Patient Care Management Research Articles

Optimizing data management in healthcare: Lessons from clinical trials and beyond

This study comprehensively explores the optimization of data management in healthcare by drawing on lessons learned from clinical trials and extending these insights to broader healthcare contexts. The study's purpose is to examine the challenges, strategies, and technological innovations that are essential for effective data management in modern healthcare systems. Utilizing a detailed literature review, the study identifies key methodologies from clinical trials that have successfully enhanced data integrity, accuracy, and security, such as the implementation of electronic data capture (EDC) systems and rigorous data governance frameworks. These methods are crucial in managing the increasing volume and complexity of healthcare data. The study's findings reveal that big data analytics and artificial intelligence (AI) are pivotal in transforming healthcare data management, enabling personalized and precise patient care. However, these technologies also introduce challenges related to data security, interoperability, and ethical considerations, particularly concerning patient privacy and the transparency of AI-driven decision-making processes. In conclusion, the study emphasizes the need for continuous innovation and improvement in healthcare data management practices. Recommendations include the integration of blockchain technology, cloud computing, and real-time data from wearable devices to address existing challenges and enhance data management capabilities. The study advocates for a balanced approach that prioritizes patient privacy, ethical governance, and regulatory compliance to ensure that technological advancements contribute positively to patient outcomes and healthcare efficiency.

Polycythemia under Clozapine: A Case Study

Clozapine is widely recognized as a last-resort treatment for resistant schizophrenia, due to its efficacy in reducing persistent symptoms and lowering the risk of suicidal behavior. However, its use is limited by severe side effects, including hematological complications such as agranulocytosis. A less documented but significant complication is clozapine-induced polycythemia. This case study explores the development of polycythemia in a patient undergoing clozapine treatment for refractory schizophrenia. Despite the reduction of clozapine doses, polycythemia persisted, necessitating continued treatment due to the lack of alternative therapeutic options. The patient’s hematological abnormalities were managed through regular phlebotomies, and close collaboration between psychiatric and hematological services. This case emphasizes the importance of rigorous hematological monitoring in patients on clozapine and calls for further research into its effects on the hematopoietic system, particularly concerning polycythemia. The mechanisms underlying this association are not well understood but may involve immune-mediated responses, bone marrow alterations, and metabolic changes, necessitating multidisciplinary management for optimal patient care.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.

Continuous Catheter Techniques Versus Single-Injection Nerve Blocks: A Comprehensive Review of Postoperative Pain Management Strategies.

Effective postoperative pain management is crucial for optimizing patient recovery and enhancing surgical outcomes. This review compares two prominent regional anesthesia techniques, continuous catheter techniques and single-injection nerve blocks, focusing on their efficacy, safety, and impact on patient outcomes. Single-injection nerve blocks involve administering a one-time anesthetic dose to a specific nerve or plexus, offering immediate but transient pain relief. In contrast, continuous catheter techniques utilize a catheter to deliver a continuous infusion of anesthetic, providing extended analgesia. The review synthesizes current evidence on the effectiveness of each method, highlighting that single-injection blocks are advantageous for their simplicity and rapid onset but may require supplementary pain management for longer procedures. Continuous catheter techniques, while offering prolonged pain relief, carry risks such as infection and catheter displacement. The comparative analysis of these techniques reveals that both have distinct roles in postoperative care, with choice depending on the surgical procedure and patient needs. Patient satisfaction, recovery times, and overall outcomes are critical factors in determining the optimal pain management strategy. Future research should focus on refining these techniques and exploring innovations to improve patient care and pain management outcomes. This review provides insights for clinicians to make informed decisions about postoperative pain management to enhance patient comfort and recovery.

A clinical decision support tool for metabolic dysfunction-associated steatohepatitis in real-world clinical settings: a mixed-method implementation research study protocol.

