Patient Care System Research Articles

Clinical Impact of Standardized Interpretation and Reporting of Multimodality Neuromonitoring Data.

Evaluate the consistency and clinical impact of standardized multimodality neuromonitoring (MNM) interpretation and reporting within a system of care for patients with severe traumatic brain injury (sTBI). Retrospective, observational historical case-control study. Single-center academic level I trauma center. Standardized interpretation of MNM data summarized within daily reports. Consecutive patients with sTBI undergoing MNM were included. Historical controls were patients monitored before implementation of standardized MNM interpretation; cases were defined as patients with available MNM interpretative reports. Patient characteristics, physiologic data, and clinical outcomes were recorded, and clinical MNM reporting elements were abstracted. The primary outcome was the Glasgow Outcome Scale score 3-6 months postinjury. One hundred twenty-nine patients were included (age 42 ± 18 yr, 82% men); 45 (35%) patients were monitored before standardized MNM interpretation and reporting, and 84 (65%) patients were monitored after that. Patients undergoing standardized interpretative reporting received fewer hyperosmotic agents (3 [1-6] vs. 6 [1-8]; p = 0.04) and spent less time above an intracranial threshold of 22 mm Hg (22% ± 26% vs. 28% ± 24%; p = 0.05). The MNM interpretation cohort had a lower proportion of anesthetic days (48% [24-70%] vs. 67% [33-91%]; p = 0.02) and higher average end-tidal carbon dioxide during monitoring (34 ± 6 mm Hg vs. 32 ± 6 mm Hg; p < 0.01; d = 0.36). After controlling for injury severity, patients undergoing standardized MNM interpretation and reporting had an odds of 1.5 (95% CI, 1.37-1.59) for better outcomes. Standardized interpretation and reporting of MNM data are a novel approach to provide clinical insight and to guide individualized critical care. In patients with sTBI, independent MNM interpretation and communication to bedside clinical care teams may result in improved intracranial pressure control, fewer medical interventions, and changes in ventilatory management. In this study, the implementation of a system for management, including standardized MNM interpretation, was associated with a significant improvement in outcome.

The sensitivity outcome index system for home care of elderly liver transplant patients was developed based on the Omaha problem classification system

ObjectiveBased on the Omaha problem classification system, a sensitivity outcome index system for home nursing of elderly liver transplant patients was established.MethodsThrough a comprehensive literature review and rigorous application of the Delphi method, a panel of 20 experts completed two rounds of effective letter consultation to obtain expert consensus opinions. The contents of indicators were determined based on this process, and the analytic hierarchy process was employed to confirm the weightage assigned to each indicator. Consequently, we established a sensitivity outcome index system for home care in elderly liver transplant patients.ResultsThe effective recovery rate of the questionnaire in two rounds of expert consultation was 100%, and the proportion of experts who gave opinions was 55% and 15%, respectively, indicating that the experts were highly active. The expert authority coefficients were calculated as 0.904 and 0.905, respectively, indicating a high degree of expert authority. In the second round, Kendall’s coordination coefficients for primary, secondary, and tertiary indicators were determined to be 0.419, 0.418, and 0.394 (P < 0.001), indicating that expert opinions tended to be consistent. Finally, we established a comprehensive sensitivity outcome index system comprising 4 first-level indexes, 20 s-level indexes, and 72 third-level indexes specifically designed for elderly liver transplantation patients.ConclusionThe sensitivity outcome index system of home nursing for elderly liver transplant patients can provide theoretical basis for nursing staff to build accurate individualized continuous nursing model.

