Healthcare Network Research Articles

Networks for healthcare delivery: asystematic literature review.

Network configurations have been proposed as an efficient form of organisation and a promising area of research; however, a lack of conceptual clarity can be noted. The purpose of this review is to allow for a broad appreciation of network configurations and provide guidance for future studies of the concept. A systematic literature review was conducted based on the PRISMA method; Scopus, Web of Science, PubMed and the Cochrane Library were searched for conference proceedings and journal articles describing organisational networks to integrate resources aimed at care delivery. Around 80 articles were included in the final review and analysed thematically and by use of bibliographic coupling. The last decades have seen an increase in the frequency of articles describing networks for healthcare delivery. The most common contexts are care for multiple and/or long-term conditions. Three clusters of articles were found, corresponding to different conceptualisations of networks in healthcare: efficiency-enhancing cooperation, efficiency-enhancing integration and involvement for cocreation. To increase conceptual clarity and allow the research on network configurations in healthcare to produce meta-learnings and guidance to practice, scholars are advised to provide ample descriptions of studied networks and relate them to established network classifications. The current review has only included articles including networks as a key concept, which provides a focused overview of the use of network configurations but limits the insights into similar approaches not described explicitly as networks.

A Deep Cryptographic Framework for Securing the Healthcare Network from Penetration

Ensuring the security of picture data on a network presents considerable difficulties because of the requirement for conventional embedding systems, which ultimately leads to subpar performance. It poses a risk of unauthorized data acquisition and misuse. Moreover, the previous image security-based techniques faced several challenges, including high execution times. As a result, a novel framework called Graph Convolutional-Based Twofish Security (GCbTS) was introduced to secure the images used in healthcare. The medical data are gathered from the Kaggle site and included in the proposed architecture. Preprocessing is performed on the data inserted to remove noise, and the hash 1 value is computed. Using the generated key, these separated images are put through the encryption process to encrypt what they contain. Additionally, to verify the user’s identity, the encrypted data calculates the hash 2 values contrasted alongside the hash 1 value. Following completion of the verification procedure, the data are restored to their original condition and made accessible to authorized individuals by decrypting them with the collective key. Additionally, to determine the effectiveness, the calculated results of the suggested model are connected to the operational copy, which depends on picture privacy.

Mitigating anticipated medicine shortages through inter-facility medicine sharing

This study develops an optimisation model to facilitate inter-facility medicine sharing in response to anticipated medicine shortages. These facilities include hospitals and medical representatives. We adopt the concept of collective response proposed in our study literature. The optimisation model is developed according to the real-world practices of inter-facility medicine sharing. We utilise case studies of particular healthcare networks to demonstrate the efficacy of the developed model. The efficacy encompasses the model’s application to real-world case studies, as well as its validity and reliability within a specific system. The results show that the developed model is able to determine which facilities should share the requested amount of medicines; and to reduce total lead times by at least one day compared to the ones obtained in the current practice. The model can be used as a decision-support tool for healthcare practitioners when responding to shortages. The study presents the managerial implications of medicine sharing at the network level and supports the development of collaboration amongst facilities in response to medicine shortages.

CHILDHOOD IMMUNIZATION: EDUCATION TO VACCINATE

The main objective of the National Immunization Program (PNI) is to ensure adequate immunization of the population, which requires constant updating and implementation of strategies to maximize the benefits of immunization. These strategies are essential, especially in the first years of life, when adherence to the vaccination schedule is crucial. In addition to the health impacts, failure to vaccinate minors also has significant legal implications in Brazil. According to Art. 14 of the Statute of Children and Adolescents (ECA), in 2023, the National Immunization Program (PNI) completed 50 years and with this we can see the evolution of this important and necessary policy for the Brazilian population, which guarantees vaccine security for children, which is distributed in the Health Care Networks (RAS) free of charge thanks to the Unified Health System (SUS).

