Patients In Healthcare System Research Articles

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 ].

Impact of Clostridioides difficile Reporting on Antimicrobial Therapy Days Directed at Treatment of C. difficile Infections

Background: Previous studies have found that solely relying on molecular testing is likely to result in the overdiagnosis and overtreatment of C. difficile infections (CDI). Comparable outcomes have been demonstrated in patients with a positive molecular test (C. difficile PCR) result and a negative toxin immunoassay (C. difficile toxin) compared to patients without CDI by either testing Method: In 2021 Memorial Hermann Healthcare System converted from C. difficile PCR testing only to C. difficile PCR testing with reflex to C. difficile toxin if positive. A previous internal audit revealed that despite this change in testing, patients who were C. difficile PCR positive and C. difficile toxin negative were still receiving treatment. This study aimed to evaluate the impact of C. difficile reporting on the total days of therapy directed at the treatment of CDI of an 11-hospital health care system in patients who testing C. difficile PCR positive/C. difficile toxin negative. Methods: Pre-post, multicenter, retrospective, observational study conducted from January 1, 2023 through March 31, 2023 (pre-intervention) and July 1, 2023 through September 31, 2023 (post-intervention) which included hospitalized adult patients with a C. difficile test ordered within the study period. Intervention included a change in reporting of C. difficile PCR positive/C. difficile toxin negative results to display a laboratory comment. The comment notifies providers of the positive C. difficile PCR result while highlighting this probably reflects colonization with C. difficile as the C. difficile toxin is negative and treatment is rarely indicated. Results: In total, 989 C. difficile PCR were order in the pre-intervention cohort compared to 1009 in post-intervention. The overall rate of patients that received therapy directed at CDI decreased from 14% to 10% after the implementation of reporting change. Total days of therapy (DOT) also decreased by 29% from 482 to 342. Days of therapy that were administered to patients with C. difficile PCR positive/negative C. difficile toxin test decreased from 183 to 91. Conclusions: Adjusting the reporting of C. difficile results led to an overall numerical decrease of antimicrobial DOT directed at CDI treatment. In particular, among patients with a positive C. difficile PCR/C. difficile toxin negative test a 50% reduction in DOT was observed. Further data are required to assess the overall clinical impact of adjusting CDI reporting methods.

Issues in assessing analytical performance specifications in healthcare systems assembling multiple laboratories and measuring systems.

Analytical performance specifications (APS) are usually compared to the intermediate reproducibility uncertainty of measuring a particular measurand using a single invitro diagnostic medical device (IVD MD). Healthcare systems assembling multiple laboratories that include several IVD MDs and cater to patients suffering from long-term disease conditions mean that samples from apatient are analyzed using a few IVD MDs, sometimes fromdifferent manufacturers, but rarely all IVD MDs in thehealthcare system. The reproducibility uncertainty for results of a measurand measured within a healthcare system and the components of this measurement uncertainty is useful in strategies to minimize bias and overall measurement uncertainty within the healthcare system. The root mean squares deviation (RMSD) calculated as the sample standard deviation (SD) and relative SD includes both imprecision and bias and is appropriate for expressing such uncertainties. Results from commutable stabilized internal and external control samples, from measuring split natural patient samples or using big-data techniques, are essential in monitoring bias and measurement uncertainties in healthcare systems. Variance component analysis (VCA) can be employed to quantify the relative contributions of the most influential factors causing measurement uncertainty. Such results represent invaluable information for minimizing measurement uncertainty in the interest of the healthcare system's patients.

Participants' Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study.

The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system's patient population. This program evaluation was conducted to explore participants' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. We examined participants' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.