Aim: A clinical decision support (CDS) tool for metabolic dysfunction-associated steatohepatitis (MASH) was developed to align health systems with clinical guidelines detailed in the MASH Clinical Care Pathway and improve patients' proactive self-management of their disease. The tool includes a provider-facing web-based application and a mobile application (app) for patients. This protocol outlines a pilot study that will systematically evaluate the implementation of the tool in real-world clinical practice settings. Materials & methods: This implementation research study will use a simultaneous mixed-methods design and is guided by the Consolidated Framework for Implementation Research. The CDS tool for MASH will be piloted for ≥3months at multiple US-based sites with eligible gastroenterologists and hepatologists (n=5-10 per site) and their patients (n=50-100 per site) with MASH or suspected MASH. Each pilot site may choose one or all focus areas within the tool (i.e., risk stratification, screening and referral, or patient care management), based on on-site capabilities. Prior to and at the end of the pilot period, providers and patients will complete quantitative surveys and partake in semi-structured interviews. Outcomes will include understanding the feasibility of implementing the tool in real-world clinical settings, its effectiveness in increasing patient screenings and risk stratification for MASH, its ability to improve provider and patient knowledge of MASH, barriers to adoption of the tool and the tool's capacity to enhance patient engagement and satisfaction with their care. Conclusion: Findings will inform the scalable implementation of the tool to ensure patients at risk for MASH are identified early, referred to specialty care when necessary and managed appropriately. Successful integration of the patient app can contribute to better health outcomes for patients by facilitating their active participation in the management of their condition.

Community members’ perceptions of community health workers in Melusi, Tshwane, South Africa

Background: Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities.Aim: This study aimed to explore the perception held by the community members regarding CHWs’ contribution to health promotion in Melusi informal settlements within the Tshwane district.Setting: The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa.Methods: Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs’ data to identify individuals with direct interaction with CHWs.Results: Participants praised CHWs’ communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility.Conclusion: The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community.Contribution: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.

PREVENT Equation: The Black Sheep among Cardiovascular Risk Scores? A Comparative Agreement Analysis of Nine Prediction Models in High-Risk Lithuanian Women.

Background and Objectives: In the context of female cardiovascular risk categorization, we aimed to assess the inter-model agreement between nine risk prediction models (RPM): the novel Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation, assessing cardiovascular risk using SIGN, the Australian CVD risk score, the Framingham Risk Score for Hard Coronary Heart Disease (FRS-hCHD), the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Materials and Methods: A cross-sectional study was conducted on 6527 40-65-year-old women with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the nine RPMs, and the results were categorized into high-, intermediate-, and low-risk groups. Inter-model agreement was quantified using Cohen's Kappa coefficients. Results: The study uncovered a significant diversity in risk categorization, with agreement on risk category by all models in only 1.98% of cases. The SCORE2 model primarily classified subjects as high-risk (68.15%), whereas the FRS-hCHD designated the majority as low-risk (94.42%). The range of Cohen's Kappa coefficients (-0.09-0.64) reflects the spectrum of agreement between models. Notably, the PREVENT model demonstrated significant agreement with QRISK3 (κ = 0.55) and PCE (κ = 0.52) but was completely at odds with the SCORE2 (κ = -0.09). Conclusions: Cardiovascular RPM selection plays a pivotal role in influencing clinical decisions and managing patient care. The PREVENT model revealed balanced results, steering clear of the extremes seen in both SCORE2 and FRS-hCHD. The highest concordance was observed between the PREVENT model and both PCE and QRISK3 RPMs. Conversely, the SCORE2 model demonstrated consistently low or negative agreement with other models, highlighting its unique approach to risk categorization. These findings accentuate the need for additional research to assess the predictive accuracy of these models specifically among the Lithuanian female population.

<i>Helicobacter pylori</i> and <i>Treponema pallidum</i> (syphilis) co-infection among HIV patients attending a private clinic in Warri, Delta State, Nigeria

This delve examined the periodicity of polyinfection of Helicobacter pylori and Treponema pallidum in HIV-infected individuals who visited Capitol Hills Clinic in Warri, Delta State, Nigeria. Syphilis and H. pylori infections are major worldwide health issues that have diverse clinical presentations and consequences. It is essential to comprehend the co-infestation rates of syphilis and H. pylori in HIV patients to effectively manage patient care, given the resurgence of syphilis and the ongoing incidence of H. pylori. A study employing a cross-sectional design was carried out, which included a hundred individuals living with HIV who were receiving medical treatment at Capitol Hills Clinic. Blood samples were obtained and examined using fast diagnostic test kits to spot the existence of H. pylori and Treponema pallidum. The study involved the analysis of demographic characteristics, such as occupation, age, marital status, religion, and sex, to discover how these components are related to the prevalence of co-infestation. Results from the study showed that 67% of HIV-infected patients had a significant co-infection incidence of H. pylori, but no cases of Treponema pallidum were observed. The incidence of H. pylori differed among various age groups, with the greatest incidence seen among those aged 21-40 years (71%). Gender-wise, males showed a somewhat greater prevalence (69%) compared to females (65%). Marital status seems to have an impact on the prevalence, as married persons exhibited a greater prevalence rate of 71% compared to singles, who had a prevalence rate of 64%. The findings underscore the significance of frequent screening for H. pylori and syphilis co-illnesses among HIV patients, especially in places with a high burden of both infections like Nigeria. These co-infections might complicate the clinical management of HIV, potentially leading to increased morbidity and mortality.