Slamsex as slow edgework: Sexualized drug use and harm reduction in post-AIDS Taiwan

BackgroundSince the mid-2010s, slamsex—sexualized drug use involving intravenously injecting meth—has rapidly emerged in metropolitan gay communities as a sociosexual practice necessitating harm reduction interventions. However, its impact on gay men's sociosexual lives and HIV technologies is not well understood. This paper addresses this gap by investigating two intertwined temporal dimensions of slamsex, viewing it as a form of slow edgework in post-AIDS Taiwan. MethodsEthnographic research was conducted in Taiwan between 2022 and 2024, involving 30 interviews with gay men who practice slamsex and 7 HIV/AIDS NGO representatives. Semi-structured interviews focused on slamming events, covering their edge, transition, and healthcare network. ResultsFindings reveal paradoxes within edgework, demonstrating that slamsex can be both extreme and risky, as well as slow and mundane. Participants navigated state surveillance and the materiality of syringes through meticulous risk calculations and digital-savvy strategies for acquiring clean syringes. The practice involved risk and a networked economy of care services provided by other injectors. In response to HIV technologies (PrEP and viral load disclosure), gay men in this study normalized HIV/AIDS while developing a sense of vulnerability to their own infection. ConclusionIn the era of HIV/AIDS normalization, slamsex as slow edgework underscores the need for temporally and spatially nuanced discussions on drug policy. This study highlights the importance of culturally tailored interventions that consider slow, networked interactions to provide harm reduction for men on the chemsex scene, as well as the needs for more evidence-based, non-discriminatory research on queer sexual health and drug studies.

Human-Centered Approach for Resilience Assessment of Healthcare Networks Subjected to Sequential Earthquakes

Human-Centered Approach for Resilience Assessment of Healthcare Networks Subjected to Sequential Earthquakes

Factors influencing delay in cancer diagnosis: a qualitative study in Chile, Colombia and Ecuador

Abstract Background Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval, little is known about related factors. This study, part of EquityCancer-LA, aims to analyse the factors influencing access to cancer diagnosis from key stakeholders’ perspective in healthcare networks of Chile, Colombia, and Ecuador. Methods A qualitative, descriptive-interpretative study was conducted in two networks per country in 2023, using semi-structured individual interviews (n = 114) with a criterion sample of primary care (PC) (n = 40) and secondary/tertiary hospitals (n = 44) health/administrative professionals, managers, and policy makers (n = 30). Thematic analysis was performed, segmented by country. Results The analysis revealed interacting factors that cause cumulative delays, with differences between countries. In all, participants identified networks structural characteristics (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and limited knowledge of PC doctors, which all lead to delayed referral. In Chile and Colombia, barriers related to care rationing/prioritization policies hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Barriers related to the health system organization also emerged: in Chile, problems related to private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (authorizations; fragmented and short-term contracting of providers); and in Ecuador, health system underfunding. The barriers mostly affected the elderly, those with low socioeconomic status, limited social support networks, and rural areas residents. Conclusions The results reveal significant barriers in access to timely cancer diagnosis, which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks. Key messages • Key health system factors influencing provider delays in cancer diagnosis are identified. • Evidence is provided for the design of policies to improve timely cancer diagnosis in studied countries.

Dementia in patients with early cardiovascular complications following ischaemic stroke: A neglected complication of the stroke-heart syndrome