Implementation of Telemedicine in Medical Practice: Opportunities and Barriers

The integration of telemedicine into medical practice represents a transformative shift in healthcare delivery, offering both unprecedented opportunities and encountering significant barriers. This journal article explores the implementation of telemedicine, examining the multifaceted landscape of benefits and challenges associated with its adoption in medical settings. The opportunities presented by telemedicine include enhanced accessibility to healthcare services, especially in remote or underserved areas, improved patient outcomes through timely interventions, and increased efficiency in healthcare delivery. Telemedicine also facilitates remote patient monitoring, teleconsultations, and the exchange of medical information, contributing to a more patient-centric and adaptable healthcare system. However, the implementation of telemedicine faces several barriers, including regulatory complexities, concerns about data security and privacy, technological infrastructure limitations, and the need for healthcare professionals to adapt to new modes of communication. Cultural and organizational resistance further complicates the seamless integration of telemedicine into established medical practices. The article critically analyzes case studies and global implementations of telemedicine, highlighting successful models and lessons learned. It emphasizes the importance of policy frameworks, standardization, and ongoing training for healthcare providers to optimize the benefits of telemedicine while mitigating potential risks.

Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial.

Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, "help request" function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference -2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406.

Deep Learning-Based Liver Histopathology Image Classification: State-of-the-Art Techniques and Emerging Trends

This research investigates the application of deep learning techniques to enhance the diagnostic accuracy of liver tumour classification in collaboration with a prominent hospital in South India. By leveraging a carefully curated dataset of histopathological images, we evaluated the performance of several advanced deep learning architectures, including DenseNet 121, ResNet50, and VGG16. Our findings reveal that DenseNet121 outperformed the other models, achieving the highest accuracy in both training and testing phases, thus exceeding our predefined accuracy benchmarks. The superior performance of DenseNet121 is attributed to its dense connectivity, which facilitates improved feature and gradient propagation throughout the network. This study highlights the significant potential of AI-driven diagnostics in enhancing liver tumour classification, thereby optimizing the diagnostic workflow and providing substantial benefits for patient care and healthcare system efficiency.

Building a biocontainment unit: Infrastructure and organizational experiences of the 13 regional biocontainment units in the United States

In the United States, the system for special pathogen patient care incorporates a network of federally funded US biocontainment units that maintain operational readiness to care for patients afflicted by high-consequence infectious diseases (HCIDs). This network has expanded in number of facilities and in scope, serving as a regional resource for special pathogen preparedness. Lessons learned for maintaining these units are shared with the intent of informing new and existing biocontainment units.

Experiences of patients with metachromatic leukodystrophy, adrenoleukodystrophy, or Krabbe disease and the experiences of their family members: a qualitative systematic review.

This review aimed to synthesize the experiences of patients with metachromatic leukodystrophy, adrenoleukodystrophy, or Krabbe disease and the experiences of their families. Leukodystrophies are metabolic diseases caused by genetic mutations. There are multiple forms of the disease, varying in age of onset and symptoms. The progression of leukodystrophies worsens central nervous system symptoms and significantly affects the lives of patients and their families. Qualitative studies on the experiences of patients with leukodystrophies and their family members were included. These experiences included treatments such as enzyme replacement therapy and hematopoietic stem cell transplantation; effects of tracheostomy and gastrostomy; burdens on the family, coordinating care within the health care system, and family planning due to genetic disorders. This review considered studies in any setting. MEDLINE (Ovid), CINAHL Plus (EBSCOhost), APA PsycINFO (EBSCOhost), Scopus, and MedNar databases were searched on November 18, 2022. Study selection, critical appraisal, data extraction, and data synthesis were conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence, and synthesized findings were evaluated according to the ConQual approach. Eleven studies were eligible for synthesis, and 45 findings were extracted corresponding with participants' voices. Of these findings, 40 were unequivocal and 5 were credible. The diseases in the included studies were metachromatic leukodystrophy and adrenoleukodystrophy; no studies were identified for patients with Krabbe disease and their families. These findings were grouped into 11 categories and integrated into 3 synthesized findings, including i) providing care by family members and health care providers as physical symptoms progress, which relates to the effects of the characteristics of progressive leukodystrophies; ii) building medical teamwork to provide appropriate support services, comprising categories related to the challenges experienced with the health care system for patients with leukodystrophy and their families; and iii) coordinating family functions to accept and cope with the disease, which included categories related to family psychological difficulties and role divisions within the family. According to the ConQual criteria, the second synthesized finding had a low confidence level, and the first and third synthesized findings had a very low confidence level. The synthesized findings of this review provide evidence on the experiences of patients with metachromatic leukodystrophy or adrenoleukodystrophy and their families. These findings indicate that there are challenges in managing a patient's physical condition and coordinating the health care system and family functions. PROSPERO CRD42022318805. A Japanese-language version of the abstract of this review is available [ http://links.lww.com/SRX/A49 ].