WP7.12 - The Impact of a ‘Golden Abscess Pathway’ in a Tertiary Teaching Hospital to Optimize Acute Abscess Management

Abstract Introduction The 'Golden Patient' initiative targets operating room efficiency by pre-selecting initial patients, especially beneficial for non-urgent emergencies like abscesses. Anorectal abscesses often face treatment delays due to the prioritization of critical cases. WSES guidelines advocate prompt incision and drainage (I&D) within 24 hours, recommending outpatient management for suitable patients. This study aims to establish an ambulatory 'Golden Abscess Pathway' in a tertiary teaching hospital and assess its impact on acute abscess management efficiency. Patients and Methods This retrospective study at the Leeds Institute of Emergency General Surgery included individuals undergoing I&D for acute abscesses. The pre-pathway cohort spanned 03/01/2023 to 28/04/2023, with the 'Golden Abscess Pathway' implemented on 19/06/2023. The post-pathway cohort covered 19/06/2023 to 16/10/2023. The analysis focused on patient demographics and intervention timelines. Results The study included 199 patients, with 93 pre-pathway (55M: 38F, mean age 34.3 ± 14.5 years) and 106 post-pathway (70M: 36F, mean age 35.4 ± 13.3 years). The 'Golden Abscess Pathway' reduced the average duration from consultation to operation (1.73 days vs. 2.75 days), advanced median operation start time (09:20 vs. 09:47), and decreased overnight stays (34.9% vs. 44.1%). Conclusion Implementation of the 'Golden Abscess Pathway' demonstrated positive outcomes, reducing delays in patient management. These results highlight the pathway's potential to enhance efficiency and overall patient care in acute abscess management.

Minimally invasive technique facilitates early extubation after cardiac surgery: a single-center retrospective study

BackgroundPostoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation.MethodsData from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People’s Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan–Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed.ResultsAfter propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01).ConclusionsSuccessful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate.

The benefits of nursing professional governance nursing research and evidenced-based practice councils for new graduate nurses

New graduate nurses are an untapped population for nursing professional governance and nursing research and evidenced-based practice councils. New graduate nurses can offer new insights into the management of patient care and nursing workflow. By educating new graduate nurses about the benefits of nursing research and evidence-based practice councils at the start of their careers, an early standard of excellence in the empowerment of applying evidenced-based practice principles to improve patient care quality can occur. This narrative literature inquiry explores new graduate nurses perspective of research and evidence-based practice councils, with the targeted goal of engagement for professional and personal growth as a nurse leader.

The Effect of Nursing Moral Distress on Intent to Leave Employment.

This study explored the impact of moral distress (MD) and respondent characteristics on intent to leave employment. Managing patient care, within organizational constraints, may create physical discomfort or mental peace disturbances such as MD, negatively impacting RN retention. Responses from 948 RNs were collected using an anonymous online survey. The impact of MD on intent to leave employment was explored. MD was significantly higher among RNs intending to leave employment. System-level and team-level integrity attributes were significant factors predicting intent to leave, controlling for potential confounders. The odds of intending to leave were 147% higher for new graduate RNs, 124% higher for direct care RNs, and 63% higher for 2nd-career RNs. Gender and race were not significant predictors. Exploring root causes contributing to MD frequency and severity is critical to maintain a healthy work environment. Mitigating MD in the work environment may enhance nursing practice and improve patient care. Support for new graduate and 2nd-career RNs can be realized, further reducing turnover for these vulnerable populations of the nursing workforce.

Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease.

Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. To investigate the risk of adverse events after COPD exacerbations in patients with atrial fibrillation (AF) treated with azithromycin prophylaxis. Retrospective cohort study within the TriNetX Platform, including AF patients with COPD exacerbations. Risks of primary and secondary outcomes were recorded up to 30days post-COPD exacerbations and compared between azithromycin users and azithromycin non-users. The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.

COVID-19 associated pulmonary embolism: clinical, biochemical and CT imaging findings.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represented a disruptive pathology that emerged in late 2019 with profound implications ranging from individual health to health systems and world economy. Our study aimed to evaluate clinical, biochemical and computerized tomography (CT) parameters values in determining the severity of pulmonary embolism (PE) associated with COVID-19. We performed an observational cohort study evaluating demographic, clinical, biochemical, coagulation markers, as well as CT imaging parameters. In our study on 186 patients with COVID-19, we found that 31 patients (16,66%) had pulmonary embolism. Significant correlations for the patients with PE were detected in C-reactive protein, lactate dehydrogenase, serum ferritin, IL-6, serum myoglobin, NT-proBNP, D-dimers, serum proteins, transaminases as well as white cell blood counts. Patients with pulmonary embolism had a more severe lung involvement, with thrombi distribution mainly involving the lower lobes. Early identification of PE is an important step for timely and efficient treatment in the intensive care management of COVID-19 patients. Our study showed that high plasmatic values of lactate dehydrogenase, ferritin, IL-6, white blood cells and D-dimers and low proteins serum levels are strongly linked with COVID-19-associated pulmonary embolism.

411. IMPACT OF FEEDING ADJUNCTS AND RADIOLOGICAL SARCOPENIA ON OUTCOMES IN NEO-ADJUVANT TREATED OESOPHAGEAL CANCER PATIENTS

Abstract Introduction Nutritional management plays a pivotal role in the care of patients with oesophageal cancer, particularly for those presenting with complete dysphagia, which poses a significant management challenge. Establishing adequate nutrition is not only a prerequisite for initiating neo-adjuvant treatment in cases of potentially curable disease but is also crucial for patient survival and quality of life. Additionally, emerging evidence suggests that sarcopenia, significantly predicts post-operative complications following oesophageal surgery. Our study aims to evaluate the impact of feeding adjuncts during neo-adjuvant treatment on outcomes, including post-operative complications, and to investigate the prevalence and implications of radiological sarcopenia in these patients. Methods Data from the Northern Oesophago-Gastric Cancer Unit database was used to identify patients diagnosed with oesophageal cancer and discussed at the multidisciplinary team (MDT) meetings from 2017 to 2021. The focus was on those deemed curable with planned neo-adjuvant treatment followed by surgery. Through MDT notes review, patients were identified that required feeding adjuncts prior to surgery. Demographics, tumour characteristics, treatment modalities, hospital stay length, complication rates, and survival outcomes were collected. Radiological sarcopenia was evaluated at initial staging and re-staging computed tomography (CT) scans. Results 353 patients were included; 15 required pre-operative feeding adjuncts. This subgroup was predominantly male (73%), with a higher proportion having squamous cell carcinoma (SCC) (34% V 17%). Progression to surgery was lower in the adjunct group (73% V 87%, p=0.11). Post-operative hospital stay and one-year survival rates were comparable between groups. The adjunct group had a higher incidence of severe post-operative complications (50% Vs 28% Clavien-Dindo grade ≥3, p=0.08). Radiological sarcopenia was higher in the adjunct group (70% Vs 52%, p=0.18), with no cases of sarcopenia reversal after re-staging in the adjunct group, versus 9% in the non-adjunct group. Conclusion These findings highlight an association between complete dysphagia in patients with potentially curable oesophageal cancer and increased rates of post-operative complications and pre-operative radiological sarcopenia. Notably, these patients are more likely to be female and have SCC. The data underscore the critical need for diligent monitoring and nutritional support for patients requiring feeding adjuncts in the neo-adjuvant phase, emphasizing the broader implications of nutritional status on surgical outcomes and overall patient care in oesophageal cancer management.

Nonalcoholic steatohepatitis/metabolic dysfunction-associated steatohepatitis emerging market: Preparing managed care for early intervention, equitable access, and integrating the patient perspective.

