Patient Care Management Research Articles

Approaches to improve management of patients with multiple chronic non-communicable diseases (literature review)

A large fraction of adult patients has two or more chronic diseases (multiple chronic diseases, MCD). There are often questions about the quality and availability of medical care for patients with MCD, which could drastically be improved using information technologies (IT). 
 The purpose of this work was to study medical care management for MCD patients abroad using IT. 
 This study was carried out by searching the Google system and PubMed. 
 MCD patients are characterized by a high heterogeneity. Effective processing of the flow of medical information (electronic patient registers, digital medical records, scientific knowledge, etc.) is usually feasible with the help of artificial intelligence technologies and supercomputers. To improve health care delivery to adult MCD patients there are described three dimensions for the IT development including 1) development the algorithms to support clinical decision making; 2) coordination of medical care delivery; and 3) attainment of patient self-management. 
 The presented results confirm the important role of IT in medical care. The number of scientific reports devoted to this issue is growing. The use of IT in medicine demonstrates the promise of the principles of automated analysis and the provision of additional information directly at the point of care delivery. This can improve medical processes and, to some extent, clinical outcomes, including indicators of patients’ quality of life.
 Conclusion. Additional studies based on data from real-life clinical settings are required to make 
 a comprehensive assessment of the areas of IT applicability.

Primary Care Management Pathways to Reduce Wait Times in Hematology: Monoclonal Gammopathy of Undetermined Significance

Background:Prolonged wait times are a worsening barrier to accessing specialist care in Canada and other countries across the globe. The flow of patients between primary care and specialists has been a recognized area for improvement (Liddy et al., 2020; Moir & Barua, 2021). Kingston Health Sciences Centre (KHSC) has aimed to optimize referrals through the implementation of primary care management pathways (PCMPs). PCMPs are diagnostic and/or treatment algorithms, co-developed by local primary care physicians and specialists with input from patients. They are designed to support primary care providers in managing low risk medical conditions in the community while more quickly identifying patients with higher risk conditions to be seen by specialists. A PCMP was implemented in June 2021 for Monoclonal Gammopathy of Undetermined Significance (MGUS) (https://kingstonhsc.ca/refer/hematology). This asymptomatic condition with low levels of monoclonal protein in the blood or urine has an approximately 1% per year risk of transforming to a hematological malignancy such as multiple myeloma (Kyle et al., 2018). The MGUS PCMP outlines diagnostic criteria, management, and monitoring instructions for low-risk MGUS along with patient information. “Red flag” features, such as renal impairment, anemia or significantly increased monoclonal protein levels, are used to highlight those who need urgent referral. The aim of this study is to evaluate the impact of an MGUS PCMP on wait times in Hematology in Kingston, Ontario. Methods:All consecutive outpatient Hematology referrals received at KHSC from January 2021 to December 2022 were reviewed. Monthly outcome measures included the number of new referrals and median wait times for patients seen. Number of MGUS referrals deferred to the PCMP was included as a process measure. Monthly balancing measures included number of re-referrals of PCMP patients, number of deaths without being seen for MGUS, and number of new multiple myeloma diagnoses. To compare 6-month pre-PCMP implementation (January 2021 to June 2021) with 18-month post-PCMP implementation (July 2021 to December 2022), generalized linear regression analysis was conducted. p < 0.05 was considered statistically significant. A survey of primary care providers was distributed through the regional Primary Care Physicians' Council to assess primary care satisfaction with the PCMP. Results: Between January 2021 and December 2022, 4504 Hematology referrals were received, 278 (6%) of which were MGUS referrals. 76 (27%) of MGUS referrals were deferred to the PCMP. There was a significant increase in monthly Hematology referrals from a mean (± standard deviation (SD)) of 163.0 (± 13.9) pre-PCMP to 195.9 (± 27.3) post-PCMP (p<0.0001). There was no significant difference in mean monthly MGUS referrals pre-and post-PCMP (11.7 ± 4.7 versus 11.6 ± 3.5). Hematology's median wait time for those seen fell from a median (interquartile range (IQR)) of 51.3 days (13) pre-PCMP to 28.5 days (11) post-PCMP (p < 0.0001). The MGUS median wait time also fell from a median (IQR) of 40.5 days (59) to 37.0 days (32.5) (p < 0.0001). No significant difference was noted in the balancing measures. Pre-PCMP to post-PCMP, the mean number of deaths without being seen for MGUS (0.17 ± 0.41 versus 0.17 ± 0.38, p=0.36) and mean monthly new multiple myeloma diagnoses (5.17 ± 1.94 versus 5.17 ± 2.50, p = 0.54) remained stable. There were 7/76 (9.2%) re-referrals of patients deferred to the PCMP, with a median (IQR) time to re-referral of 64 days (348). A survey to assess primary care provider satisfaction with the PCMP included a total of 28 respondents; 19/28 (67.9%) reported using PCMPs. On a scale of 0 to 5, where 5 is the highest satisfaction, the median (IQR) overall experience was 4/5 (1.5) and impacts on supporting patient care and changing management were also 4/5 (1). The most common concern, raised by 7/28 respondents (25%), was the downloading of more work to primary care. Conclusion: The MGUS PCMP was associated with reduction in wait times for overall Hematology and MGUS despite an increase in referrals. Limitations of this study include concurrent changes in the program, including staffing and the COVID-19 pandemic. These results suggest that PCMPs may be an effective tool to address Hematology wait times, likely best complemented with other strategies to avoid overburdening primary care providers.