Interprofessional collaboration to support patient-centered care: literature review

Patient-centered care is the hope of every patient who needs health care to handle their problems immediately, physically, psychologically, socially and culturally. Interprofessional collaboration of active health workers will create comprehensive services to manage and make the right decisions in patient care. This literature review aimed to explore how interprofessional collaboration can create a comprehensive professional service system to support patient-focused care. Nine articles were included in this literature review. Interprofessional collaboration begins by communicating and coordinating with members of the health care provider team, which has been proven to reduce errors and increase satisfaction in providing health services, providing a sense of comfort in interacting. Implementing interprofessional collaboration in a health care system allows all aspects of health care providers to provide complete services to realize a comprehensive and comprehensive health care system for patients. Coordination in services that prioritizes interprofessional collaboration is the creation of synergies in services, clinical decision-making of care and accuracy in handling all patient problems so that services that focus on patient needs are the main goals achieved. Interprofessional collaboration is proven to make patients feel satisfied with the perceived service system, namely holistic and comprehensive services focusing on patients and families

Pulmonary Fibrosis: Unveiling the Pathogenesis, Exploring Therapeutic Targets, and Advancements in Drug Delivery Strategies.

Idiopathic pulmonary fibrosis (IPF) is an ailment with no cure and a very high rate of progression that ultimately leads to death. The exact reason for this disease is still not acknowledged. Many underlying mechanisms of wound healing and various types of stimuli that trigger the pathogenesis of IPF continue to be intensively explored. The exact therapy for the reversal of this disease is not yet known and is constantly in progress. Existing treatments only slow down the process or mitigate the symptoms to enhance the patient's healthcare system. The only two Food and Drug Administration-approved oral medications include pirfenidone and nintedanib whose high dose and systemic circulation can have side effects to a greater extent. Further research on restorative and extra-curative therapies for IPF is necessary due to the absence of viable therapeutic choices. To assure minimum off-targeted site delivery and longer duration of action, techniques that offer a sustainable release of the drug, better bioavailability, and patient compliance can be used.The work is an overview of the main therapeutic targets and pertinent developing therapies for the management of IPF. This study is an attempt to focus on various drug delivery systems that are responsible for showing effectiveness in defense mechanisms against IPF.

"If You Don't Trust Your Doctor That Much...You'd Feel Less Confident Doing a Research Study": Factors Influencing Black Patient Participation in Hematology Trials

Background Racial disparities exist in incidence and survival from hematological cancers. These differences are driven by multiple factors, including disease biology and access to high-quality cancer care (e.g., enrollment in a clinical trial). Black persons constitute 5-7% of participants in therapeutic cancer clinical trials (Bhatnagar et al. 2017, S. Al Hadidi et al. 2020, S. Al Hadidi et al. 2022), despite accounting for 14% of the US population. While previous studies have broadly focused on understanding factors that underpin that disparity in clinical trials, very few have focused explicitly on populations with hematological cancers. Further, research evaluating the perspectives of hematologists on factors that influence clinical trial enrollment for the Black population remains limited. The objective of this study was to understand factors that influenced Black participant enrollment in hematology-focused clinical trials by examining the perspectives of Black patients with multiple myeloma and their hematologists. Methods Between August 2021-January 2022, hematologists were recruited to participate in single semi-structured 60-minute virtual interviews, while patients diagnosed with multiple myeloma were asked to participate in focus group discussions (FGDs) lasting up to 90 minutes via videoconferencing. Through the Sort and Sift, Think, and Shift approach (Maietta et al. 2021),analytic memoing and diagramming of key quotations were used to assess topics and identify larger conceptual themes. We tabled and grouped themes, topics, and associated quotations at multiple levels using the National Institute on Minority Health and Health Disparities Research framework. Topics and themes from FGDs and hematologist interviews were then distilled into key claims. Results We conducted 6 FGDs with 23 patients and 13 semi-structured interviews with hematologists. Hematologists perceived trust at multiple levels (e.g., patient-provider, patient-health care system) as an influential determinant of Black patients' enrollment in clinical trials (Table 1). Factors that fostered patient-hematologist trust included the length of the relationship, use of transparent and empathic communication, and shared racial identities of patients and hematologists. For patients, trust in the hematologist, health care system, and proposed trial intervention were determinants of whether Black patients enrolled in a clinical trial. Patients also emphasized the importance of hematologists acknowledging the historical events that led to the intentional harm of Black persons engaged in research-related activities and recommended additional efforts to foster shared medical decision-making. Some hematologists perceived clinical trial discussions as potentially harmful when building trust in their patient relationships. Hematologists also considered patient context--such as geographic location, socioeconomic challenges, and health literacy along with study eligibility criteria--when deciding to offer a clinical trial (Figure 1). Hematologists also viewed lack of time, trial availability, and adequate clinical trial infrastructure as barriers to discussing and enrolling Black patients in clinical trials. Conclusion Black patients and hematologists perceived trust at multiple levels as critical to enhancing the enrollment of Black participants in hematology-focused cancer clinical trials. Additionally, hematologists' perceptions about patients, including the additional burdens associated with clinical trial participation, also impacted whether or not Black patients are given the opportunity to participate in a clinical trial. Addressing disparities in clinical trial enrollment among Black participants requires multilevel interventions such as 1) fostering patient-clinician relationships, 2) increasing clinical trial availability and partners in community-based settings, 3) providing support to overcome logistical barriers, 4) acknowledging and finding strategies to address physician biases. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

