Patient Visits Research Articles

Carbon footprint of private dental clinics in Egypt: a cross-sectional study

BackgroundClimate change is a global challenge, caused by increasing greenhouse gas (GHG) emissions. Dental clinical practice contributes to these emissions through patient and staff travel, waste, energy and water consumption and procurement. Carbon footprinting quantifies GHG emissions. This study assessed the Carbon Footprint (CFP) of private dental clinics in Egypt.Materials and methodsData were collected from private dental clinics in Alexandria and Elbeheira, in Northwestern Egypt from July to August 2024 through interview questionnaires. A CFP calculator was used to estimate carbon emissions from patient and staff travel, waste, energy and water consumption, and procurement. To determine the average CFP per clinic and per patient visit, the CFP of all clinics was averaged, both with and without considering the depreciation of dental equipment.ResultsData from 27 dental clinics were collected. The average CFP of an Egyptian private dental clinic, which, per year, received 3,322 patient visits, and where 5 personnel worked 279 days was 14,426.8 kg CO2e, or 4.3 kg CO2e per patient visit. The largest contributor to the CFP was patient travel (45.6%), followed by staff travel (19.6%), energy consumption (18%), procurement (12.4%), waste (4.2%), and water consumption (0.3%). After considering the yearly depreciation of dental equipment, the CFP per clinic in a year increased by 12.2%.ConclusionPrivate dental clinics in Egypt produce substantial carbon emissions. Patient travel was the major contributor to the CFP. While there was a high CFP of electricity consumption, the CFP of gas was zero. The high CFP of waste was likely due to improper segregation and the lack of recycling. Country-specific CFP calculators are needed to accurately measure the carbon emissions of dental clinics in various settings. Preventing oral diseases, raising public awareness to sustainable practices, promoting walking and cycling, improving public transportation, implementing waste recycling, shifting to renewable sources of energy, and local manufacturing of dental products are important to reduce carbon emissions in dental clinics.

Prediction of outpatient rehabilitation patient preferences and optimization of graded diagnosis and treatment based on XGBoost machine learning algorithm

BackgroundThe Department of Rehabilitation Medicine is key to improving patients’ quality of life. Driven by chronic diseases and an aging population, there is a need to enhance the efficiency and resource allocation of outpatient facilities. This study aims to analyze the treatment preferences of outpatient rehabilitation patients by using data and a grading tool to establish predictive models. The goal is to improve patient visit efficiency and optimize resource allocation through these predictive models.MethodsData were collected from 38 Chinese institutions, including 4,244 patients visiting outpatient rehabilitation clinics. Data processing was conducted using Python software. The pandas library was used for data cleaning and preprocessing, involving 68 categorical and 12 continuous variables. The steps included handling missing values, data normalization, and encoding conversion. The data were divided into 80% training and 20% test sets using the Scikit-learn library to ensure model independence and prevent overfitting. Performance comparisons among XGBoost, random forest, and logistic regression were conducted using metrics, including accuracy and receiver operating characteristic (ROC) curves. The imbalanced learning library’s SMOTE technique was used to address the sample imbalance during model training. The model was optimized using a confusion matrix and feature importance analysis, and partial dependence plots (PDP) were used to analyze the key influencing factors.ResultsXGBoost achieved the highest overall accuracy of 80.21% with high precision and recall in Category 1. random forest showed a similar overall accuracy. Logistic Regression had a significantly lower accuracy, indicating difficulties with nonlinear data. The key influencing factors identified include distance to medical institutions, arrival time, length of hospital stay, and specific diseases, such as cardiovascular, pulmonary, oncological, and orthopedic conditions. The tiered diagnosis and treatment tool effectively helped doctors assess patients’ conditions and recommend suitable medical institutions based on rehabilitation grading.ConclusionThis study confirmed that ensemble learning methods, particularly XGBoost, outperform single models in classification tasks involving complex datasets. Addressing class imbalance and enhancing feature engineering can further improve model performance. Understanding patient preferences and the factors influencing medical institution selection can guide healthcare policies to optimize resource allocation, improve service quality, and enhance patient satisfaction. Tiered diagnosis and treatment tools play a crucial role in helping doctors evaluate patient conditions and make informed recommendations for appropriate medical care.