Nonalcoholic steatohepatitis (NASH)/metabolic dysfunction-associated steatohepatitis (MASH) is an advanced form of liver disease that can lead to significant morbidity and mortality primarily due to hepatic complications including fibrosis, cirrhosis, hepatocellular carcinoma, and liver failure, as well as cardiovascular disease. As the development of NASH/MASH is closely linked to cardiometabolic risk factors such as obesity and type 2 diabetes mellitus, its prevalence is increasing along with the prevalence of those conditions. Identifying at-risk patients or those early in the disease process is essential to optimizing care and may prevent future complications. Current treatment options include disease-modifying interventions, off-label use of US Food and Drug Administration (FDA)-approved medications for comorbid conditions, and resmetirom, the recently first-ever FDA-approved medication specifically for use in NASH/MASH. There is also considerable continued activity in related drug development research with several other potential emerging treatments. With the increasing prevalence of NASH/MASH and emerging treatments, it is important for managed care organizations (MCOs) to be prepared to assist in patient care and implement equitable treatment management. Understanding patient perspectives and their experience with NASH/MASH provides insights for MCOs such as the need for education of both health care providers and patients to encourage early diagnosis and for enhancing access to individualized care including resources and support. Additionally, MCOs can consider potential management strategies for new and emerging treatments.

Bibliometric Analysis of Factors Affecting Performance and Completeness of Electronic Medical Records (EMR) in Primary Health Services

ABSTRACT Electronic Medical Records (EMR) completeness and accuracy are fundamental to effective patient care, clinical decision-making, and overall healthcare management. In recent years, there has been increasing attention to improving EMR documentation by healthcare professionals to improve data quality and patient care outcomes. This bibliometric study aimed to explore the trends, research focus, and gaps in the literature regarding EMR completeness from 2019 to 2024. The study used Publish or Perish software to collect data from Google Scholar with specific keywords such as Performance, Factors, Electronic Medical Record (EMR), EMR Completeness, Primary Healthcare, Filling, Documentation, and Medical Record Accuracy. The analysis included the 30 highest ranked journals. In addition, VOS Viewer was used for network visualization, overlay, and density to analyze thematic linkages and identify potential research gaps. Bibliometric analysis showed that Indonesia, the United States, and Ethiopia were the main contributors in EMR-related publications. Frequent themes such as data completeness, quality, and accuracy, emphasize their crucial role in the EMR research field. These findings emphasize the importance of continuously improving EMR data completeness and accuracy, which are critical for reliable clinical decision making and effective healthcare delivery. Future research should focus on developing methodologies to improve data quality and integration of EMR systems with other health information systems. In addition, exploration of policy and regulatory implications related to EMR completeness may provide valuable insights for healthcare practice. Keywords: EMR Completeness, Data Quality, Bibliometric Analysis, Health Documentation, VOS Viewer.

ENTIMOS: Decision Support Tool Highlights Potential Impact of Non-intravenous Therapies for Multiple Sclerosis on Patient Care via Clinical Scenario Simulation.

