Healthcare Products Research Articles

AI as a Medical Device for Ophthalmic Imaging in Europe, Australia, and the United States: Protocol for a Systematic Scoping Review of Regulated Devices.

Artificial intelligence as a medical device (AIaMD) has the potential to transform many aspects of ophthalmic care, such as improving accuracy and speed of diagnosis, addressing capacity issues in high-volume areas such as screening, and detecting novel biomarkers of systemic disease in the eye (oculomics). In order to ensure that such tools are safe for the target population and achieve their intended purpose, it is important that these AIaMD have adequate clinical evaluation to support any regulatory decision. Currently, the evidential requirements for regulatory approval are less clear for AIaMD compared to more established interventions such as drugs or medical devices. There is therefore value in understanding the level of evidence that underpins AIaMD currently on the market, as a step toward identifying what the best practices might be in this area. In this systematic scoping review, we will focus on AIaMD that contributes to clinical decision-making (relating to screening, diagnosis, prognosis, and treatment) in the context of ophthalmic imaging. This study aims to identify regulator-approved AIaMD for ophthalmic imaging in Europe, Australia, and the United States; report the characteristics of these devices and their regulatory approvals; and report the available evidence underpinning these AIaMD. The Food and Drug Administration (United States), the Australian Register of Therapeutic Goods (Australia), the Medicines and Healthcare products Regulatory Agency (United Kingdom), and the European Database on Medical Devices (European Union) regulatory databases will be searched for ophthalmic imaging AIaMD through a snowballing approach. PubMed and clinical trial registries will be systematically searched, and manufacturers will be directly contacted for studies investigating the effectiveness of eligible AIaMD. Preliminary regulatory database searches, evidence searches, screening, data extraction, and methodological quality assessment will be undertaken by 2 independent review authors and arbitrated by a third at each stage of the process. Preliminary searches were conducted in February 2023. Data extraction, data synthesis, and assessment of methodological quality commenced in October 2023. The review is on track to be completed and submitted for peer review by April 2024. This systematic review will provide greater clarity on ophthalmic imaging AIaMD that have achieved regulatory approval as well as the evidence that underpins them. This should help adopters understand the range of tools available and whether they can be safely incorporated into their clinical workflow, and it should also support developers in navigating regulatory approval more efficiently. DERR1-10.2196/52602.

The Requirements of Managing Phase I Clinical Trials Risks: The British and Italian Case Studies.

Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the "Clinical Trial Quality Team", which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.

A Review of E-commerce As Part From the Excelence Movement Theory in Hospital Management System

<p align="justify">The e-commerce market in Indonesia has experienced substantial growth over the years, particularly during the COVID-19 pandemic. With advancements in Information and Communication Technology (ICT), numerous companies, including hospitals, have altered their operational methods and customer interactions. This paper aims to investigate the application of e-commerce as a constituent of the Excellence Movement Theory within Hospital Management Systems. The review methodology involves conducting a literature search on relevant material pertaining to the core issue at hand. The findings illustrate how implementing an e-commerce platform within hospitals can enhance administrative processes' efficiency, improve patient care quality, and generate additional revenue from sales of healthcare products and services. Additionally, several challenges associated with utilizing an e-commerce platform in hospital management systems are addressed in this discussion. By incorporating e-commerce into hospital management practices through this review process, it can become an essential element of Indonesia's excellence movement strategy for managing hospitals effectively.</p>

The assessment of composition, biological properties, safety and molecular docking of corn silk (Zea mays L.) extracts from the valorization of agricultural waste products in Thailand