Association between equivalized annual household income and regular medical visits for hypertensive patients since the COVID-19 outbreak.

Previous studies have shown an increase in blood pressure during the coronavirus disease 2019 (COVID-19) pandemic even among patients receiving antihypertensive treatment. This study aims to evaluate the association between equivalized annual household income and refraining from regular medical visits for hypertensive patients since the COVID-19 outbreak. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), including 2832 hypertensive patients aged 20-79 years from the 2020 survey and at least one survey between 2021 and 2023. They were categorized into lower-income (<median of ¥3,182,000) and higher-income (≥median) groups. Refraining from regular medical visits was defined as not attending scheduled medical visits for hypertension in the past two months. Poisson regression or generalized linear mixed models were used, inverse probability weighted for Internet survey selection. After weighting, the mean age was 64.8 ± 10.3 years and 63.7% were men. In 2020, the proportion of hypertensive patients refraining from regular medical visits after weighting was 19.6% in the lower-income group and 8.8% in the higher-income group, with an adjusted proportion ratio (95% confidence interval) of 1.86 (1.13-3.06) for the lower-income group compared with the higher-income group. After 2020, the proportion of those refraining from regular medical visits declined in all income groups, and the income-related differences disappeared. During the social restrictions due to the COVID-19 pandemic, hypertensive patients with lower equivalized annual household incomes were more likely to refrain from regular medical visits. Strategies to reduce income-related inequities in medical care utilization may be necessary for future public health crises. A nationwide Internet survey in Japan revealed hypertensive patients with lower equivalized annual household incomes were significantly more likely to refrain from regular medical visits in 2020, during the social restrictions due to the COVID-19 pandemic. Addressing income-related inequities in medical care utilization is crucial for future public health crises.

Evaluation of a Global Initiative for Asthma Education and Implementation Program to Improve Asthma Care Quality (CARE4ALL): Protocol for a Multicenter, Single-Arm Study.

Poor symptom control and exacerbations of asthma diminish quality of life and pose a significant burden to patients and society. Implementing evidence-based management as recommended by the Global Initiative for Asthma (GINA), especially introducing inhaled corticosteroid-containing treatments, has the potential to vastly reduce exacerbations and the high burden of asthma in China. However, domestic implementation of the GINA recommendations has been unsatisfactory, especially in lower-level hospitals; thus, an enhancement to the awareness of and adherence to the GINA recommendations among Chinese physicians is needed to improve patient outcomes. This study aims to bridge the gap between the GINA recommendations and the current clinical practice in China by demonstrating the benefits of an asthma quality improvement program (QIP). A single-arm study will be conducted at around 30 hospitals across China to assess the impact of a specially designed asthma QIP. Approximately 1500 patients with asthma aged ≥14 years will be enrolled in participating hospitals and followed up for 48 weeks. The QIP-targeted at all pulmonologists and specialist nurses-will include an initial comprehensive training (including a pretraining questionnaire and posttraining quizzes) provided by a dedicated, qualified training team based on the GINA 2021 recommendations, followed by regular reinforcement learnings (integrated into the regular department lectures delivered by department directors), with multiple offline and online approaches (eg, an online patient management platform) provided as supportive tools. During this study, GINA implementation performance will be continuously monitored to inform necessary adjustments at the hospital level. The primary end point is change from baseline in the proportion of participants with an inhaled corticosteroid-based maintenance or reliever treatment at week 48. Secondary end points and exploratory end points include changes in clinical practice and patient outcomes such as treatment patterns, asthma control, and hospitalization rates due to exacerbations. This study has been completed, with 1500 patients enrolled and 1271 patients completing the study. The last visit of the last patient was on September 3, 2024, and the database lock was on September 28, 2024. Final analysis of data has started in October 2024. The Change Asthma Clinical Practice through GINA Education and Implementation for All Patients With Asthma (CARE4ALL) study will hopefully help improve asthma management and patient outcomes in China by bridging the gap between evidence-based GINA recommendations and the current clinical practice. ClinicalTrials.gov NCT05440097; https://clinicaltrials.gov/study/NCT05440097. DERR1-10.2196/65197.