Abstract Background Early cardiovascular complications may occur in 20-30% of patients following following ischaemic stroke (stroke-heart-syndrome, SHS). The risk of dementia in patients with SHS remains unexplored. We aimed to quantify the risk of incident dementia in patients with SHS. Methods We conducted a retrospective analysis using a global federated health care network (TriNetX). We included patients who were discharged alive post-ischaemic stroke from 2000 to 2022. These individuals were classified into two cohorts based on the incidence of cardiovascular complications within 30 days post-stroke (acute heart failure [HF], acute myocardial infarction [AMI], ventricular fibrillation or flutter [VFF], or Takotsubo disease [TTS]), ie. those with SHS (Group 1) and those with stroke-only (without SHS; Group 2). The primary outcome was the five-year risk of dementia (vascular dementia [F01], dementia in other disease [F02], unspecified dementia [F03], Alzheimer’s disease [G30]). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis after 1:1 propensity score matching (PSM). Results We identified 70,113 patients with SHS (age 67.3±14.0; 42.2% females) and 1,092,540 patients with stroke-only (age 65.2±14.9, 48.1% females). Prior to PSM, patients with SHS were generally older and had a higher prevalence of cardiovascular treatments compared to those without SHS. Following PSM, 70,111 well-balanced patients were considered in each group, however, patients with SHS had a higher risk of dementia compared to patients with stroke-only (HR 1.25, 95%CI 1.20-1.30). Among the SHS complications, the highest dementia risks were associated with acute HF (HR 1.28, 95%CI 1.21-1.36) and AMI (HR 1.24, 95%CI 1.17-1.30), with no significant associations were found for TTS, and VFF. The increased risk of dementia in patients with SHS compared to patients with stroke-only was independent of oral anticoagulant (OAC) use, sex, and age (> or < 75 years) [Figure 1]. Conclusion Stroke-heart syndrome is associated with increased risk of dementia. Innovative strategies to identify and to prevent SHS complications would improve long-term prognosis in patients with recent stroke.

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America

Abstract Background Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador. Methods This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination. Results In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador. Conclusions The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination. Key messages • Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors. • Strengthening primary care and cross-level coordination is needed.

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.

Influence of socioeconomic aspects on morbidity and mortality rates from COVID-19 in the state of Tocantins, Brazil

This study aimed to analyze the spatial correlation of COVID-19 with social vulnerability indices in the state of Tocantins. Methodology: An ecological and cross-sectional study was conducted, analyzing the temporal evolution of the pandemic using the local bivariate Moran's index and the Kernel intensity estimator for COVID-19 cases in Tocantins from 2020 to 2022. Results: The northern region of the state showed the highest concentration of cases and deaths, a concerning fact given the high social vulnerability of most municipalities in this region. Conclusion: The study identified a positive spatial correlation between the incidence and mortality rates of COVID-19 and the social vulnerability index of the municipalities. These findings highlight the need to strengthen preventive measures and expand the physical, technological, and human resources of the healthcare network, especially in areas serving populations with higher vulnerability and traditional communities. This is particularly relevant as the disease also affects more isolated areas, impacting indigenous, riverside, and quilombola populations.

GLP-1 Receptor Agonists Confer No Increased Rates of IBD Exacerbation Among Patients With IBD.

In patients with inflammatory bowel disease (IBD), multimorbidity with obesity and type 2 diabetes is common and increasing. Glucagon-like peptide 1 (GLP-1) receptor agonists are increasingly being prescribed for patients with IBD, yet their impact on patients with IBD is largely unknown. We aimed to assess the impact of GLP-1 receptor agonists on the course of IBD. We identified all IBD patients prescribed GLP-1 receptor agonists at a large academic healthcare network between 2009 and 2023. We analyzed demographics and IBD characteristics in the year pre- and post-GLP-1 receptor agonist prescription and matched them to non-IBD controls. Our primary outcome was IBD exacerbation in the year following GLP-1 receptor agonist initiation, measured as a composite of IBD-related hospitalization, corticosteroid prescription, medication escalation or changes, or IBD-related surgery. Secondary outcomes included change in metabolic risk factors. Overall, 224 patients met inclusion criteria. At GLP-1 receptor agonist initiation, the median age was 54 years, 63% were female, 77% were White, and median BMI was 33.2kg/m2. Compared to the 12-month period prior to GLP-1 receptor agonist initiation, in the 12 months post-GLP-1 receptor agonist initiation, there was no change in rates of IBD exacerbation, IBD-related hospitalization, steroids prescription, medication escalation or changes, or IBD-related surgery. There was a significant decrease in BMI in the year following GLP-1 receptor agonist initiation (median BMI 33.5 vs 31.6kg/m2, P < .01), with rates of decrease comparable to non-IBD matched controls. In patients with IBD, GLP-1 receptor agonists are effective for weight loss and associated with few episodes of disease exacerbation.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes. Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates. Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 ( n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified ( n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded ( n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%–50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes. Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume. Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

Smart Green Cotton Textiles with Hierarchically Responsive Conductive Network for Personal Healthcare and Thermal Management.