192 Using the Electronic Health Record to Identify Patients Presenting to the Emergency Department at Highest Risk for Subsequent Overdose

The emergency department (ED) is frequently the primary point of entry into the health care system for patients with opioid use disorder (OUD), with acute ED presentations including acute overdose (OD), withdrawal, and the medical and psychiatric complications of OUD. Each subsequent OD increases the risk of death. Strategies to best identify patients at highest risk for subsequent OD can lead to improved utilization of ED-based interventions such as medications for opioid use disorder (MOUD), naloxone kits, and ED-based peer supporters providing linkage to treatment.

Analysis Of Factors Affecting Nurse Anxiety Levels In Covid-19 Patients At RSU Royal Prima Medan

Since the emergence of the first confirmed case of Covid19 in Wuhan at the end of 2019, much attention has been focused on how the patient's health care system to the development of vaccines. However, the discussion about how the struggle of health workers, especially nurses, seems to have received less attention. Therefore, this study was conducted to find out how the anxiety level of nurses for Covid-19 patients is in terms of the influence of organizational support, social support, workload and personal resilience. The results showed that workload and personal resilience had a positive and significant effect on anxiety levels (p < 0.005) but organizational support and social support had no significant effect on anxiety levels (p > 0.005). From the results of the multivariate test, it was found that the p value was 0.000 (p < 0.005) which stated that together or simultaneously, the independent variables in this study had a significant influence on the dependent variable, namely the level of anxiety.

Reframing Our Health Care System for Patients With Hearing Loss.

Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.

Effectiveness of general practitioner-delivered nutrition care interventions on dietary and health outcomes in adults with diet-related chronic conditions: a systematic review protocol

This systematic review will evaluate the effectiveness of nutrition care interventions delivered by general practitioners versus usual care or no care on dietary and health outcomes in adults with diet-related chronic conditions or risk states. General practitioners are usually the first contacts in the health care system for patients with diet-related chronic conditions. While there is some evidence that general practitioners can be effective in delivering nutrition care for a number of outcomes, to inform future care, an update of the evidence is required as well as an examination of which components are associated with positive outcomes. Published studies will be included if they report on adults with or at risk of diet-related chronic conditions; one-on-one nutrition care interventions individually delivered by general practitioners during primary care consultations; usual or no care as comparators; dietary and/or health outcomes with a minimum three-month follow-up; and randomized controlled trials. Included studies will be available in, or able to be translated into, English and will have no date restrictions. The databases to be searched will include CINAHL, Embase, MEDLINE, and ProQuest Nursing and Allied Health. Following deduplication, two reviewers will independently screen the titles and abstracts in Covidence, followed by the full texts of potentially relevant studies. Disagreements will be resolved through discussion or with a third reviewer. Included studies will be critically appraised and data will be extracted using a modified JBI tool. Findings will be reported in tables and narrative synthesis, and pooled with statistical meta-analysis, where possible. PROSPERO CRD42021289011.