Sociodemographic Characteristics, Indicators of Quality, and Hospital Visits in Patients With COPD During COVID-19

Sociodemographic Characteristics, Indicators of Quality, and Hospital Visits in Patients With COPD During COVID-19

Improved Adherence to Lipid Screening in the Pediatric Cardiology Clinic: A Quality Improvement Project.

Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023. All outpatient visits for patients 9-11 and 17-21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic dot phrase, group and individual feedback, and Epic best practice alert (BPA), were incorporated via plan-do-study-act cycles. Balancing measures included anonymous provider surveys on visit length and experience. More than 1,700 patient visits were included. At baseline, 35% of all age-appropriate patients were screened. The Epic dot phrase prompted a positive shift with a new mean of 59% screened. Another change occurred after the BPA alert, with an increase in screening to 84%. Lipid screening prompted by this initiative found that 38% of those with testing results in Epic had abnormal results requiring follow-up. Providers did not report a significant change in visit length due to screening. Quality improvement interventions improved adherence to universal lipid screening guidelines. The Epic dot phrase and BPA facilitated positive shifts. These simple interventions can be spread to other practices to improve adherence to lipid screening and other guidelines.

Critical Issues in the Management of CRMS/CFSPID Children: A National Real-World Survey.

Notwithstanding guidance from the European Cystic Fibrosis (CF) Society (ECFS) neonatal screening (NBS) working group, significant variation persists in the evaluation and management of Cystic Fibrosis Screen Positive, Inconclusive Diagnosis (CFSPID) subjects, leaving many aspects of care under debate. This study reports the results of a national survey investigating management and treatment approaches of pre-school CFSPIDs in Italy. In February 2024, a comprehensive questionnaire was distributed to all Italian CF centers. The survey explored various aspects of CFSPID management in the year 2023, including patient visit schedules, sweat tests (ST) timing, screening procedures, therapeutic interventions, and discharge criteria. Data on regional NBS protocols, number of CFSPID cases, and CF:CFSPID ratio were also collected. By December 31, 2023, CF Italian centers were following 522 CFSPIDs. In 2023, CF NBS identified 85 CF and 68 CFSPID cases, resulting in a CF:CFSPID ratio of 1.25:1. Seven centers diagnosed more CFSPID than CF, with the lowest CF:CFSPID ratio being 0.20:1. A quarter of all centers reported management plans that deviated widely from ECFS guidelines. Respiratory cultures were performed in 16 (69.6%) centers in the absence of symptoms. Nine (38.9%) prescribed antibiotics in any case of positive Pseudomonas aeruginosa cultures, including first detections and asymptomatic subjects. Spirometries were performed by 14/23 centers (60.9%) in procedure-competent children at each visit. Follow up care continued after age 6 for all CFSPIDs in 15 (65.2%) centers regardless of age, genotype or ST results. A diagnosis of CF was established based on repeated pathological STs and/or multiorgan involvement. Children with STs in intermediate range and mono-organ involvement were classified as CFTR-related disorders (CFTR-RD). Despite available data on clinical course and recommendations on management of CFSPIDs, different approaches persist in clinical practice. Further efforts should be considered to disseminate and encourage adherence to international guidelines.