Administration of intravenous (IV), high-efficacy treatments (HETs) for the treatment of multiple sclerosis (MS) poses a high resourcing and planning burden on infusion centres, resulting in treatment delays that may increase the risk of breakthrough disease activity. Simulation tools can be used to systematically analyse capacity scenarios and identify and better understand constraints, therefore enabling decision-makers to optimise patient care. We have previously applied ENTIMOS, a discrete event simulation model, to assess scenarios of patient flow and care delivery using real-life data inputs from the neurology infusion suite at Charing Cross Hospital London. The model predicted that, given current capacity and projected demand, patients would experience high-risk treatment delays within 30 months. This study aimed to address key healthcare challenges for MS patient care management as seen from a neurologist's perspective. We used ENTIMOS to predict the impact of several distinct and clinically plausible scenarios on patient waiting times at the same MS infusion suite and to quantify mitigation strategies needed to assure continuity of care. We used real-world experience of an expert neurologist to identify five clinical scenarios: (1) switching patients to a subcutaneous (SC) MS treatment of the same therapeutic agent, in the same hospital setting; (2) extending opening times to the weekend; (3) reducing the number of infusion chairs (to simulate social distancing measures applied during the coronavirus disease 2019 [COVID-19] pandemic); (4) increasing demand for infusions; and (5) increasing the scheduling approval time. Patient waiting time for next due infusion and time to high-risk treatment delays (≥ 30 days) were the main analysed model outputs. Previously published base case results were used as reference. All hypothetical scenarios were run over a 3-year horizon (with the exception of scenario 1, which was run over a 3- and 5-year horizon). Strategies to mitigate treatment delays were analysed and discussed. Switching 50% of patients to SC treatment of the same therapeutic agent administered in hospital postponed the predicted high-risk treatment delays to shortly beyond the 3-year simulation timeframe (month 38). Weekend opening reduced waiting times from 20 days to 4 days and prevented treatment delays, however, at elevated labour costs. Reducing the infusion chairs increased waiting time to 53 days on average and 86 days at the end of the simulation, leading to high-risk treatment delays within 6 months. An increased demand for infusions increased waiting time to 26 days on average and 47 days at the end of the simulation, leading to high-risk treatment delays within 22 months. Prolonged scheduling approval time did not reduce the waiting time, nor postpone the high-risk treatment delays. Decision makers need transparency on capacity constraints to better plan resourcing at infusion suites and MS treatments. Our results showed that various mitigation measures, such as increasing capacity by additional infusion chairs per year and transferring patients to other infusion suites, may help prevent treatment delays. Switching patients from IV to an SC version of the same therapeutic agent reduced the waiting time moderately and postponed high-risk treatment delays. It was insufficient to prevent high-risk treatment delays in the long term.

The role of cholesterol-modified prognostic nutritional index in nutritional status assessment and predicting survival after liver resection for hepatocellular carcinoma.

Malnutrition, which is often underestimated in patients with hepatocellular carcinoma (HCC), has a proven adverse effect on survival rates. The purpose of this study was to verify the effectiveness of the cholesterol-modified prognostic nutritional index (CPNI) in determining the nutritional status and predicting overall survival (OS) and recurrence-free survival (RFS) in patients with HCC by comparing it with several other nutritional indicators. This retrospective single-center study enrolled 1450 consecutive HCC patients who underwent curative liver resection from January 2015 to November 2019. We evaluated the prognostic significance of several nutritional indicators, including CPNI, the controlling nutritional status (CONUT), the nutritional risk index (NRI), and the prognostic nutritional index (PNI), by applying time-dependent receiver operating characteristic (ROC) curves, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. Among several objective nutrition evaluations (including CPNI, CONUT, NRI, and PNI), CPNI demonstrated the greatest prognostic predictive power for predicting OS. Meanwhile, CPNI demonstrated marginally higher accuracy in predicting RFS compared to PNI, and significantly outperformed CONUT and NRI. Univariate and multivariate analyses suggested that CPNI was an independent risk factor for the OS and RFS of patients with HCC undergoing curative liver resection. In most subgroups, malnutrition as identified by CPNI demonstrates strong stratification ability in predicting both OS and RFS. CPNI serves as an accurate and stable instrument for evaluating nutritional status and forecasting survival outcomes in HCC patients following liver resection, which has the potential to markedly influence clinical decision-making processes and the management of patient care.

Experience of transcultural nursing for migrant workers in covid-19 field hospitals: a qualitative study in Samut Sakhon Province, Thailand

Introduction: This study aimed to explore Thai nurses’ experiences of caring for migrant workers with COVID-19 in a field hospital. Methods: This is a qualitative study. An in-depth interview was used to collect data from nine nurses between May and September 2022. The data were transcribed verbatim and content analysis was performed to analyze the data. Interviews with interpreters and co-workers of participants in the field hospital were used to examine data triangulation. Results: Three themes described the transcultural nursing experiences of nurses caring for COVID-19 migrant patients: 1) the role of nurses in a field hospital caring for migrant patients with COVID-19, 2) care delivery through the nursing process, and 3) cultural competence and transcultural nursing approach under mask and personal protective equipment for migrants with COVID-19 in the field hospital. Conclusions: Nurses' experiences highlighted the crucial role of managing patient care resources, coordinating with other healthcare professionals, and providing direct patient care in various situations in a field hospital. Despite mental and cultural care challenges, nurses still embrace transcultural nursing for migrant patients, addressing cross-cultural communication and basic needs and respecting beliefs related to religion to provide optimal care. Keywords: transcultural nursing, covid-19 field hospital, migrant workers, migrant patients