Associative links between obesity and vitamin D levels as a risk factor for primary hyperparathyroidism

Background. To date, the fact and mechanisms of associative links between vitamin D deficiency and primary hyperparathyroidism (PGPT) have been established. In turn, the level of 25(OH)D is influenced by climatic conditions and the presence of obesity (Ob). These set the purpose of the study— to determine the supply of vitamin D in patients with endocrine disorders living in the climate in Ukraine, and to assess the impact of Ob on vitamin D levels and the development of hypercalcemia— signs of PGPT. Materials and methods. BMI, serum calcium (Ca) and vitamin D levels in 145 patients who were in the endocrinology clinic for various endocrine pathologies were studied. The frequency of vitamin insufficiency and vitamin D efficiency, hypercalcemia in groups with and without obesity was analyzed. Results. The proportion of obese in the general group was 33.8%, among men— 28.57%, among women— 35.04% (p < 0.05). The level of Ca in the blood was 2.39±0.02 mmol/l, high Ca level occurred in 16.55%, and Ob— іn 49 (33.49%) patients. Against the background of Ob, the level of Ca was 2.42±0.02, and in non-obese people— 2.38±0.02 (p>0.05). Average level of vitamin D in the blood in the general group was 22.95±0.73mg/ml and was probably lower in individuals with Ob (20.95±1.39 vs. 24.09±0.81mg/ml in groups without Ob, p < 0.05). Distribution of the disease by the degree of provision of vitamin D showed that in a cohort with low security vitamin D and the presence of Ob subgroup with a deficiency of vitamin D (20–29ng/ml) was almost twice as large as the similar subgroup without Ob. As follows, the presence of Ob in patients with endocrine pathology has no probable effect on the incidence of hypercalcemia, but is associated with a probable decrease in the level of vitamin D in the blood with a predominance of subgroups with vitamin D deficiency, while in the group without Ob. Conclusions. In the climatic conditions of Ukraine and the functioning health care system in patients with endocrine pathology, the average level of vitaminD is within its deficiency (22.95±0.73 ng/ml). The presence of obesity in patients with endocrine pathology is associated with a probably lower supply of vitamin D, almost doubling the subgroup with vitamin deficiency (<20ng/ml). The combination of obesity and vitaminD deficiency should be considered as a risk factor for primary hyperparathyroidism in patients with endocrine pathology. Such patients need regular monitoring of blood calcium and parathyroid hormone, as well as medical support for vitamin D.

Glaucoma - the significant challenge for the healthcare system in Poland

Introduction
 Glaucoma is a group of optic neuropathies characterized by progressive degeneration of retinal ganglion cells (RGCs) and visual field loss. Glaucoma is the leading cause of irreversible blindness in the world. The World Health Organization classifies it as a social and civilization disease and emphasizes the need to improve ophthalmic care systems in order to meet the constantly growing challenge for public health, which is glaucoma. The aim of this article is to identify the main problems that affect the health care system of patients with glaucoma in Poland.
 Review methods
 The review of literature on glaucoma was performed using the PubMed and Google Scholar databases. The latest available epidemiological data and the current legal acts concerning the health care system of patients with glaucoma in Poland were also analyzed.
 Abbreviated description of the state of knowledge
 The incidence of glaucoma in Poland is constantly increasing, due to the aging of the population. The insidious course of the disease, low public awareness and difficulties in access effective ophthalmic services mean that the disease is diagnosed too late, when significant damage to the optic nerve has already occurred. In addition, the poor mental health of patients, treatment difficulties related to the frequent comorbidity of general diseases and the use of other drug therapies, complicate the course of glaucoma and make it difficult to inhibit its progression.
 Summary
 Glaucoma is a significant challenge for public health and the healthcare system in Poland. Therefore, it is very important to take systemic measures as soon as possible that contribute to improve public awareness of eye diseases, increase the availability of ophthalmic care, early detection and appropriate monitoring of the course of glaucoma.