NOVEL STUDY ON CLINICAL DECISION SUPPORT SYSTEM

A Clinical Decision Support System (CDSS) in Computational Biology is like a smart assistant for doctors. It uses computer science and biological data to help doctors make better decisions in healthcare. It looks at complex biological information to give insights into diagnosing diseases, choosing treatments, and managing patient care. This system tailors recommendations to each patient, making diagnoses more accurate and improving patient health. CDSS is a crucial part of modern medicine, using data to change how doctors make decisions and advancing personalized treatments in genomics, drug development, and predicting diseases. Keywords: CDSS, Smart Assistant, Healthcare Service, Diagnosing Diseases, Choosing Treatments.

Compliance with Health Care Quality Standards in Government Accredited Hospitals in the Province of Albay

Global health systems operate within ever-evolving local and global environments, influenced by various factors, including economic shifts, demographic dynamics, and technological advancements, among other variables. A study was conducted to determine the Health Care Quality Standards among the government-accredited hospitals in the province of Albay. Specifically, it identified the status of Health Care Quality Standards in the Province of Albay along with Policies and Procedures, Services, Human Resources, Budget, and Logistical Resources. It determines the Health Care Quality Standards among the government-accredited hospitals in the province of Albay regarding Patient Care Management, Human Resource Management, Information Management, and Safe Practice and Environment. The quantitative method was used to gather responses from respondents. The respondents of the study are personnel from the top and middle management and selected patients in the three hospitals. Hence, the study revealed that the Health Care Quality Standards among the government-accredited hospitals in the province of Albay are complied with based on the requirements set forth by the hospitals among the four components. Thus, it ensures that health services are responsive to the needs of targeted individuals and communities and encourages the role of communities as co-producers of health. The study recommends a sustainable healthcare management framework to strengthen and sustain comprehensive healthcare services, thus improving the community's quality of life.

The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey

BackgroundThe COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova.MethodsWe present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic.ResultsResults highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking.ConclusionsDuring the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.

L’entourage et la prise en charge psychiatrique ambulatoire en milieu pénitentiaire : enquête menée auprès des structures d’accompagnement vers la sortie implantées en France

ObjectivesA specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison. MethodsThis study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as “SAS” in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled. ResultsSixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients’ entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care. ConclusionsCurrently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrating family and friends into care can be achieved by taking the concrete steps set out in this study, in order to provide optimum care and overall patient management.

Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study

Background/AimNutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. MethodsThis multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. ResultsA total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24hours of admission. On the study day, the median energy intake of the patients during the last 24hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU. ConclusionNutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.

