulnerability. The main differences are related to the delimitation of the boundaries of the proposed sites and to the inscription process; in addition, while for the Italian National Register spatial analyses of land-use changes and landscape structure are mandatory according to a precise methodology, for the China-NIAHS no specific landscape analyses are required. The main critical issues are the lack of public participation and the lack of a monitoring plan after the inscription. The absence of monitoring is also the main vulnerability of the FAO GIAHS Programme. This research can offer important information for different stakeholders at the international, national, and local levels dealing with agricultural heritage conservation and valorization. In particular, it highlights the need of developing a multidisciplinary monitoring system with a standard methodology based on different indicators that can contribute to maximizing the impact of these initiatives. This research also provides useful information for the countries that are interested in developing a national initiative for agricultural heritage systems’ identification and valorization/conservation or for countries that intend to improve their national programs.

Integrating Entropy-based Data Reduction and Machine Learning in Multidisciplinary Engineering Systems for Enhanced Response Prediction

This research presents a framework that aims to capture and model streamlined design variables in multidisciplinary engineering systems, particularly when uncertainties are present. In multidisciplinary domains, there may be correlated design variables that are surplus, leading to data redundancy and potentially affecting the prediction of system responses. To address this issue, the framework utilizes data reduction techniques based on the correlation degree of random design variables, which are evaluated using an entropybased correlation coefficient (e). By doing so, the framework enables a more precise prediction of system responses. The data reduction process is dependent on the value of e and employs two distinct approaches. For strong correlations (high e values), feature extraction techniques such as Principal Component Analysis and the Auto-encoder algorithm are applied. On the other hand, for weak correlations, feature selection is implemented using the Independent Features Test. To effectively predict the complex responses of multidisciplinary systems while enhancing computational efficiency, the framework integrates an Artificial Neural Network. The efficacy of the proposed framework is demonstrated through examples, including a cantilever beam with randomly distributed materials and an electro-mechanical stretchable patch antenna.

A Survey of Availability and Affordability of Polypills for Cardiovascular Disease in Selected Countries.

The recent inclusion of polypills-fixed-dose combinations of antihypertensive medicines and a statin with or without aspirin-in the World Health Organization's Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for cardiovascular diseases (CVDs). Although there exists extensive evidence on the effectiveness, safety and acceptability of polypills, there has been no research to date assessing the real-world availability and affordability of polypills globally. We conducted a cross-sectional survey, based on the WHO/Health Action International methodology, in 13 countries around the world. In the surveyed countries, we first ascertained whether any polypill was authorised for marketing and/or included in EMLs and clinical guidelines. In each country, we collected retail and price data for polypills from at least one public-sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable if the lowest-paid worker spent more than a day's wage to purchase a monthly supply. Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. In the four countries, no surveyed public pharmacies stocked polypills. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Private sector availability was 100% in Argentina and Spain. Most combinations (n = 5) identified were in India. Combinations found in India and Spain were affordable in the local context. A lowest-paid government worker would spend between 0.2 (India) and 2.8 (Mauritius) days' wages to pay the price for one month's supply of the polypills. Polypills were likely to be affordable if they were manufactured in the same country. Low availability and affordability of polypills in the public sector suggest that implementation remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Cluster market of civil aviation training complex services

Classification and features of the educational services market are of interest due to the commercialisation of education and the widespread increase in the level of requirements for staff qualification. Vocational education represents a special segment of this market. The market of professional education of aviation specialists is an important and dynamically developing segment of the educational industry that can offer promising opportunities for training and career development in aviation. According to many researchers, the special importance of this element of the educational services market structure should be based on the integration of joint efforts of corporate training centres, industry agencies and the government with the needs of customers and industry standards. Personnel training itself is a complex multi-disciplinary system. Based on the research in the field of professional education of aviation specialists, the authors define the market of civil aviation simulator complexes services, characterise the market products and identify other features of the market and propose the concept of "cluster market of aviation simulator complexes services".