Investigating the Applicability of an Administrative Claims Database in Japan in Collecting Safety Information on Diseases for Which Patients Visit Multiple Facilities during Drug Treatment

Investigating the Applicability of an Administrative Claims Database in Japan in Collecting Safety Information on Diseases for Which Patients Visit Multiple Facilities during Drug Treatment

Should We Be Resurrecting the Handshake?

The simple handshake has been around for more than 3,000 years as a sign of friendship and as an indication that neither party is carrying a weapon. The physician-patient relationship often begins with a traditional handshake. Hand hygiene is an integral part of patient encounters to reduce the spread of infectious diseases; however, many physicians and allied health providers believe taking a break for hand hygiene interrupts the natural flow of the initial introduction and nonverbal body trust-inducing language. The elimination of the handshake may allow providers to focus on more culturally acceptable universal verbal and nonverbal communication skills that help us build essential trust with our patients. Yet, research indicates that handwashing reduces hospital-acquired infections, so it stands to reason that it should be integral to every patient visit.

Strategy for Improving Smoking Cessation Services in Primary Health Care

Amidst the rising numbers of smokers in Indonesia and the increasing burden of smoking-related diseases on the country, the Smoking Cessation Services (SCS) still fail to operate optimally. The aim of this research is to develop a more effective strategy for the SCS model based on the challenges encountered during its implementation. The research method employed qualitative study with a case study approach. The research location was in Depok City, chosen as a national exemplary of SCS. Research period from February to May 2024. Data collection was conducted through in-depth interviews and observations at Community Health Centers who involved in SCS including health professionals, health promotors, and managers. The findings indicate that the SCS is not yet optimal due to insufficiently trained staff, low patient turnout, and failure to achieve the target quit rate. The services still focus on counseling and have not yet incorporated pharmacotherapy. The research concludes that short-term alternative strategies include follow-up calls to patients, establishing telecommunication groups with patients, and reaching out to new patients through schools, while long-term strategies such as program integration and building a telemedicine information system could be implemented to enhance patient visits.

Barriers and facilitators to implementing six monthly multi-month dispensing of antiretroviral therapy in two urban HIV clinics during the COVID-19 Era in Malawi.

Following the COVID-19 pandemic, the Malawi Government released a policy that promoted the scale-up of six-monthly multi-month dispensing (6-MMD) of antiretroviral therapy (ART) to people living with HIV in order to decrease congestion at health facilities and transmission of COVID-19. We evaluated the barriers and facilitators to implementing the scale-up of 6-MMD.We conducted a cross-sectional study and collected quantitative and qualitative data from 13 January 2022 to 5 February 2022 at two high-volume primary health facilities in urban Blantyre, Malawi. A survey was self-administered to healthcare workers (HCWs) and a subset were purposively selected for key informant interviews. The interviews were guided by the consolidated framework for implementation research and questions focused on perceived barriers and facilitators to 6-MMD. We calculated proportions of reported barriers and facilitators based on the Likert scale. A thematic content analysis was done for qualitative data. Of the 77 HCWs who participated in the surveys, 56 (73%) were female and 22 (29%) were nurses. Major barriers to the implementation of 6-MMD were low drug supply and lack of understanding of the policy. Other reported barriers were s missing clinic appointments and viral load sample collection, if timelines for ART dispensation and viral load testing were misaligned. The major facilitators were orientation and review meetings, teamwork among staff, and the use of the electronic medical records system to track patients. Additionally, reduction in the number of patient visits, which reduced the workload of healthcare workers was cited as another motivator for implementing 6-MMD. Major facilitators to transition to 6-MMD included health care worker capacity building, teamwork and use of electronic medical records while major barriers included low drug supplies and lack of understanding of policy guidance. These findings may be helpful when developing strategies for increasing coverage and uptake of 6-MMD of ART.