KNOWLEDGE ATTITUDE AND PRACTICES ABOUT ENDOSCOPY PROCEDURES AMONG NURSES OF NISHTAR HOSPITAL MULTAN

This study explores nurses' knowledge, attitudes, and practices in gastrointestinal endoscopy procedures, focusing on nurses from Nishtar Hospital Multan. It explores their understanding and practical application of endoscopy protocols and their pivotal role in patient care and procedure management. In a cross-sectional study conducted at Nishtar Hospital Multan, data was collected from 150 nurses using a Likert scale questionnaire. The research considered participants willing to participate and provided informed consent. Data analysis was carried out using SPSS software. The demographic profile of the nurses revealed a predominantly female workforce (56%). Age-wise, the majority were under 45 years old (38%). About 80% held a diploma degree, indicating specialized training. A significant portion had eight years of work experience (82%). In terms of endoscopy experience, 72.7% had less than 10 years. Most received training (82%) and were vaccinated against Hepatitis B (82%). In terms of attitudes and practices, the nurses displayed a high level of agreement with key hygiene and infection control practices, such as handwashing, with 100% agreement in some cases. They also recognized the importance of infection prevention through measures like masks, gowns, and gloves . Furthermore, they acknowledged the significance of patient comfort and the need to provide information to patients during endoscopy. The study reveals that while nurses possess strong knowledge and positive attitudes toward endoscopy procedures, ongoing training and continuous assessment are necessary to ensure optimal practices. Nurses play a crucial role in patient care and procedural success, prioritizing their comprehensive education and training. Further research and periodic evaluation can drive improvements in their work's theoretical and practical aspects, ultimately enhancing patient outcomes and safety in endoscopy units.

Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending

The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. High- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. ClinicalTrials.gov Identifier: NCT04047147.

Aptasensors: employing molecular probes for precise medical diagnostics and drug monitoring.

Accurate detection and monitoring of therapeutic drug levels are vital for effective patient care and treatment management. Aptamers, composed of single-stranded DNA or RNA molecules, are integral components of biosensors designed for both qualitative and quantitative detection of biological samples. Aptasensors play crucial roles in target identification, validation, detection of drug-target interactions and screening potential of drug candidates. This review focuses on the pivotal role of aptasensors in early disease detection, particularly in identifying biomarkers associated with various diseases such as cancer, infectious diseases and cardiovascular disorders. Aptasensors have demonstrated exceptional potential in enhancing disease diagnostics and monitoring therapeutic drug levels. Aptamer-based biosensors represent a transformative technology in the field of healthcare, enabling precise diagnostics, drug monitoring and disease detection.

Personal Health Literacy and Life Simple 7: The Multi-Ethnic Study of Atherosclerosis

ABSTRACT Background Personal Health literacy (PHL) is essential in cardiovascular risk management. Hindrances in PHL can lead to poor cardiovascular outcomes. Purpose To investigate whether limited PHL is associated with lower likelihoods of i) overall cardiovascular health and ii) individual cardiovascular health components as defined by the American Heart Association’s Life Simple (LS7). Methods Multi-Ethnic Study of Atherosclerosis participants (N = 3719; median age[range]: 59[45–84]) completed a PHL questionnaire in 2016–2018. PHL was classified as limited (score ≥10) or adequate (score <10). LS7 components were measured in 2000–2002. Robust Poisson regression was employed to compute prevalence ratios and 95% confidence intervals (PR[95%CI]) of LS7 measures. Results 14.7% of participants had limited PHL. Limited PHL was associated with lower likelihoods of optimal LS7 (0.69[0.50, 0.95], p = .02) and average LS7 (0.95[0.88, 1.02], p = .15) after adjustment. Limited PHL was significantly associated with a 7% lower likelihood of ideal fasting blood glucose level after adjustment (0.93[0.89, 0.98], p < .01). Discussion Limited PHL was modestly associated with suboptimal cardiovascular health and elevated blood glucose, independent of income and education. Translation to Health Education Practice Health educators and providers should equitably address PHL barriers to improve cardiovascular management and quality of care for patients and communities.

'Corridor care' in the emergency department: managing patient care in non-clinical areas safely and efficiently.

Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end - or at least reduce - corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs.