Whereas cotton as an abundant natural cellulose has been widely used for sustainable and skin-friendly textiles and clothes, developing cotton fabrics with smart functions that could respond to various stimuli is still eagerly desired while remaining a great challenge. Herein, smart multiresponsive cotton fabric with hierarchically copper nanowire interwoven MXene conductive networks that are seamlessly assembled along a 3D woven fabric template for efficient personal healthcare and thermal comfort regulation is successfully developed. The robust hierarchically interwoven conductive network was "glued" and protected by organic conductive polymer poly(3,4-ethylenedioxythiophene) along a 3D interconnected fabric template to enhance interfacial adherent and environmental stability. Benefiting from the robust multiresponsive hierarchically interwoven conductive network, smart cotton fabric exhibits real-time response to various external stimuli (light/electrical/heat/temperature/stress), and the details of human activities can be accurately recognized and monitored. Furthermore, the porous structure of 3D smart fabric induced strong capillary force and confinement to phase change materials PEG, which exhibits a wide range of phase transition temperatures for efficient thermal comfort regulation. After further encapsulation with transparent fluorosilicone resin, the smart cotton fabric exhibits excellent self-cleaning performance with water/oil repellent. The smart multiresponsive cotton fabrics hold great promise in next-generation wearable systems for efficient personal healthcare and thermal management.

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

The clinical and genetic spectrum of paediatric speech and language disorders.

Speech and language disorders are known to have a substantial genetic contribution. Although frequently examined as components of other conditions, research on the genetic basis of linguistic differences as separate phenotypic subgroups has been limited so far. Here, we performed an in-depth characterization of speech and language disorders in 52 143 individuals, reconstructing clinical histories using a large-scale data-mining approach of the electronic medical records from an entire large paediatric healthcare network. The reported frequency of these disorders was the highest between 2 and 5 years old and spanned a spectrum of 26 broad speech and language diagnoses. We used natural language processing to assess the degree to which clinical diagnoses in full-text notes were reflected in ICD-10 diagnosis codes. We found that aphasia and speech apraxia could be retrieved easily through ICD-10 diagnosis codes, whereas stuttering as a speech phenotype was coded in only 12% of individuals through appropriate ICD-10 codes. We found significant comorbidity of speech and language disorders in neurodevelopmental conditions (30.31%) and, to a lesser degree, with epilepsies (6.07%) and movement disorders (2.05%). The most common genetic disorders retrievable in our analysis of electronic medical records were STXBP1 (n = 21), PTEN (n = 20) and CACNA1A (n = 18). When assessing associations of genetic diagnoses with specific linguistic phenotypes, we observed associations of STXBP1 and aphasia (P = 8.57 × 10-7, 95% confidence interval = 18.62-130.39) and MYO7A with speech and language development delay attributable to hearing loss (P = 1.24 × 10-5, 95% confidence interval = 17.46-infinity). Finally, in a sub-cohort of 726 individuals with whole-exome sequencing data, we identified an enrichment of rare variants in neuronal receptor pathways, in addition to associations of UQCRC1 and KIF17 with expressive aphasia, MROH8 and BCHE with poor speech, and USP37, SLC22A9 and UMODL1 with aphasia. In summary, our study outlines the landscape of paediatric speech and language disorders, confirming the phenotypic complexity of linguistic traits and novel genotype-phenotype associations. Subgroups of paediatric speech and language disorders differ significantly with respect to the composition of monogenic aetiologies.

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Trends over time in oral anticoagulation and stroke rates in atrial fibrillation: A community-based study

ObjectivesOver the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF. Materials and methodsThis community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA2DS2-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021. ResultsAmong 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (p < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both p < 0.001). In 2020, patients with CHA2DS2-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA2DS2-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %). ConclusionImprovements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.

Quantum image encryption protocol for secure communication in healthcare networks

Quantum image encryption protocol for secure communication in healthcare networks