Corn, known as Zea mays L., is an important source of nutrition for humans and animals. Corn silk is a byproduct of corn which is typically disposed in agriculture of Thailand. Examination of the composition, biological properties, safety and molecular docking interactions of corn silk extracts was the objective of this research. The crude extracts were determined for percentage yield, phytochemical composition, antioxidative activity, enzyme inhibition activities, safety profile and active content analysis. The corn silk extract with water by reflux technique (Rcsw) had the highest percentage yield and total phenolic content at 16.23% and 23.87±3.22 mgGAE/g extract, respectively, while the corn silk extract with 50% ethanol by reflux technique (Rcs50) gave the highest total flavonoid content at 220.58±47.51 mgQE/g extract. The four selected corn silk extracts had cosmeceutical potential including antioxidant activities, tyrosinase inhibition, anti-aging activity and a non-toxic profile on HET-CAM and cell culture test. The content analysis by HPLC was the highest in the corn silk extract with water by ultrasonication (Ucsw) at 18.70±2.12 mg GA/g and 903.29±23.18 mg QE/g. The comprehension of the molecular mechanisms that affected the interaction between active ingredients and the structures of tyrosinase, collagenase and hyaluronidase has been provided via molecular docking of the extracts. The findings of this research have illustrated the potential of corn silk extracts in the advancement of innovative health care products.

Lethal puncturing of planktonic Gram-positive and Gram-negative bacteria by magnetically-rotated silica hexapods

Planktonic bacterial presence in many industrial and environmental applications and personal health-care products is generally countered using antimicrobials. However, antimicrobial chemicals present an environmental threat, while emerging resistance reduces their efficacy. Suspended bacteria have no defense against mechanical attack. Therefore, we synthesized silica hexapods on an α-Fe2O3 core that can be magnetically-rotated to inflict lethal cell-wall-damage to planktonic Gram-negative and Gram-positive bacteria. Hexapods possessed 600 nm long nano-spikes, composed of SiO2, as shown by FTIR and XPS. Fluorescence staining revealed cell wall damage caused by rotating hexapods. This damage was accompanied by DNA/protein release and bacterial death that increased with increasing rotational frequency up to 500 rpm. Lethal puncturing was more extensive on Gram-negative bacteria than on Gram-positive bacteria, which have a thicker peptidoglycan layer with a higher Young's modulus. Simulations confirmed that cell-wall-puncturing occurs at lower nano-spike penetration levels in the cell walls of Gram-negative bacteria. This approach offers a new way to kill bacteria in suspension, not based on antimicrobial chemicals.

The effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being: a systematic review and meta-analysis.

Widespread challenges to mental well-being among nurses and healthcare professionals threaten the productivity and quality of healthcare. Digital solutions may prove to effectively support nurses' and healthcare professionals' mental well-being. To synthesise evidence regarding the effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being. This systematic review followed the JBI guidance for systematic reviews of effectiveness. The PubMed, CINAHL, Scopus, Pro-Quest and APA PsycArticles databases were reviewed for randomised controlled trials and quasi-experimental studies published at any point prior to the 26th of October 2021. Meta-analysis and narrative synthesis were performed. Fourteen studies were included. Personal mental well-being solutions significantly improved nurses' and healthcare professionals' mental well-being. The effectiveness of work-related digital solutions could not be demonstrated. The meta-analysis revealed little to no effect on professionals' work engagement. Personal digital solutions may have the potential to improve the mental well-being of nurses and healthcare professionals. With the support of nurse managers' facilitation, nurses have a key role to promote their own mental well-being by utilising digital mental health solutions. Nevertheless, further adequately powered, well-designed research is required.

Quality Evaluation of Asparagus officinalis by Profile of Amino Acids and Mineral Elements in Different Parts Combined with Chemometrics Methods.

Asparagus officinalis has a homologous value in medicine and vegetables. Its immature stem, commonly called asparagus, is a central edible part. Asparagus skin and leaf also contain rich nutrients. However, these parts are often discarded. This study investigated amino acid and mineral elements in immature stem, skinless asparagus, asparagus skin, and leaf. Their quality was further evaluated by chemometrics methods such as principal component analysis and neural network analysis. The results showed amino acid content was high in immature stem and skinless asparagus and low in leaf, whereas the mineral elements were in four parts. Quality evaluation results showed four parts were divided into three grades. Immature stem and skinless asparagus were grouped into cluster 1 with the best quality as high-quality raw materials in food and health-care products. Meanwhile, three AA (Cys, His, Arg) and two mineral elements (Na, Cr) were identified as quality evaluation iconic substances.