The proportion of secondary caries in the work load of dentist

Annotation. The aim of the study was to determine the proportion of teeth with secondary caries among carious lesions in children and adults to determine the amount of dentist’s work load for the primary and secondary teeth caries. A targeted epidemiological study of the dental status of 264 residents of Sumy oblast in the age group of 35-44 years old and 364 children aged 3, 6, 12 and 15 years was conducted. The analysis of the results determined the prevalence and intensity of caries. The intensity of adult dental caries was estimated by the integrated Decayed Missing Filled Teeth (DMFT) index and dft in children. It was found that the prevalence of caries among 3 year old children was 34.0% (95% CI: 25; 43), 6 years old – 69.0% (95% CI: 59; 78), 12 years old – 62.0% (95% CI: 52; 72), 15 years old – 68.0 (95% CI: 58; 77), adults - 100%. The intensity of caries at the age of 3 years by dft index was 1.54±0.11 teeth, 6 years (DMFT + dft) – 3.16±0.15 teeth, 12 years (DMFT) – 2.33±0.12, 15 years (DMFT) – 2.86±0.18 and in adults DMFT was 14.91±0.37 teeth. 64.0±13.0% of children at the age of 3 years, 52.9±6.0% – at the age of 6 years, 30.0±10.0% - at the age of 12 years, 48.5±6.1%, – at the age of 15 years and 47.2±2.9% of adults needed dental treatment for the primary caries. 36,0±13,0% of children at the age of 3 years, 47,1±6,0% – at the age of 6 years, 70,0±10,05% – at the age of 12 years, 51,5±6.1% – at the age of 15 years and 52,8±3,3% of adults needed dental treatment for secondary caries. Thus, almost half of dentist’s working time is precisely on repeated visits of patients for the elimination of the consequences of poor-quality treatment of primary teeth caries, which resulted from a number of reasons.

Right Aortic Arch in Pediatric: Experience of a Center

Background: Congenital aortic arch anomalies encompass various malformations, which can range from asymptomatic to presenting with severe respiratory or gastrointestinal issues. These anomalies may occur alone or alongside other congenital heart defects. Imaging is crucial for identifying these conditions and guiding accurate preoperative decisions. Objectives: This study aimed to assess the frequency of these abnormalities in patients with a right aortic arch, explore the reasons for their referral, and evaluate patient outcomes. Methods: This cross-sectional study was conducted on children under the age of 20 who visited the Congenital Heart Diseases Clinic at Imam Reza Hospital, Iran. We collected data from 277 records of patients with right aortic arch from 2002 to 2022. Data were gathered using a checklist, including echocardiographic results, angiography findings, and other diagnostic modalities for the patients. Statistical analysis was performed using IBM SPSS software, Version 25. Results: In this study, 118 (29.8%) patients had heterotaxia, of which 106 (26.8%) had dextrocardia and were excluded [82 (20.7%) with situs inversus, 21 (5.3%) with situs solitus, and 15 (3.7%) with situs ambiguous]. Among the 277 patients with a right aortic arch, 7 (2.3%) had an aberrant left subclavian artery branch. There were 141 (50.9%) female patients. The trachea and esophagus were compressed. Respiratory symptoms were commonly present in patients with a compressive right arch and aberrant left subclavian artery (Kommerell’s diverticulum), which showed a significant relationship. Congenital major heart anomalies were found in 261 (94.2%) patients, with the most common being right obstructive lesions related to tetralogy of fallot (TOF), seen in 115 (41.5%) patients. Complex congenital heart disease was present in 75 (27.1%) patients. Septal defects were observed in 44 (15.9%) patients, including ventricular septal defect in 39 (14.0%). Nine (3.2%) patients had left obstructive lesions, including coarctation of the aorta. Arterial anomalies, such as patent ductus arteriosus, were present in 14 (5.0%) patients. Sixteen patients had normal heart structures or minor cardiac anomalies. The most common non-cardiac abnormality was musculoskeletal. Finally, 189 (68.2%) patients underwent surgery, and 16 (5.8%) died. Conclusions: More detailed examinations during patient visits, attention to clinical symptoms, and modern imaging can hasten the identification of cardiac abnormalities in children, which plays an important role in the diagnosis and prognosis of patients.