Dynamic Sensor Selection for Efficient Monitoring of Coupled Multidisciplinary Systems

Abstract Coupled multidisciplinary systems involve different disciplines/subsystems with feedback-coupled interactions, illustrating the complex interdependencies inherent in real-world engineering systems. Effective monitoring of a coupled multidisciplinary system is crucial for real-time assessment of the interactions between various disciplines within the system. This monitoring provides the data necessary for detecting and addressing issues in a timely manner and facilitates adaptive decision-making for taking reliable design or control actions. However, processing and analyzing data in real time is computationally intensive, and limited resources, such as computational power, sensor capabilities, and budget, may constrain the extent to which a system can be monitored comprehensively. To address this, this paper develops a particle-based approach that dynamically selects a subset of sensors that provides the highest information about the state of the system in real time. The proposed approach first predicts the amount of uncertainty in the estimation of the state of the system given noisy measurements from different subsets of available sensors. Then, it selects the sensors that reduce this uncertainty the most, enhancing the precision and efficiency of the monitoring process. The efficacy of the proposed framework is demonstrated via two coupled multidisciplinary systems in the numerical experiments.

Child life specialist services, practice, and utilization across health care: a scoping review.

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization. The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked. All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included. This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022. Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings. Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

Leveraging wastewater: Validating the national-scale SARS-CoV-2 surveillance system in Cyprus for elevated public health surveillance and enhanced epidemiological insight

The validation of a cross-country, national-scale SARS-CoV-2 wastewater surveillance system for the monitoring of public health in the Republic of Cyprus, took place during October 2021-September 2022. The chronicle of SARS-CoV-2 genetic marker concentrations and prevailing Variants of Concern (VoCs) in all large Wastewater Treatment Plants (WWTPs) of Cyprus for a continuous period of 1 year, was recorded through an integrated, multi-disciplinary sewage-based surveillance system set up to track, visualize and make the collected information and statistical analysis outcomes, publicly available. Composite sampling and physicochemical parameter normalization of Population Equivalents (PE) and SARS-CoV-2 genetic marker concentration loads were utilized.Chemical Oxygen Demand (COD) was selected for normalization of genetic fragment loads. The selection of a normalization method should be tailored according to the characteristics of each individual city/WWTP population structure, flows and wastewater origin. Metagenomic sequencing showed the transition of the SARS-CoV-2 genome from the Delta to the Omicron variant prevalence, in agreement with changes in wastewater gene concentrations. Differences in the early detection of SARS-CoV-2 genetic markers were found among cities. The established system was able to track and monitor the trend of SARS-CoV-2, even in times of absence of other public health measures such as tracing of confirmed COVID-19 cases, showing the capacity of the wastewater system to quickly capture shifts in infections.The work done herein, confirmed the ability of the national-scale system to timely observe pandemic trends, evaluate effects of control measures implemented and monitor the burden of infected patients that shed SARS-CoV-2 fragments.

Construction and Implementation of Application-Oriented Undergraduate Teaching and Teaching Evaluation System Based on Multiple Information Fusion

At present, many schools implement teaching quality evaluation systems with student performance and practical activities as the core data of evaluation. Based on the introduction of the training objectives and discipline nature of the information management and information system specialty, this paper analyzes the construction principles of the multi-disciplinary curriculum system of the specialty and puts forward relevant countermeasures for the construction of the multi-disciplinary education system. This paper introduces the definition of practical teaching evaluation system and teaching evaluation algorithm. Among them, naive Bayesian algorithm can improve the sample accuracy by 95%, so it is necessary to build an application-oriented undergraduate practice teaching evaluation system.