Deriving Criteria Weights for Acute Care Hospital Accreditation in South Korea: Using Analytic Hierarchy Process

Purpose:The acute hospital accreditation program launched in South Korea has shown positive effects on safety culture and quality of care. However, relative weights have not yet been investigated for accreditation criteria with a hierarchical structure. This study aimed to derive the relative weights of acute-care hospital accreditation criteria.Methods: We conducted an online survey using the analytic hierarchy process (AHP) technique to assess the validity, importance, and urgency of acute hospital accreditation criteria. The AHP online survey link was distributed in November 2022 after obtaining informed consent from 10 experts in hospital accreditation.Results: 'Basic value system' ranked highest, while 'patient care system' ranked second in terms of validity, importance, and urgency. 'Performance management system' had the lowest validity and urgency, while 'organizational management system' carried the lowest importance. Within the 'patient care system' domain, 'surgery and anesthesia sedation management' scored highest in validity and importance, and 'patient care' scored highest in urgency. 'Care delivery system and evaluation' received the lowest scores for all three aspects. In the 'organizational management system' domain, infection control ranked highest in terms of validity, importance, and urgency. The lowest validity was observed for 'management and organizational operation' and the lowest importance and urgency were noted for 'human resource management'.Conclusion: The weights for validity, importance, and urgency, as shown in each domain and chapter, and the number of measurable elements included, are largely inconsistent. This study will contribute to the development of the structure and scientific improvement of accreditation standards.

Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bulgaria

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems.

Predicting ICU Interventions: A Transparent Decision Support Model Based on Multivariate Time Series Graph Convolutional Neural Network.

In this study, we present a novel approach for predicting interventions for patients in the intensive care unit using a multivariate time series graph convolutional neural network. Our method addresses two critical challenges: the need for timely and accurate decisions based on changing physiological signals, drug administration information, and static characteristics; and the need for interpretability in the decision-making process. Drawing on real-world ICU records from the MIMIC-III dataset, we demonstrate that our approach significantly improves upon existing machine learning and deep learning methods for predicting two targeted interventions, mechanical ventilation and vasopressors. Our model achieved an accuracy improvement from 81.6% to 91.9% and a F1 score improvement from 0.524 to 0.606 for predicting mechanical ventilation interventions. For predicting vasopressor interventions, our model achieved an accuracy improvement from 76.3% to 82.7% and a F1 score improvement from 0.509 to 0.619. We also assessed the interpretability by performing an adjacency matrix importance analysis, which revealed that our model uses clinically meaningful and appropriate features for prediction. This critical aspect can help clinicians gain insights into the underlying mechanisms of interventions, allowing them to make more informed and precise clinical decisions. Overall, our study represents a significant step forward in the development of decision support systems for ICU patient care, providing a powerful tool for improving clinical outcomes and enhancing patient safety.