Implementing HIV teams to improve HIV indicator condition-guided testing in general practitioner centers in the Netherlands

BackgroundHIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV teams, using trained GP ambassadors, promoted local HIV indicator condition-guided testing practices in urban GP centers in the Netherlands.MethodsWe conducted a prospective implementation study between May 2021 and March 2023. Patients ≥ 18 years newly diagnosed with HIV indicator conditions in three GP centers were included. The intervention consisted of HIV expert led education for GPs with a stepwise implementation of point-of-care testing (phase 1), followed by adding peer-to-peer case feedback by trained GP ambassadors (phase 2). Questionnaires were used to assess the experiences and beliefs of HIV indicator condition-driven testing in patients and GPs. The primary outcome was the overall HIV testing rate in patients diagnosed with indicator conditions compared to pre-implementation. Secondary outcomes were HIV testing rate per phase and per indicator condition, HIV positivity rate, and patients’ and GPs’ experiences with this testing strategy.ResultsIn 132,338 patient visits, 846 (0.6%, 95%CI 0.6–0.7%) HIV indicator conditions were diagnosed, including 485 sexually transmitted infections (57.3%). Overall, 215 (25.4%) indicator conditions were tested for HIV after the implementation of HIV teams. The testing rate was comparable between the two phases (25.2% versus 25.9%, p = 0.83). The testing rates pre- and post-implementation were comparable (21.3% versus 25.4%, p = 0.33). The most frequently tested HIV indicator conditions were unexplained weight loss (n = 13, 41.9%), unexplained lymphadenopathy (n = 8, 38.1%), and sexually transmitted infections (n = 161, 33.2%). Three patients (1.4%, 95%CI 0.3–4.0%) tested positive for HIV. Test acceptance in patients was high as was the self-perceived knowledge of GPs on HIV indicator conditions.ConclusionsImplementing HIV teams did not enhance HIV indicator condition-guided testing in urban GP centers from a low HIV prevalence setting. The high patients acceptance rate and self-perceived knowledge among GPs regarding HIV indicator conditions did not manifest in high HIV testing rates. Patients accepted testing, but a gap was found between the self-perceived knowledge of GPs regarding HIV indicator conditions and testing, and the actual HIV testing rate.Trial registrationClinicalTrials.gov NCT05225493 (registration date: 17-01-2022).

A novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients based on complete data from an entire health care system.

Dyspnoea is one of the emergency department's (ED) most common and deadly chief complaints, but frequently misdiagnosed and mistreated. We aimed to design a diagnostic decision support which classifies dyspnoeic ED visits into acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), pneumonia and "other diagnoses" by using deep learning and complete, unselected data from an entire regional health care system. In this cross-sectional study, we included all dyspnoeic ED visits of patients ≥ 18 years of age at the two EDs in the region of Halland, Sweden, 07/01/2017-12/31/2019. Data from the complete regional health care system within five years prior to the ED visit were analysed. Gold standard diagnoses were defined as the subsequent in-hospital or ED discharge notes, and a subsample was manually reviewed by emergency medicine experts. A novel deep learning model, the clinical attention-based recurrent encoder network (CareNet), was developed. Cohort performance was compared to a simpler CatBoost model. A list of all variables and their importance for diagnosis was created. For each unique patient visit, the model selected the most important variables, analysed them and presented them to the clinician interpretably by taking event time and clinical context into account. AUROC, sensitivity and specificity were compared. The most prevalent diagnoses among the 10,315 dyspnoeic ED visits were AHF (15.5%), eCOPD (14.0%) and pneumonia (13.3%). Median number of unique events, i.e., registered clinical data with time stamps, per ED visit was 1,095 (IQR 459-2,310). CareNet median AUROC was 87.0%, substantially higher than the CatBoost model´s (81.4%). CareNet median sensitivity for AHF, eCOPD, and pneumonia was 74.5%, 92.6%, and 54.1%, respectively, with a specificity set above 75.0, slightly inferior to that of the CatBoost baseline model. The model assembled a list of 1,596 variables by importance for diagnosis, on top were prior diagnoses of heart failure or COPD, daily smoking, atrial fibrillation/flutter, life management difficulties and maternity care. Each patient visit received their own unique attention plot, graphically displaying important clinical events for the diagnosis. We designed a novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients by analysing unselected data from a complete regional health care system.