Quality Assurance and Safety Culture in a Healthcare Organization

Patient care and quality management have as one of their primary focuses ensuring the safety of their patients. The four principles of biomedical ethics presented by Beauchamp and Childress are one quality management paradigm that emphasizes the importance of the patient. The Institute of Medicine's six improvement goals capture the essence of excellent medical treatment. Care, money, and health are the three pillars upon which the Institute for Healthcare Improvement's Triple Aim rests. The present review was written with the aforementioned contexts in mind, with the intention of highlighting the system's initiatives to address various efforts of enhancing quality and patient safety. We provide a reflective overview of healthcare legislation, policy, and regulation with special attention paid to the ideas of informed consent and informed refusal. This analysis also details the steps taken and regulations enforced by the administration and management to provide care that is focused on the individual patient. Finally, we discuss model policies like the Delivery System Reform Incentive Payment Program, which incorporates quality management frameworks, the Hospital-Acquired Conditions Reduction Program, which promotes patient safety, and the Hospital Readmissions Reduction Program, which aims to reduce hospital readmissions.

Electronic medical record and its impact on health care and management. A systematic review between the years 2013 – 2023

The adoption of Electronic Health Records (EHR) has revolutionized the landscape of healthcare and healthcare management in recent decades. These technological systems have been the subject of extensive interest and study to understand their impact on improving patient care and efficiency in health management. For this reason, this study proposes to evaluate the impact of the use of electronic medical records on health care and management. In addition, the study includes a systematic review of the literature of research carried out between 2013 and 2023 on the use of the Electronic Health Record (EHR) focused on patient care and health management. The PICO methodology was used to formulate the search equation in the Scopus database. To select the studies, the PRISMA methodology was used through 3 stages: identification, screening, and inclusion, obtaining a total of 17 articles for review, according to inclusion and exclusion eligibility criteria. At the beginning of the systematic search, 56400 studies were found, 5220 were related to health care, 244 researchers work carried out between 2013 and 2023 focused on health management. Also, 17 studies obtained at the end of the third search stage, 42,11 % indicated that the EHR facilitates medical care, 21,05 % indicated that it provides better safety and greater patient satisfaction. On the other hand, 36,36 % and 45,45 % mentioned that with the EHR there is a good quality of care and better clinical management, respectively, compared to the use of paper medical records. In conclusion, the EHR offers benefits in medical care and facilitates decision making at the health management level. Its interoperability means that clinical management is integrated with all other medical systems to provide quality care, despite certain limitations that persist in the health field.

Chronic care Management in diabetes patients: the role of telemedicine

Il Diabete Mellito (DM) è una delle malattie cronico-degenerative più diffuse nella popolazione, con implicazioni sanitarie e sociali di grande rilevanza. L’utilizzo delle tecnologie nel trattamento del diabete ha dimostrato di migliorare il controllo glicemico riducendo le ospedalizzazioni e i costi. La disponibilità e l’equità di accesso alle tecnologie e alle cure innovative sono quindi strumenti fondamentali per la gestione del paziente diabetico. Il presente progetto ha incluso pazienti con Diabete Mellito tipo 1 (DMT1) in terapia insulinica con sistemi integrati (sensore-microinfusore) o con sistemi Hybrid Closed-loop e pazienti DMT1 in terapia insulinica multiniettiva (MDI) con sensore Glucose Continuos Monitoring (CGM) o Flash Glucose Monitoring (FGM) o che utilizzavano ancora autocontrollo capillare (SMBG). Le prestazioni consistevano in visite ambulatoriali di controllo atte a valutare il compenso glicemico dei pazienti, rispettando un timing di follow up adeguato alle esigenze cliniche. L’obiettivo del contributo è quello di costituire un PDTA per l’erogazione dei servizi di telemedicina con particolare riferimento alla televisita e al telemonitoraggio. I dati relativi agli indicatori analizzati hanno dimostrato risultati soddisfacenti. Sebbene il periodo di analisi sia stato breve, questi dati potrebbero risultare utili per migliorare le performance dei servizi di Diabetologia, se proiettati in archi temporali più ampi. I risultati dell’analisi mostrano un miglioramento dell’accessibilità, una riduzione del tempo di visita, dei tempi di attesa, delle settimane per il completamento delle visite programmate e il miglioramento del compenso glicemico. La telemedicina, nelle sue declinazioni di televisita, teleconsulto, telemonitoraggio e teleassistenza, è uno strumento che si inserisce nello scenario dell’assistenza alla cronicità con lo scopo di fornire risposte adeguate alle domande di maggiore efficienza nella gestione del paziente cronico. Il nuovo modello di presa in carico del cittadino è costruito attorno alla parola “prossimità”, con potenziamento delle cure domiciliari affinché la casa possa diventare il luogo privilegiato dell’assistenza. PAROLE CHIAVE diabete mellito tipo 1; closed-loop; telemedicina; Percorso Diagnostico Terapeutico Assistenziale (PDTA); prossimità.