A study protocol to investigate if acipimox improves muscle function and sarcopenia: an open-label, uncontrolled, before-and-after experimental medicine feasibility study in community-dwelling older adults

IntroductionSarcopenia is the age-associated loss of muscle mass and strength. Nicotinamide adenine dinucleotide (NAD) plays a central role in both mitochondrial function and cellular ageing processes implicated in sarcopenia. NAD...

Intelligent, Flexible Artificial Throats with Sound Emitting, Detecting, and Recognizing Abilities.

In recent years, there has been a notable rise in the number of patients afflicted with laryngeal diseases, including cancer, trauma, and other ailments leading to voice loss. Currently, the market is witnessing a pressing demand for medical and healthcare products designed to assist individuals with voice defects, prompting the invention of the artificial throat (AT). This user-friendly device eliminates the need for complex procedures like phonation reconstruction surgery. Therefore, in this review, we will initially give a careful introduction to the intelligent AT, which can act not only as a sound sensor but also as a thin-film sound emitter. Then, the sensing principle to detect sound will be discussed carefully, including capacitive, piezoelectric, electromagnetic, and piezoresistive components employed in the realm of sound sensing. Following this, the development of thermoacoustic theory and different materials made of sound emitters will also be analyzed. After that, various algorithms utilized by the intelligent AT for speech pattern recognition will be reviewed, including some classical algorithms and neural network algorithms. Finally, the outlook, challenge, and conclusion of the intelligent AT will be stated. The intelligent AT presents clear advantages for patients with voice impairments, demonstrating significant social values.

Using Nuclear Magnetic Resonance to Troubleshoot a Stability Issue in a Real-World Formulation Chassis-Application to Consumer Oral Healthcare.

With direct application to current and future consumer healthcare products, this research sheds light on the importance of packaging and its potential effects on both Active Pharmaceutical Ingredient (API) delivery and stability. Industrially sourced, proprietary experimental formulations (PEFs), specifically oral cleansers, based on salicylic acid and hydrogen peroxide, discolored over time at different rates, depending on packaging type used. This discoloration stemmed from an interplay of two factors, involving both spontaneous formulation degradation and the interaction of both degradants and salicylic acid with the internal surface of the packaging. This manuscript reports on the investigation to uncover the origins of discoloration. To investigate this real-world, industrial pipeline problem, we exploited the high dimensionality and simple sample preparation uniquely afforded by NMR. Using a combination of 1D/2D NMR and diffusion-ordered NMR spectroscopy (DOSY) to leverage molecular mass estimations from, we not only quickly confirmed the identities of these degradants, but also assessed their formation as a function of temperature and pH, providing insight into the mechanisms underlying their formation. We were able to identify catechol as the main source of discoloration over a period of several weeks, being formed at the ppm level. Furthermore, we evaluated the formulation-container interaction, employing NMR, ICP-MS, and ATR-IR. Despite this comprehensive analysis, the root causes of discoloration could only tentatively be assigned to a surface Ti complex of salicylic acid and other hydroxy carboxylic acids. Through the understanding of formulation degradation pathways, we were able to support further toxicology assessment, vital to both consumer safety and the manufacturer. This work underscores the invaluable role of NMR in the analysis of intricate proprietary mixtures with a consumer-centric purpose. Our findings demonstrate that conventional analytical techniques falter in the face of such complexity, requiring extensive preparation and pre-analytical processing, highlighting the novelty and crucial relevance of NMR research to manufacturers and consumers. Such an analysis is of value in the pursuit of materials within the consumer-healthcare space, which meet the requirements for successful recycling or re-use.

Plasma-induced Polymerization and Grafting of Acrylic Acid on the Polypropylene Nonwoven Fabric Using Pulsed Underwater Diaphragm Electrical Discharge