MP18-12 ASSESSING THE UTILIZATION OF THE HEALTHCARE SYSTEM IN PATIENTS WITH OVERACTIVE BLADDER

You have accessJournal of UrologyCME1 May 2022MP18-12 ASSESSING THE UTILIZATION OF THE HEALTHCARE SYSTEM IN PATIENTS WITH OVERACTIVE BLADDER Elisabeth Sebesta, Stephanie Gleicher, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Elisabeth SebestaElisabeth Sebesta More articles by this author , Stephanie GleicherStephanie Gleicher More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is common and represents a significant healthcare burden. It is not known how many patients with OAB seek out medical care for or are treated for their condition. The objective of this study was to assess the proportion of patients who sought out medical care and received treatment for bladder symptoms, in addition to any predictive factors for seeking medical care. METHODS: A sample of 3,396 adults was recruited electronically to complete a questionnaire on clinical and demographic information, social needs, and urinary symptoms (LURN SI-10, ICIQ-UI SF, and PPBC). Participants were excluded if currently pregnant, had a history of cystectomy, pelvic radiation, or neurologic lower urinary tract dysfunction. Descriptive statistics were performed, in addition to uni- and multivariable logistic regression to assess for predictive factors for seeking out medical care. RESULTS: 1,303 participants (38.4%) were identified with OAB (any urge incontinence in 1 week or urgency with frequency >8 times/day). Most identified as female (82.7%) and white, non-Hispanic (86.1%). Respondents mostly lived in a suburban community (39.4%), had private insurance (50.2%), worked full time (43.5%), and had at least a college degree (42.1%). The majority reported their last doctor’s visit for any reason was within a year (94.7%), however, only 48.3% of patients reported ever asking a doctor about bladder symptoms. Finally, only 135 (10.4%) patients reported taking bladder medications. On logistic regression, older age, history of urologic surgery, having both Medicare/Medicaid and private insurance, and increased symptom severity were predictive of having asked a provider about urinary symptoms (Table 1). Unemployed patients and those with a college degree were less likely to see a physician. CONCLUSIONS: In this cohort, only half of those with clinical OAB have discussed urinary symptoms with a provider, and a smaller proportion treated with oral medications. Those more likely to seek medical care had prior urologic surgery, indicating patients that are already receiving urologic care, in addition to increased symptom severity. Further research is needed to determine barriers that prevent patients from seeking care for OAB, and how as providers we may more effectively reach these patients. Source of Funding: UL1 TR000445 from NCATS/NIH © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e300 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elisabeth Sebesta More articles by this author Stephanie Gleicher More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement PDF DownloadLoading ...

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System

A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6–8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.

5G Network as a Technology to Fight Covid-19 Pan-demic in Indonesia: a Review

Since March 2020 until now the Covid-19 pandemic has caused a very signifi-cant impact on people's lives in Indonesia. Based on August 2021 data, the num-ber of positive COVID-19 cases reached nearly 4 million cases and the number of recovered patients reached 3.2 million. the use of communication technology is an important part of efforts to overcome the pandemic and help people to access digital health services. Along with this pandemic, Indonesia has just launched 5G network technology with much better performance than 4G technology so that it can be used to create a better healthcare system for patients. This paper provides a review and opportunity for the use of 5G technology for the development of a digital health service system.

Exploring Quinolone Scaffold: Unravelling the Chemistry of Anticancer Drug Design.