Prevention of perioperative ischemic stroke after non-cardiac and non-neurosurgical operations in the light of the Scientific Statement and Guidelines for the Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack AHA/ASA 2021. Part 2: Perioperative antithrombotic therapy, diagnosis, treatment

One of the possible measures that can enhance the quality of medical care, reduce the number of adverse outcomes, and also achieve target values for the use of reperfusion methods of treatment for acute ischemic stroke is to improve the system of care for patients with in-hospital ischemic stroke. One type of in-hospital stroke is perioperative stroke that develops during or 30 days after surgery. Since the publication in 2014 of the last fundamental work on the prevention of perioperative stroke, the approaches to primary and secondary prevention, diagnosis, conservative and reperfusion treatment of ischemic stroke have been seriously modified. The numerous changes have created the preconditions for a revision of existing approaches to providing care for patients with perioperative ischemic stroke. In 2021, updated documents from foreign researchers/associations on the perioperative ischemic stroke in non-cardiac and non-neurosurgical patients were published. The second part of our review presents current data on the perioperative antithrombotic prophylaxis, clinical and instrumental diagnosis, treatment and organization of care for perioperative ischemic stroke in this category of patients. The issues of using reperfusion treatment methods in non-cardiac and non-neurosurgical patients with perioperative stroke, such as systemic thrombolytic therapy and endovascular interventions, are discussed in detail, including the world experience of their “offlabel” use.

The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis.

This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses. This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute Hospital over a 5-year period with a sample size of 6614 patients included for analysis in an unadjusted logistic regression model and 1920 patients analyzed in an adjusted logistic regression model. Various factors, including the use of occupational therapy services as well as individual factors such as pain levels, cancer stage, and living environment, were considered in relation to readmission status. Logistic regression analyses were used to assess the provision of occupational therapy service's association with 30-day hospital readmissions. Patients who received occupational therapy services had a statistically significant decrease in their risk of a30-day hospital readmission compared to patients with cancer who did not receive occupational therapy services. In an unadjusted analysis, patients with cancer who had occupational therapy services were 33.5% (OR = 0.665) less likely to be readmitted within 30 days compared to a patient who did not have occupational therapy services (p < 0.001). In an analysis after adjusting for patient health-related factors, patients with cancer who had occupational therapy services were 22.2% (OR = 0.778) less likely to readmit to a hospital compared to a patient who did not have occupational therapy services (p < 0.046). The results of the study are intended to contribute to the body of knowledge on the benefits of occupational therapy services on an individual as well as a health systems-based level for patients with cancer diagnoses while hospitalized. The knowledge of the utility of occupational therapy services for patients with cancer diagnoses while in the hospital can assist providers, patients, and hospital leadership in understanding some of the potential benefits for patient care and healthcare systems at large while seeking to avoid the deleterious effects from a hospital readmission.

Exploring healthcare workers’ experience and barriers in disclosing patient safety-related incidents: A qualitative study in Indonesian hospitals

ABSTRACT Background Open disclosure of patient safety incidents is a strategy to enhance patient safety by preventing future occurrences. This study aimed to identify factors that facilitate or hinder the implementation of open disclosure in Indonesian hospitals. Methods Using a qualitative descriptive research method, 12 healthcare professionals with at least one year of experience and prior incident disclosure experience participated in online interviews. Thematic analysis revealed that open disclosure practices are uncommon in Indonesian hospitals. Results The findings suggest that open disclosure practices are not common practice in Indonesian hospitals. Key issues include unclear responsibility for disclosure, determining which incidents should be disclosed, understanding patient and family responses, implementing follow-up procedures and addressing barriers such as cultural factors, fear of disclosure, lack of protection and insufficient awareness and training among healthcare professionals. Conclusion Promoting open disclosure can improve patient-provider relationships and patient safety. Therefore, healthcare organizations, policymakers and educational institutions should collaborate to foster open disclosure, safeguard patients and educate healthcare professionals, leading to a more secure, transparent and patient-centric healthcare system.

Evaluating User Experience and DNA Yield from Self-Collection Devices.