Shaping the future of men's sexual health: How artificial intelligence can assist in the management and treatment of erectile dysfunction

AbstractArtificial intelligence (AI) is a complex combination of multidisciplinary machines and systems that can replicate human‐like cognitive tasks to execute capabilities such as pattern recognition, decision‐making, and problem‐solving. Dating back to the 2000s, AI has been utilized in the medical field, however the interest in this subject has sharply increased over the past several years. Erectile dysfunction (ED) is an increasingly pervasive issue as men age, affecting up to 150 million men worldwide. In the field of men's health, AI has been employed to assist physicians in the evaluation and management of ED. This article aims to summarize the ways in which AI has been utilized in the management of ED, as well as the considerations that must be made when implementing this technology. AI can be utilized for virtual health assistance to protect patient privacy and increase access to care. Augmented reality can aid surgeons in real‐time during operations, as well as be utilized to prepare physicians for situations that they may encounter in the operating room. Pharmaceutical companies can benefit from AI in the interpretation of data, analysis of chemical compounds and in drug development. Additionally, AI can be used to assist patients in post‐procedure recovery in the form of rehabilitation and post‐treatment monitoring. While the utilization of AI in men's health is an exciting venture, there are tremendous ethical and practical considerations that have limited its use in the management of ED.

Development and Validity and Reliability of an Instrument to Assess Patient's Spiritual Well-Being.

Spiritual care is not limited to palliative care or end-of-life care. The spiritual well-being of patients also needs to be taken into account in the multidisciplinary healthcare system of whole person care. For medical institutions providing spiritual care, it is necessary to develop a tool for clinical spiritual care providers to assess patient's spiritual well-being of. The purpose of this study was to construct a questionnaire that would allow spiritual care providers or pastors to assess the spiritual well-being of patients. The study combined qualitative and quantitative research methods. Qualitative research used in-depth interviews or focus groups with patients and family members to obtain textual data. The text was analyzed by Colaizzi analysis. The researchers constructed the Patient's Spiritual Well-Being Scale (PtSpWBS) from the themes obtained through qualitative analysis. Through the participation of 661 patients, quantitative research was conducted to analyze the reliability, validity and component analysis of the PtSpWBS. Through qualitative research, it was found the spiritual needs of patients had two domains, namely spiritual awareness and spiritual dynamics. Based on this result, a 15-question PtSpWBS was designed. Cronbach's alpha was used to check the reliability of the PtSpWBS, and the internal consistency was calculated with a Cronbach's alpha value of 0.899. The Bartlett's Test of Sphericity of the PtSpWBS reached a significant difference (p<0.0001), and the KMO value of sampling appropriateness was 0.900. The three components were spiritual health, religion connection, and spiritual awareness. A PtSpWBS score ≦ 41 indicated the patient had poor spiritual well-being. The study constructed the PtSpWBS for clinical spiritual care providers to evaluate spiritual well-being of patients; this questionnaire has good reliability and validity. The PtSpWBS can be truly used by departments that specialize in providing spiritual care in medical institutions to conduct spiritual well-being assessment.

Perceptions regarding the multidisciplinary treatment of patients with severe trauma in Korea: a survey of trauma specialists.

Patients with multiple trauma necessitate assistance from a wide range of departments and professions for their successful reintegration into society. Historically, the primary focus of trauma treatment in Korea has been on reducing mortality rates. This study was conducted with the objective of evaluating the current state of multidisciplinary treatment for patients with severe trauma in Korea. Based on the insights of trauma specialists (i.e., medical professionals), we aim to suggest potential improvements. An online questionnaire was conducted among 871 surgical specialists who were members of the Korean Society of Traumatology. The questionnaire covered participant demographics, current multidisciplinary practices, perceived challenges in collaboration with rehabilitation, psychiatry, and anesthesiology departments, and the perceived necessity for multidisciplinary treatment. Out of the 41 hospitals with which participants were affiliated, only nine conducted multidisciplinary meetings or rounds with nonsurgical departments. The process of transferring patients to rehabilitation facilities was not widespread, and delays in these transfers were frequently observed. Financial constraints were identified by the respondents as a significant barrier to multidisciplinary collaboration. Despite these hurdles, the majority of respondents acknowledged the importance of multidisciplinary treatment, especially in relation to rehabilitation, psychiatry, and anesthesiology involvement. This survey showed that medical staff specializing in trauma care perceive several issues stemming from the absence of a multidisciplinary system for patient-centered care in Korea. There is a need to develop an effective multidisciplinary treatment system to facilitate the recovery of trauma patients.