Globally, cancer is considered as the major leading cause in burdening the patient's health care system globally. The growing threat of drug-resistant cancers renders an urgent need to develop more successful candidates for the anti-cancer therapy. In view of the outstanding pharmacological activities, Quinolone and its derivatives have attracted more attention towards drug designing and biological evaluation in the search for new drug molecules. The inspired researchers attempted efforts in order to discover the quinolone based analogs due to their wide range of biological activities. Due to immense pharmacological importance, distinct synthetic methods have been executed to attain new drug entities from quinolones and all the reported molecules have shown constructive anticancer activities. Some of the synthetic protocols like one pot synthesis, post-Ugi-transformation, catalysed based synthesis, enzyme-based synthesis and nano-catalyst based synthetic procedures are also discussed as recent advancements in the production of quinolone derivatives. In this review, recent synthetic approaches in the medicinal chemistry of quinolones and potent quinolone derivatives on the basis of structural activity relationship are outlined. Moreover, their major methods and modifications are discussed.

The effect of cognitive-behavioral group training of self-care skills on self-care in patients with schizophrenia

Background & Aim: Self-care is one of the challenges of the health care system in patients with schizophrenia. It has been less studied due to these patients have no insight into the symptoms. This study aimed to determine the effect of cognitive-behavioral group training on self-care skills in patients with schizophrenia. Methods & Materials: This single-blind randomized controlled clinical trial (blinding of data analysts) was performed on 50 hospitalized schizophrenia patients by convenience sampling method and random block allocation to the intervention (n=26) and control (n=24) groups in Ebn-Sina Psychiatric Hospital of Mashhad, Iran from late July 2020 to mid-January 2021. The intervention group received cognitive-behavioral group training of self-care skills based on Kashani Lotfabadi et al. (2020) protocol in 10 sessions (two sessions per week). The control group was placed on a waiting list. Data collection tools included the Self-Care Requisites Scale (SCRS-H) and the Positive and Negative Syndrome Scale (PANSS). The data were analyzed by SPSS 25 version, repeated measures of ANOVA test. Results: 60 % (n=30) of participants were female, and 40% (n=20) were male with a mean age of 32.98±8.35 years. The results of repeated measures of ANOVA indicated a significant difference between the intervention and control groups in terms of descending mean score of total self-care during the test stages (p=0.001). Conclusion: Cognitive-behavioral group training of self-care skills could promote self-care behaviors in patients with schizophrenia. Therefore, we suggest using this intervention to strengthen self-care skills in patients with schizophrenia.

Multimorbidity phenotypes in patients presenting to the emergency department with possible acute coronary syndrome

BackgroundMultimorbidity (> 2 conditions) increases the risk of adverse outcomes and challenges health care systems for patients with acute coronary syndrome (ACS). These complications may be partially attributed to ACS clinical care which is driven by single-disease-based practice guidelines; current guidelines do not consider multimorbidity. ObjectivesTo identify multimorbidity phenotypes (combinations of conditions) with suspected ACS. We hypothesized that: 1) subgroups of patients with similar multimorbidity phenotypes could be identified, 2) classes would differ according to diagnosis, and 3) class membership would differ by sex, age, functional status, family history, and discharge diagnosis. MethodsThis was a secondary analysis of data from a large multi-site clinical study of patients with suspected ACS. Conditions were determined by items on the Charlson Comorbidity Index and the ACS Patient Information Questionnaire. Latent class analysis was used to identify phenotypes. ResultsThe sample (n = 935) was predominantly male (68%) and middle-aged (mean= 59 years). Four multimorbidity phenotypes were identified: 1) high multimorbidity (Class 1) included hyperlipidemia, hypertension (HTN), obesity, diabetes, and respiratory disorders (COPD or asthma); 2) low multimorbidity (Class 2) included only obesity; 3) cardiovascular multimorbidity (Class 3) included HTN, hyperlipidemia, and coronary heart disease; and 4) cardio-oncology multimorbidity (Class 4) included HTN, hyperlipidemia, and cancer. Patients ruled-in for ACS primarily clustered in Classes 3 and 4 (OR 2.82, 95% CI 1.95–4.05, p = 0.001 and OR 1.76, 95% CI 1.13–2.74, p = 0.01). ConclusionIdentifying and understanding multimorbidity phenotypes may assist with risk-stratification and better triage of high-risk patients in the emergency department.