THE NEED FOR PROSTHETIC TREATMENT WITH DIFFERENT DENTURE DESIGNS FOR RESIDENTS OF ODESA AND THE ODESA REGION

Objective. The aim of this study is to analyze the need for orthopedic treatment with removable dental prosthetic constructions among the residents of Odesa and the Odesa region based on a retrospective analysis of outpatient dental patient records. Materials and Methods. This research was conducted using outpatient records (form 043/o) of patients who sought dental treatment with removable orthopedic constructions at healthcare institutions in the Odesa region and city dental departments from 2019 to 2023. Results. The analysis examined the proportion of removable prostheses relative to the total number of prostheses manufactured. From 2019 to 2023, 5,439 individuals (38.1%) in the Odesa region received removable dental prostheses, while 8,272 (61.9%) were from Odesa. A total of 95,237 prostheses were produced, with 65.3% (62,182) made in Odesa. In 2020, 33,488 prostheses were manufactured; in 2021, 42,026; and in 2022, 19,723. The need for prosthetic treatment in Odesa is estimated at 57% (570 individuals per 1,000 population). Patient visits were recorded as follows: 176 individuals in 2020, 212 in 2021, and 182 in 2022. In 2022, the number of visits decreased by 10,428 individuals (15.5%) compared to 2020, and by 3,001 individuals (17.95%) compared to 2021, indicating a decline in the accessibility of dental services. Conclusion. The study conducted in the Odesa region (2019-2023) revealed a high demand for orthopedic treatment, particularly for removable dental prostheses. 38.1% of patients received prostheses, with 61.9% coming from Odesa. A decrease in patient visits was observed in 2022 that was likely due to the consequences of the COVID-19 pandemic and economic difficulties. The results highlight the need for monitoring the population's demand for dental services and adapting strategies to improve accessibility and quality of treatment.

Predicting patient visits at the psychiatric polyclinic of a public hospital in Bali, Indonesia: A forecasting approach using single exponential smoothing

Background: Hospital planning requires effective management of resources, facilities, and costs, and accurate patient visit forecasting is integral to this process. Forecasting methods, such as single exponential smoothing, are widely used to predict patient visits and aid in resource allocation. However, forecasting for psychiatric polyclinics presents unique challenges due to the fluctuating nature of mental health conditions and the difficulty in predicting patient behavior outside clinical settings. Objective: This study aimed to apply the single exponential smoothing method to forecast psychiatric polyclinic visits at a public hospital in Bali province, Indonesia, for the years 2024–2026, with the goal of assisting hospital management in planning resources and services. Methods: A retrospective analysis was conducted using patient visit data from January 2021 to December 2023. The data was processed and analyzed using the single exponential smoothing method through SPSS software. Forecasting accuracy was assessed using Root Mean Squared Error (RMSE) and Mean Absolute Percentage Error (MAPE), with forecasts for 2024–2026 generated for monthly patient visits. Results: The forecast for psychiatric polyclinic visits predicted a steady increase in visits, with 9,320 visits in 2024, 9,627 visits in 2025, and 9,939 visits in 2026. The accuracy of the forecasting model was confirmed by a MAPE of 2.87%, indicating high precision. The RMSE value was 26.8%, suggesting the average forecasting error was 26.8%. Conclusion: The single exponential smoothing method proved to be a reliable and straightforward tool for forecasting psychiatric polyclinic visits. With a high degree of forecasting accuracy, the method offers practical applications for hospital administrators to plan for future patient volume, optimize resource allocation, and ensure sufficient service capacity. Future research could explore the use of additional forecasting models and broader datasets to enhance predictive accuracy.