Polypropylene (PP) nonwovens are used in many hygiene, healthcare and medical products due to their low cost, high chemical resistance and inertness. From an economic point of view, PP textiles would be used as an excellent support material in regenerative medicine or tissue engineering, but here surface functionalization is necessary to ensure cell adhesion and proliferation. Acrylic acid (AAc) is an excellent source of carboxylic-rich (-COOH) coatings suitable for this purpose, but their multistep preparation is time-consuming. Plasma polymerization provides an excellent solution to this demanding procedure since the process of polymerization and grafting to the substrate takes place simultaneously. Here, we propose a relatively fast and effective method for AAc plasma polymerization by using a pulsed underwater diaphragm electrical discharge operated in an aqueous solution consisting of AAc. AAc layers are successfully grafted onto PP nonwovens, which are continuously rewound through the slit where the plasma is generated. The presence of plasma polymerized AAc layer in the fibrous structure of PP nonwoven was monitored by SEM, FTIR and XPS measurements. Additionally, the improved wettability and adhesion characteristics were investigated by the critical wetting surface tension (CWST) method, the standard method of strike-through time (STT) and „tape-peel“ test. Resulting AAc modified PP nonwoven possesses hydrophilic character, enhanced adhesion and a considerable amount of -COOH groups on the surface. Although after the washing test the FTIR and XPS results indicated a lower concentration of the carboxylic groups, the CWST and STT measurements confirmed the stable hydrophilic character of the PP nonwovens surface.

Control of the Colloidal and Adsorption Behaviors of Chitin Nanocrystals and an Oppositely Charged Surfactant at Solid, Liquid, and Gas Interfaces.

Chitin has a unique hierarchical structure, spanning the macro- and nanoscales, and presents chemical characteristics that make it a suitable component of multiphase systems. Herein, we elucidate the colloidal interactions between partially deacetylated chitin nanocrystals (cationic ChNC) and an anionic surfactant, sodium dodecyl sulfate (SDS). We investigate charge neutralization and association (electrophoretic mobility, surface tensiometry, and quartz crystal microgravimetry) and their role in the stabilization of Pickering emulsions. We find SDS adsorption and association with ChNC under distinctive regimes: At low SDS concentration, submonolayer assemblies form on ChNC, driven by the hydrophobic effect and electrostatic interactions. With the increased SDS concentration, bilayers or patchy bilayers form, followed by adsorbed hemimicelles and micelles. We further suggested the role of hydrophobic effects in the observed colloidal transitions and complex conformations. At the highest SDS concentration tested, charge neutralization and SDS/ChNC flocculation take place. Remarkably, at given concentrations, adsorbed SDS endows the chitin nanoparticles with an effective hydrophobicity that opens the opportunity to achieve tailorable Pickering stabilization. Hence, a facile route is proposed by in situ modification by SDS physisorption, which extends the potential of renewable nanoparticles in the formulation of complex fluids, for instance, those relevant to household and healthcare products.

A trustworthy AI reality-check: the lack of transparency of artificial intelligence products in healthcare.

Trustworthy medical AI requires transparency about the development and testing of underlying algorithms to identify biases and communicate potential risks of harm. Abundant guidance exists on how to achieve transparency for medical AI products, but it is unclear whether publicly available information adequately informs about their risks. To assess this, we retrieved public documentation on the 14 available CE-certified AI-based radiology products of the II b risk category in the EU from vendor websites, scientific publications, and the European EUDAMED database. Using a self-designed survey, we reported on their development, validation, ethical considerations, and deployment caveats, according to trustworthy AI guidelines. We scored each question with either 0, 0.5, or 1, to rate if the required information was "unavailable", "partially available," or "fully available." The transparency of each product was calculated relative to all 55 questions. Transparency scores ranged from 6.4% to 60.9%, with a median of 29.1%. Major transparency gaps included missing documentation on training data, ethical considerations, and limitations for deployment. Ethical aspects like consent, safety monitoring, and GDPR-compliance were rarely documented. Furthermore, deployment caveats for different demographics and medical settings were scarce. In conclusion, public documentation of authorized medical AI products in Europe lacks sufficient public transparency to inform about safety and risks. We call on lawmakers and regulators to establish legally mandated requirements for public and substantive transparency to fulfill the promise of trustworthy AI for health.

Sour Jujube (Ziziphus jujuba var. spinosa): A Bibliometric Review of Its Bioactive Profile, Health Benefits and Trends in Food and Medicine Applications.