Potential barriers to public awareness of integrated healthcare

The aim of this abstract is to focus on aspects of the regulatory framework that could potentially hinder the implementation of integrated healthcare when seen in the context of vertical integration. Integrated healthcare has been advocated in concept for a long time. International organisations, including the World Health Organisation, are promoting initiatives such as Integrated Delivery Networks, and the European Framework for Action on Integrated Health Services Delivery, which aim to support integrative approaches and reduce fragmentation of care. Within the European Union, the integrative approach is also supported by a number of initiatives and projects. At the same time, it should be borne in mind that healthcare is a multidisciplinary system in which the pharmaceutical industry also plays an important role. Moreover, the pharmaceutical sector is a highly competitive and regulated field, which is also subject to several constraints. Among them, the European Commission in its report "Competition enforcement in the pharmaceutical sector (2009-2017)" (Brussels, 28.1.2019) had reported on breaches of competition law found by national authorities related, inter alia, to vertical agreements. Vertical integration in the pharmaceutical business is seen in many countries as a competition-threatening factor when medical institutions and laboratories become owned by the pharmaceutical industry. Consequently, it can be assumed that there is a partial conceptual reluctance in society toward the introduction of "integrated healthcare". This aspect should be taken into account when working on the motivating and inhibiting factors for the introduction of integrated healthcare. This is an example of how influencing factors can be related not only to administrative issues and the involvement of doctors and patients in the implementation of integrated healthcare, but also to the public acceptance of a particular concept when there are different contextual interpretations. Thus, a clear and coherent explanation of the concept of integrated healthcare would be supportive of policymakers and the public and would facilitate the implementation of the integrated approach.

Reform and Reconstitution of Core Courses in Mechanical and Electronic Engineering Under the Background of New Engineering

With the arrival of the intelligence era of Industry 4.0, social development has shown complex and diversified characteristics, gradually forming an innovation ecological environment constructed by vertical interaction of multi-layer innovation systems and horizontal collaboration of multiple organizations and departments, which has posed extremely challenging requirements for higher engineering education to cultivate engineering talents with comprehensive engineering qualities who can solve complex engineering problems. However, practical engineering problems may involve a complex knowledge chain of interdisciplinary and multi-disciplinary cross-coupling. Therefore, higher engineering education needs to form a new interdisciplinary and multi-disciplinary integrated engineering innovation talent training system. Based on the characteristics of the mechanical and electronic engineering major, we will reshape and reconstruct the core courses of the mechanical and electronic engineering major. Two core courses are formed: Drive and Measurement and Control I and Drive and Measurement and Control II, with information flow and energy flow as the main lines, following up with the comprehensive practical curriculum system based on the unity of knowledge and practice and ability-oriented thinking, supporting teaching objectives, promoting students’ individual development, and providing guidelines for relevant curriculum reforms.

Enhancing decision-making framework for talent cultivation quality evaluation using dual Hamy mean and prioritized aggregation operators