Clinicopathological Characteristics of Patients with Ovarian Carcinoma in a Tertiary Care Center of the Sub-Himalayan Region: An Ambispective Study

Abstract Background and Objective: The ovary is considered one of the complex organs with respect to histology, embryology, steroidogenesis, as well as tumor incidence. In order to attain a better knowledge of the disease mechanism, the current research highlights a correlation between the pathological and clinical features of epithelial ovarian carcinoma. The aim of this research is to evaluate the oncological and clinicopathological results of patients who were diagnosed with ovarian cancer (OC) in a tertiary care center situated in the Sub-Himalayan region. Materials and Methods: Seventy patients with OC registered at the department of surgical oncology, obstetrics and gynecology, and medical oncology between January 2019 and December 2021 had been estimated in this prospective and retrospective observational research. Age, histological type, stage at presentation, and treatment pattern were the characteristics examined in the patients. Results: The patients’ average age was 48.18 ± 12.309 years, having a maximum age of 74 years as well as the minimum age of 21 years. The most frequent symptom was abdominal pain (30%). Hypertension was the most commonly seen comorbidity in 7 (10%) patients. Most of the patients had high-grade serous carcinoma in 40 (56.1%) patients. Neoadjuvant chemotherapy and adjuvant type of chemotherapy were given to 30 (42.9%) patients. After 3 months, follow-up imaging showed that there was no residual disease in 51 (72.8%) patients, and the disease progression was seen in 8 (11.4%) patients. Conclusion: Because of their clinical correlation, behavioral predictability, as well as proper management of patient care, the right clinicopathological detection of ovarian tumors is extremely important.

Nursing care management in substitutive renal therapy in patients with COVID-19: integrative review

Introducción: Among the systems most affected by COVID-19, the renal system stands out, which leads to challenges in the management of nursing care for these patients. Objective: To describe the scientific evidence on nursing care management in patients diagnosed with COVID-19 undergoing Renal Replacement Therapy. Methodology: Articles were searched in PubMed, SCOPUS, Web of Science, LILACS, BDENF, EMBASE, IBECS, CINAHL, COCHRANE LIBRARY, and Scielo databases, using the following cross-references: “renal therapy” AND “nursing care” AND “covid-19”. To systematize the searches, the Boolean operator “AND” was used. Initially, 167 primary references were identified in the selected databases/virtual library, and as a final sample, 14 articles were included. Results: It was found that among the contributions to nursing care management in hemodialysis patient care in the context of the COVID-19 pandemic, the use of health technologies (examples: use of telehealth and the development of new protocols), development of new methods in nursing care management and continuing education are described in the literature. These tools were essential for the continuity of nursing care. Conclusion: Among the tools used for nursing care management in the context of the pandemic of COVID-19 in hemodialysis patients, health technologies and continuing education in health are included, enabling qualified care management.

The Use of Embedded IMU Insoles to Assess Gait Parameters: A Validation and Test-Retest Reliability Study.

Wireless wearable insoles are interesting tools to collect gait parameters during daily life activities. However, studies have to be performed specifically for each type of insoles on a big data set to validate the measurement in ecological situations. This study aims to assess the criterion validity and test-retest reliability of gait parameters from wearable insoles compared to motion capture system. Gait of 30 healthy participants was recorded using DSPro® insoles and a motion capture system during overground and treadmill walking at three different speeds. Criterion validity and test-retest reliability of spatio-temporal parameters were estimated with an intraclass correlation coefficient (ICC). For both systems, reliability was found higher than 0.70 for all variables (p < 0.001) except for minimum toe clearance (ICC < 0.50) with motion capture system during overground walking. Regardless of speed and condition of walking, Speed, Cadence, Stride Length, Stride Time and Stance Time variables were validated (ICC > 0.90; p < 0.001). During walking on treadmill, loading time was not validated during slow speed (ICC < 0.70). This study highlights good criterion validity and test-retest reliability of spatiotemporal gait parameters measurement using wearable insoles and opens a new possibility to improve care management of patients using clinical gait analysis in daily life activities.