Research on the comprehensive utilization of sour jujube and its beneficial properties to human health has attracted extensive attention. This study aims to conduct a bibliometric analysis of the bioactive profile of sour jujube and future trends in applications. The research advancements within this field from 2000 to 2023 were addressed using the Web of Science database and VOSviewer. Among the 322 results, the most frequent keywords of bioactivity are flavonoids, antioxidants, saponins, insomnia, polyphenols, terpenoids and anti-inflammatory; the most studied parts of sour jujube are seeds, fruits and leaves; the published articles with high citations mainly focus on identification, biological effects and different parts distribution of bioactive compounds. The bioactivity of various parts of sour jujube was reviewed considering their application potential. The seeds, rich in flavonoids, saponins and alkaloids, exhibit strong effects on central nervous system diseases and have been well-developed in pharmacology, healthcare products and functional foods. The pulp has antioxidant properties and is used to develop added-value foods (e.g., juice, vinegar, wine). The leaves can be used to make tea and flowers are good sources of honey; their extracts are rich sources of flavonoids and saponins, which show promising medicinal effects. The branches, roots and bark have healing properties in traditional folk medicine. Overall, this study provides a reference for future applications of sour jujube in food and medicine fields.

An innovative mobile app for the provision of medical information and collection of safety data on exposure to medicines during pregnancy or breastfeeding: An IHI ConcePTION contribution

AbstractObjectiveTo increase the volume, quality, and comprehensiveness of pregnancy and breastfeeding reports related to medication exposure.MethodsInnovative Health Initiative (IHI) ConcePTION, in collaboration with the Medicines and Healthcare products Regulatory Agency (MHRA), has developed a mobile application designed for exchange of safety information for pregnancy and breastfeeding. The users will also be able to report medication exposure during pregnancy and breastfeeding, regardless of the outcome, by answering simple questions, tailored for their level of medical knowledge.ResultsThrough the first version of the app, the users will receive trusted safety information on their medication of interest, from the Health Authority (RSS feeds, tagged for ‘pregnancy’ and ‘breastfeeding’). By using the app, women and healthcare providers will also be able to help future mothers, by reporting the events they experienced following the utilization of medications during pregnancy and breastfeeding. These will be analyzed by MHRA to further characterize the safety profiles of the medications required to be used in these situations.ConclusionCollection of pregnancy outcomes after exposure to medications during pregnancy is limited by under‐reporting and focused on reporting of harms. By developing the app, ConcePTION brings reliable safety information closer to healthcare professionals and pregnant and breastfeeding women and proposes an easy‐to‐use, general data protection regulation‐compliant, secure tool tailored for safety in pregnancy and breastfeeding.

Investigation of sex-based differences in the immunotoxicity of silver nanoparticles

The growing application of silver nanoparticles (AgNPs) in consumer, healthcare, and industrial products has raised concern over potential health implications due to increasing exposure. The evaluation of the immune response to nanomaterials is one of the key criteria to assess their biocompatibility. There are well-recognized sex-based differences in innate and adaptive immune responses. However, there is limited information available using human models. The aim was to investigate the potential sex-based differences in immune functions after exposure to AgNPs using human peripheral blood mononuclear cells (PBMCs) and plasma from healthy donors. These functions include inflammasome activation, cytokine expression, leukocyte proliferation, chemotaxis, plasma coagulation, and complement activation. AgNPs were characterized by dynamic light scattering and transmission electron microscopy. Inflammasome activation by AgNPs was measured after 6- and 24-hours incubations. AgNPs-induced inflammasome activation was significantly higher in the females, especially for the 6-hour exposure. No sex-based differences were observed for Ag ions controls. Younger donors exhibited significantly more inflammasome activation than older donors after 24-hours exposure. IL-10 was significantly suppressed in males and females after exposure. AgNPs suppressed leukocyte proliferation similarly in males and females. No chemoattractant effects, no alterations in plasma coagulation, or activation of the complement were observed after AgNPs exposure. In conclusion, the results highlight that there are distinct sex-based differences in inflammasome activation after exposure to AgNPs in human PBMCs. The results highlight the importance of considering sex-based differences in inflammasome activation induced by exposure to AgNPs in any future biocompatibility assessment for products containing AgNPs.

Country of Origin of Medical Products and Risk of Labour Rights Abuse: A Cross-Sectional Analysis Using Four Procurement Datasets.