At present, the solidification of disciplines and majors in higher education, unclear training objectives, and the need to strengthen teacher information literacy are practical problems that constrain the optimization of the “artificial intelligence+” talent training model. Scientifically adjusting training objectives, upgrading the “artificial intelligence+” talent training model in higher education by integrating multi-disciplinary curriculum systems, strengthening school enterprise cooperation, industry education integration, establishing credit recognition mechanisms and diversified evaluation mechanisms. The quality evaluation of “Artificial Intelligence+” talent cultivation in higher education in the era of education informatization 2.0 is looked as the multiple-attribute decision-making (MADM) issue. In this paper, we extended the dual Hamy mean (DHM) operator and prioritized aggregation (PA) operator to 2-tuple linguistic neutrosophic sets (2TLNSs) to propose the 2-tuple linguistic neutrosophic prioritized DHM (2TLNPDHM) operator. Finally, a decision example for quality evaluation of “Artificial Intelligence+” talent cultivation in higher education in the era of education informatization 2.0 is employed to show the 2TLNPDHM operator. The main contributions of this study are summarized: (1) the 2TLNPDHM operator is built; (2) the 2TLNPDHM operator is designed to cope with the MADM with 2TLNNs; (3) an empirical real-life example for quality evaluation of “Artificial Intelligence+” talent cultivation in higher education in the era of education informatization 2.0 is supplied to proof the designed method; (4) some comparative decision studies are used to show the rationality of the 2TLNPDHM.

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses.

Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.

Virtual hospital and artificial intelligence: a first step towards the application of an innovative health system for the care of rare cerebrovascular diseases.

The development of virtual care options, including virtual hospital platforms, is rapidly changing the healthcare, mostly in the pandemic period, due to difficulties in in-person consultations. For this purpose, in 2020, a neurological Virtual Hospital (NOVHO) pilot study has been implemented, in order to experiment a multidisciplinary second opinion evaluation system for neurological diseases. Cerebrovascular diseases represent a preponderant part of neurological disorders. However, more than 30% of strokes remain of undetermined source, and rare CVD (rCVD) are often misdiagnosed. The lack of data on phenotype and clinical course of rCVD patients makes the diagnosis and the development of therapies challenging. Since the diagnosis and care of rCVDs require adequate expertise and instrumental tools, their management is mostly allocated to a few experienced hospitals, making difficult equity in access to care. Therefore, strategies for virtual consultations are increasingly applied with some advantage for patient management also in peripheral areas. Moreover, health data are becoming increasingly complex and require new technologies to be managed. The use of Artificial Intelligence is beginning to be applied to the healthcare system and together with the Internet of Things will enable the creation of virtual models with predictive abilities, bringing healthcare one step closer to personalized medicine. Herein, we will report on the preliminary results of the NOVHO project and present the methodology of a new project aimed at developing an innovative multidisciplinary and multicentre virtual care model, specific for rCVD (NOVHO-rCVD), which combines the virtual hospital approach and the deep-learning machine system.

Usefulness of oral health assessment performed by multiple professionals using a short video recording acquired with a tablet device

Background/purposeAppropriate oral health assessment and management can improve the oral health and nutritional status of hospitalized patients. The active participation of dental professionals in the nutritional support team (NST) can help achieve this outcome. However, the participation of dental professionals in NSTs is often limited, indicating the requirement for establishing a remote oral health assessment method. This study aimed to establish a multidisciplinary oral health assessment system using short video recordings with a tablet device. Materials and methodsFifty inpatients receiving NST aid at the Tokyo Medical and Dental University Hospital were included in this study. The degree of agreement between the oral health assessment performed at the bedside and using the short video recordings of the oral health acquired with a tablet device by a single dentist and the degree of agreement for evaluations performed using the video recordings between multiple professionals were evaluated. The oral health status was assessed using the Oral Health Assessment Tool (OHAT). ResultsThe intraclass correlation coefficient (ICC) of the OHAT total scores for oral health assessment performed at the bedside and using the videos by a single dentist was 0.914 (95% confidence interval [CI], 0.854–0.950). ICCs of the OHAT total scores for the video assessment performed by dentists and multiple professionals were 0.904 (95% CI, 0.838–0.944) and 0.802 (95% CI, 0.676–0.883), respectively. ConclusionComprehensive oral health assessment of patients can be performed by multiple professionals using the short video recordings of the oral health acquired with a tablet device.