Increasing cumulative cabergoline dose in patients with prolactinoma improves metabolic parameters independently of decrease in prolactin levels

Objectives: In prolactinoma patients treated with cabergoline, all of whom achieved normoprolactinemia, longitudinal changes in metabolic parameters and the factors influencing these changes were investigated. Methods: This retrospective-longitudinal study was conducted at a pituitary disease center. Medical records of newly diagnosed prolactinoma patients between 2013 and 2023 were reviewed. After applying exclusion criteria, 102 prolactinoma patients were included in the final analysis. Clinical and laboratory parameters of prolactinoma patients were recorded. Metabolic parameters assessed were fasting plasma glucose, lipid levels, fasting insulin levels, HbA1c levels, and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) levels. Subsequently, metabolic parameters assessed at the initial and final visits were compared, and factors influencing these parameters were analyzed. Results: All prolactinoma patients were treated with cabergoline, and all were in remission at their final visit. The treatment significantly reduced fasting plasma glucose, HbA1c, and LDL cholesterol levels (P&amp;lt;0.05). Although there were improvements in other lipid parameters, fasting insulin, BMI, and HOMA-IR compared to baseline, the differences were not statistically significant. A correlation analysis was conducted to identify factors influencing fasting plasma glucose, HbA1c, and LDL cholesterol levels at the final visit in prolactinoma patients. The analysis revealed that only the cumulative dose of cabergoline significantly impacted all three metabolic parameters (P&amp;lt;0.05). Conclusions: Cabergoline not only balances prolactin levels but also directly improves metabolic health. Current and future evidence clearly indicates that dopamine agonists like cabergoline could be an effective treatment not only for patients with prolactinomas but also for individuals affected by metabolic disorders without hyperprolactinemia.

A Blockchain Based Framework for Electronic Health Records Access Control

ABSTRACT Nowadays, patient health information is gathered from multiple sources like wearable computing devices, ultra-smart sensing devices, and medical imaging equipment. The security of the data is essential as the average patient visit and medical record in the patient’s lifetime is high. To ensure data and privacy of the data, fine-grained information access is essential. Also, the medical records are scattered and available in multiple places, duplicated or fragmented. Security and privacy breaches are increasing, and it is sold to hackers for more price than banking data. We propose a fine-grained access control and information access to facilitate patient electronic health record management employing attribute-based encryption stored in blockchain. We implemented the blockchain in the Hyperledger Fabric platform. We have evaluated and compared the signing and verification time of the attribute-based encryption under various settings. To add further, our attribute-based access control mechanism scheme ensures that only if the participant’s attributes meet the access policy can alone access the electronic health records. Our performance analysis and security analysis illustrate our scheme’s robustness and our scheme is secure and efficient.

Chiropractic Care in Children: A Review of Evidence and Safety.

Complementary therapies are used to treat many pediatric symptoms and health conditions, and chiropractic care is one of the most commonly used forms of complementary therapies by children and adolescents. Research studies have investigated the evidence behind and safety of chiropractic care in pediatrics with various musculoskeletal and non-musculoskeletal conditions. There are limited data with a range of findings and often no definite conclusion. Despite the paucity of evidence of benefits of chiropractic care in children, the considerations around safety, and the differing opinions regarding pediatric chiropractic practice inside and outside the field, many pediatric patients visit chiropractors, and chiropractors often care for pediatric patients. Pediatric health care providers should discuss the use of all complementary therapies with patients, so guidance can be optimal with a focus on promoting health and safety.