An Efficient Binary Sand Cat Swarm Optimization for Feature Selection in High-Dimensional Biomedical Data.

Recent breakthroughs are making a significant contribution to big data in biomedicine which are anticipated to assist in disease diagnosis and patient care management. To obtain relevant information from this data, effective administration and analysis are required. One of the major challenges associated with biomedical data analysis is the so-called "curse of dimensionality". For this issue, a new version of Binary Sand Cat Swarm Optimization (called PILC-BSCSO), incorporating a pinhole-imaging-based learning strategy and crossover operator, is presented for selecting the most informative features. First, the crossover operator is used to strengthen the search capability of BSCSO. Second, the pinhole-imaging learning strategy is utilized to effectively increase exploration capacity while avoiding premature convergence. The Support Vector Machine (SVM) classifier with a linear kernel is used to assess classification accuracy. The experimental results show that the PILC-BSCSO algorithm beats 11 cutting-edge techniques in terms of classification accuracy and the number of selected features using three public medical datasets. Moreover, PILC-BSCSO achieves a classification accuracy of 100% for colon cancer, which is difficult to classify accurately, based on just 10 genes. A real Liver Hepatocellular Carcinoma (TCGA-HCC) data set was also used to further evaluate the effectiveness of the PILC-BSCSO approach. PILC-BSCSO identifies a subset of five marker genes, including prognostic biomarkers HMMR, CHST4, and COL15A1, that have excellent predictive potential for liver cancer using TCGA data.

Exploring Gender Disparities in the Prevalence and Clinical Characteristics of Atherosclerotic Cranial Stenosis.

Background Atherosclerotic cranial stenosis (ACS) is a significant contributor to vascular events, including ischemic strokes. While early clinical studies suggested a divergence in the distribution of intracranial and extracranial stenosis between genders, recent evidence has highlighted the complexity of these disparities. Therefore, this study aims to investigate gender differences in the prevalence and clinical characteristics of atherosclerotic cranial stenosis in patients admitted with stroke. Methods This cross-sectional study was conducted at a tertiary care hospital located in the Southern Region of Saudi Arabia between June 2022 and December 2022. It included patients of all age groups who had been diagnosed with an ischemic stroke during the study period. Data were collected from electronic health records and medical archives, and data analysis was performed using Statistical Package for the Social Sciences (SPSS version 26, IBM Inc., Chicago, IL, USA). Results In our study, 201 stroke patients were analyzed, with 161 (80.09%) identified as having atherosclerotic stenosis. Of these, 57.8% were male, and 42.2% were female. Gender disparities were evident, with higher stenosis prevalence in males (46.27% vs. 33.83% in females). Significant gender differences were observed in dyslipidemia (p = 0.013), metabolic syndrome (p = 0.019), and smoking habits (p < 0.001). Males exhibited higher rates of extracranial stenosis (p = 0.012) and combined stenosis (p = 0.009) compared to females; however, females exhibited higher rates of intracranial stenosis (p = 0.013). Further analyses revealed significant associations in dyslipidemia (adjusted odd ratio (AOR): 0.245, p = 0.004), metabolic syndrome (AOR: 5.159, p = 0.006), obesity (AOR: 8.085, p = 0.016), smoking habits (AOR: 0.002, p < 0.001), and intracranial stenosis (AOR: 5.667, p = 0.005) within the female cohort. Conversely, age, hypertension, diabetes mellitus, ischemic heart disease, and extracranial stenosis did not show statistically significant associations in females (p > 0.05). Conclusion We observed a substantial presence of atherosclerotic cranial stenosis, with males showing higher rates, and identified significant gender-related variations in dyslipidemia, metabolic syndrome, and smoking habits as important factors. This highlights the necessity of tailoring ACS assessment and treatment by considering gender-specific risk factors and clinical characteristics for improved patient care and stroke management.