The COVID-19 pandemic emphasized an urgent need for devices used in the self-collection of biospecimens in an evolving patient care system. The mailing of biospecimen self-collection kits to patients, with samples returned via mail, provides a more convenient testing regimen, but could also impart patient sampling variabilities. User compliance with device directions is central to downstream testing of collected biospecimens and clear instructions are central to this goal. Here, we performed an evaluation of 10 oral DNA collection devices involving either swab or saliva self-collection and analyzed ease of use and comfort level with a device, as well as DNA recovery quantity/quality and sample stability. We show that while these DNA quality/quantity metrics are comparable between devices, users prefer direct saliva collection over swab-based devices. This information is useful in guiding future experiments including their use in human RNA, microbial, or viral sample collection/recovery and their use in clinical testing.

The patient experience of a postpartum readmission for hypertension: a qualitative study

BackgroundHypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this study is to understand the perspective of patients readmitted for postpartum hypertension.MethodsThis was a qualitative study with data generated through semi-structured interviews. Patients readmitted with postpartum HDP at an urban academic medical center from February to December 2022 were approached and consented for an interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n = 9). Two coders coded all interviews using Nvivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus among the two coders. Themes were identified through an initial a priori template of codes which were expanded upon using grounded theory, and researchers were reflexive in their thematic generation.ResultsSix themes were generated: every pregnancy is different, symptoms of preeclampsia are easily dismissed or minimized by both patient and providers, miscommunication regarding medical changes can increase the risk of readmissions, postpartum care coordination and readmission logistics at our hospital could be improved to facilitate caring for a newborn, postpartum care is often considered separately from the rest of pregnancy, and patient well-being improved when conversations acknowledged the struggles of readmission.ConclusionsThis qualitative research study revealed patient-identified gaps in care that may have led to readmission for hypertensive disorders of pregnancy. The specific recommendations that emerge from these themes include addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.

A Data-Driven Approach to Defining Risk-Adjusted Coding Specificity Metrics for a Large U.S. Dementia Patient Cohort.

Medical coding impacts patient care quality, payor reimbursement, and system reliability through the precision of patient information documentation. Inadequate coding specificity can have significant consequences at administrative and patient levels. Models to identify and/or enhance coding specificity practices are needed. Clinical records are not always available, complete, or homogeneous, and clinically driven metrics to assess medical practices are not logistically feasible at the population level, particularly in non-centralized healthcare delivery systems and/or for those who only have access to claims data. Data-driven approaches that incorporate all available information are needed to explore coding specificity practices. Using N = 487,775 hospitalization records of individuals diagnosed with dementia and discharged in 2022 from a large all-payor administrative claims dataset, we fitted logistic regression models using patient and facility characteristics to explain the coding specificity of principal and secondary diagnoses of dementia. A two-step approach was produced to allow for the flexible clustering of patient-level outcomes. Model outcomes were then used within a Poisson binomial model to identify facilities that over- or under-specify dementia diagnoses against healthcare industry standards across hospitalizations. The results indicate that multiple factors are significantly associated with dementia coding specificity, especially for principal diagnoses of dementia (AUC = 0.727). The practical use of this novel risk-adjusted metric is demonstrated for a sample of facilities and geospatially via a U.S. map. This study's findings provide healthcare facilities with a benchmark for assessing coding specificity practices and developing quality enhancements to align with healthcare industry standards, ultimately contributing to better patient care and healthcare system reliability.

Geriatric proximal femur fracture updates.

Proximal femur fractures in the aging population present a variety of challenges. Physiologically, patients incurring this fracture are typically frail, with significant medical comorbidities, yet require early surgical treatment to restore mobility to prevent deterioration. Socioeconomically, the occurrence of a fragility fracture may be the beginning of the loss of independence, and the burdens of rehabilitation and support are borne by the individual patient and health care systems.

Social difficulties and care burden of adult Duchenne muscular dystrophy in Japan: a questionnaire survey based on the Japanese Registry of Muscular Dystrophy (Remudy).