Background Case studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO). Methods Public procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA). In each dataset, the product COO was matched to the International Trade Union Confederation risk rating for labour abuse and deemed high-risk when rated 4, 5, or 5+. Results In the Norway data, 55.4%of products by value had a COO declared, 49.1% of which mapped as high-risk of labour rights abuses. COO was identified for 70/100 products in the Cambridge data, with COO matching high-risk at 59.9% by value. The level of risk for specific medical product categories varied between the Norway, US FDA, and UN Comtrade datasets, but those with higher proportional risk included medical/surgical gloves and electrosurgical products. Conclusion Evidence of high-risk of labour rights abuse in the manufacture of healthcare products present in these data indicates a likely high level of risk across the sector. There is an urgent need for global legislative and political reform, with a particular focus on supply chain transparency as a key mechanism for tackling this issue.

Tanning Melanotan Jabs and Nasal Spray: Safe or Not?

Cultural values among young population are focused on the concept of skin tanning as a perception of health and attractiveness. This has populated the development of using synthetic tanning agents especially with the advertisement coming from the social media. Synthetic tanning agents in forms of nasal spray or injections have gained publicity of use within society through the web and other uncontrolled sourcing routes. Warnings have been issued by UK Medicines and Healthcare products Regulatory Agency, and Irish Medicines Board against the use of subcutaneous injections labelled as Melanotan, after the upsurge in consuming tanning injections that has noticed in recent years [1].

Unlocking the relationship between ambidextrous leadership style and HRM practices in knowledge-intensive SMES

PurposeThis paper aims to explore the relationship between owner-manager or leader’s ambidextrous leadership style and its effect on human resource management (HRM) practices, contextual ambidexterity and knowledge-intensive small- and medium-enterprises (SMEs) strategic agility.Design/methodology/approachThis study presents an in-depth qualitative case study analysis of two knowledge-intensive SMEs from India’s information technology and health-care products industry serving a range of global clients. Using the theoretical lenses of empowerment-focused HRM practices, ambidextrous leaders, contextual ambidexterity and strategic agility, semi-structured interview data of leaders, managers and employees of the case organizations were analysed. Through a two-staged analytical process, we abductively developed a novel conceptual framework at the intersection of the above theoretical lenses.FindingsThe findings suggest that the knowledge-intensive SME’s strategic agility, ambidexterity and empowerment-focussed HRM approach was influenced by the owner-manager or leader’s ambidextrous leadership style and their philosophy towards managing people and had a positive impact in creating a culture of trust, participation, risk-taking and openness, and led to delivering innovative products and services as well as several positive employee-level outcomes.Originality/valueRecent literature reviews on HRM In SMEs highlight several gaps, including the impact of owner-manager or leader’s philosophy of managing people in shaping HRM practices and employee outcomes. This paper thus adds to the existing literature on HRM and knowledge-intensive SMEs.

A new cloud-based method for composition of healthcare services using deep reinforcement learning and Kalman filtering

Healthcare has significantly contributed to the well-being of individuals around the globe; nevertheless, further benefits could be derived from a more streamlined healthcare system without incurring additional costs. Recently, the main attributes of cloud computing, such as on-demand service, high scalability, and virtualization, have brought many benefits across many areas, especially in medical services. It is considered an important element in healthcare services, enhancing the performance and efficacy of the services. The current state of the healthcare industry requires the supply of healthcare products and services, increasing its viability for everyone involved. Developing new approaches for discovering and selecting healthcare services in the cloud has become more critical due to the rising popularity of these kinds of services. As a result of the diverse array of healthcare services, service composition enables the execution of intricate operations by integrating multiple services' functionalities into a single procedure. However, many methods in this field encounter several issues, such as high energy consumption, cost, and response time. This article introduces a novel layered method for selecting and evaluating healthcare services to find optimal service selection and composition solutions based on Deep Reinforcement Learning (Deep RL), Kalman filtering, and repeated training, addressing the aforementioned issues. The results revealed that the proposed method has achieved acceptable results in terms of availability, reliability, energy consumption, and response time when compared to other methods.