Little is known about the social difficulties and health care needs of adult Duchenne muscular dystrophy (DMD) patients in Japan, as well as the financial and physical stress experienced by their caregivers. This study aimed to clarify the social circumstances surrounding adult DMD patients and assess the degree of involvement of family members in their care and the associated economic burden of the disorder in Japan. Adult DMD patients were identified through the Registry of Muscular Dystrophy (Remudy) in Japan and invited to complete a questionnaire together with a caregiver. Data on health care use, quality of life, work status, informal care, and household expenses were collected to estimate the costs associated with DMD from social and caregiver household perspectives. In total, 234 (63.7%) of 367 adult DMD patients (mean age, 27.4 ± 6.0; range, 20-48years) completed the questionnaire. Of these, 38 (21%) had developmental disorders (mental retardation, autism, and learning disorders), 57 (33%) experienced bullying in school, and 44 (77%) indicated the reason for bullying to be their physical handicap. Employment histories were noted by 72 (31%), although 23 (10%) lost their jobs mainly due to physical difficulties. Of the 234 patients, 164 (74%) lived with their relatives, and 78% of care time was supplied by family members, in particular, their mothers. The mean rate of care work provided by family members was 81%. Household income of families with an adult DMD patient was lower, whereas the rate of living with parent(s) and grandparent(s) was higher, in comparison with the general Japanese population. Adult DMD patients in Japan experience many social difficulties from childhood up to adulthood. As adults, many DMD patients experience bullying and workplace difficulties. Families were found to provide most of the care and financial support for DMD patients. Our results suggest the need to improve public patient care systems, including financial support, to address the physical and economic burdens of care for adult DMD patients in Japan.

Blockchain Targets Integrated IoT for Smart Healthcare Systems - A Bibliometric Analysis

Blockchain technology and the Internet of Things (IoT) for smart healthcare systems has emerged as a promising area of research, as evidenced by a bibliometric analysis. This analysis explores the scholarly literature on the integration of blockchain and IoT in healthcare, identifying key trends, influential publications, and research directions. By leveraging blockchain's decentralized and immutable nature alongside the IoT's ability to collect and transmit real-time health data from various devices, smart healthcare systems aim to enhance data security, interoperability, and patient privacy. Bibliometric analysis provides valuable insights into the evolution of research in this field, highlighting emerging topics, interdisciplinary collaborations, and potential applications that can revolutionize healthcare delivery and management in the future. This paper introduces the Weighted Key Signature for Smart Healthcare Systems (WKSS), a framework designed to optimize healthcare operations within smart environments. With advanced technologies such as blockchain, Internet of Things (IoT), and integration technologies, WKSS aims to improve patient care, resource utilization, and overall healthcare system efficiency. The framework encompasses key components including digital signature generation, computational efficiency, and bibliometric analysis to provide insights into emerging trends and key contributors within smart healthcare systems. Through a comprehensive analysis, including simulations and bibliometric studies, this paper demonstrates the effectiveness of WKSS in reducing patient waiting times, enhancing resource utilization rates, and improving healthcare provider efficiency. Through simulations and bibliometric analysis, significant improvements were observed in key metrics. The average patient waiting time decreased from 45 to 34 minutes, resource utilization rates increased from 70% to 85%, and examination room occupancy rose from 60% to 75%. Additionally, physician and nurse utilization rates improved from 80% to 90% and from 75% to 85%, respectively.

“Patient Care System

Patients can register, enter their information into the system, and schedule medical visits through our project's patient care system. Every patient can receive a unique ID from our program, which also automatically saves all of the patient and staff information. Using the ID, the user can look up a doctor's availability and a patient's data. You can log in to the patient care system with your username and password. An administrator or a receptionist can access it. The database can only contain data that they add. It is simple to retrieve the data. It has an extremely user-friendly interface. The patient care system also has features that allow for easy communication between patients and healthcare providers, such as secure messaging and appointment reminders. Additionally, the system can generate reports on patient demographics, appointment scheduling, and medical history, which can be useful for tracking patient progress and improving overall patient care. Overall, our project's patient care system streamlines the healthcare process and enhances the patient experience. Keyword: Admin Module, Doctor module, health care services, user module.