Quality Health Research Articles

Work motivation of implementing nurses to improve the quality of health services

Introduction: The motivation of the implementing nurse is essential to improving the quality of health services. Implementing nurses plays a vital role in providing quality services to patients. High work motivation is crucial in enhancing nurses' performance and commitment to providing the best care. Objective: Knowing the motivation behind implementing nurses can improve the quality of health services. Method: This research is quantitative, with a cross-sectional study design using a quantitative analytical approach. The number of samples was 81 people using total sampling. The research instrument used was a questionnaire with a Likert scale. The analysis method uses the Fisher's exact test. Results: Based on the results of the analysis, these employees have discipline that is still lacking in completing work, while of the 5 respondents who have low work motivation, three respondents (3.7%) have good performance. This is because employees have effectiveness, efficiency, authority, responsibility, discipline, and good work initiative. The statistical test results using Fisher's exact test obtained p = 0.009, smaller than a = 0.05 (p < 0.05), which means Ho is accepted and Ha is rejected. This suggests there is a meaningful relationship between work motivation and. Conclusion: The researchers found that the work motivation of implementing nurses can improve the quality of health services. Implementing nurses can enhance healthcare quality, build team spirit, and achieve organisational goals. These efforts help increase patient satisfaction and improve job satisfaction and nurses' well-being. Therefore, understanding and applying compelling work motivation is the key to improving the quality of health services.

A cost-effective ECG monitoring in rural areas: leveraging artificial neural networks for efficient healthcare solutions

Cardiovascular diseases engender serious public health concerns in developing nations since access to specialized medical equipment is often limited and standard treatment expenses can be prohibitive. This study proposes an efficient and relatively affordable electrocardiogram (ECG) monitoring system that reads and analyzes a person's electrocardiogram data to provide affordable and quality healthcare solutions. The device initially extracts features from electrocardiogram records by reading electrical signals in the heart. Extracted data are then analyzed by a trained deep learning model to determine precisely if the heart is in a healthy state or undergoing complexities. Experimental results showed that the fine-tuned ANN architecture outperformed the state-of-the-art architectures in this field with an accuracy of 98.95%. The data can also be sent to specialists through an MQTT server if necessary, allowing for remote diagnosis and treatment. The system is intended to be deployed in countries where rural regions lack access to specialized healthcare equipment and professionals. Additionally, the device is inexpensive and, hence can be made accessible to people with limited affordability.

The nexus of minds unveiling the significance of AI in mental health and viable remedie

The world is evolving at a cutthroat rate, and the integration of mental well-being and technology can yield promising results. For this reason, I have created The Nexus of Minds, which focuses on exploring the role of AI in changing the dynamics and thought processes of how we address and approach mental health issues. I am focusing on the transformative potential of Artificial Intelligence as a force for accessible, personalized, and effective mental healthcare. Mental healthcare has a huge spectrum, and I am exploring the multifaceted applications of AI, which have the potential to change the landscape. Machine Learning, Data Analytics, and Natural Language Processing have shown immense advancements, which is empowering AI to redefine how mental health issues are diagnosed and treated. Ranging from earlier intervention through continuous monitoring to all-time support, this book focuses on different ways in which AI solutions are improving the quality of mental healthcare and clinical results. It focuses on how AI is empowering people on their mental health journey. In addition to the technological innovation, I will navigate through the ethical considerations that need to be focused on, including but not limited to privacy, algorithmic bias, data privacy and security, and the role of human connection and empathy in mental healthcare. By understanding these essentials, I am offering insights into the responsible, ethical, and balanced integration of AI into mental health support. Moreover, this book focuses on apps and chatbots that are already providing help to people struggling with mental health illnesses and how they are benefiting from AI-centric mental health services. As a result, the readers will be able to gain an understanding of how AI will improve the quality of mental healthcare and destigmatize mental health conditions. With "The Nexus of Minds," I envision a future where AI won't be merely a tool but an absolute force in mental healthcare by breaking down the stigma and societal barriers to give hope to struggling people. This book will become a guiding beacon, providing information about the seamless coexistence of ethical and compassionate mental healthcare and tech advancement. I have taken an interdisciplinary approach, making it a promising resource for healthcare professionals, policymakers, researchers, and common people who want to see a bright future in the mental health industry.

Impact of technological innovations on healthcare delivery: A literature review of efficiency, patient care, and operational challenges

The rapid integration of technology in healthcare systems globally has ushered in transformative changes in patient care, operational efficiency, and data management. This literature review assesses the impact of emerging technologies such as blockchain, information technology, electronic medical records (EMRs), and artificial intelligence (AI) within healthcare settings. Drawing from a wide range of peer-reviewed articles and empirical studies, this paper synthesizes current research findings to understand the multifaceted effects of these technologies on healthcare delivery. The review highlights how these innovations enhance healthcare quality, streamline operations, and tackle prevalent challenges, particularly focusing on their implementation in Saudi Arabian healthcare contexts. Key findings indicate that while technological advancements offer significant improvements in patient care and system management, they also introduce challenges related to privacy, security, and the need for significant infrastructure investments. The review underscores the necessity for ongoing research to navigate technology adoption’s complexities and optimize healthcare practices effectively. This paper contributes to academic and practical discussions on leveraging technology to foster more efficient and responsive healthcare systems worldwide.\

Long COVID Definitions and Models of Care : A Scoping Review.

Definitions of long COVID are evolving, and optimal models of care are uncertain. To perform a scoping review on definitions of long COVID and provide an overview of care models, including a proposed framework to describe and distinguish models. English-language articles from Ovid MEDLINE, PsycINFO, the Cochrane Library, SocINDEX, Scopus, Embase, and CINAHL published between January 2021 and November 2023; gray literature; and discussions with 18 key informants. Publications describing long COVID definitions or models of care, supplemented by models described by key informants. Data were extracted by one reviewer and verified for accuracy by another reviewer. Of 1960 screened citations, 38 were included. Five clinical definitions of long COVID varied with regard to timing since symptom onset and the minimum duration required for diagnosis; 1 additional definition was symptom score-based. Forty-nine long COVID care models were informed by 5 key principles: a core "lead" team, multidisciplinary expertise, comprehensive access to diagnostic and therapeutic services, a patient-centered approach, and providing capacity to meet demand. Seven characteristics provided a framework for distinguishing models: home department or clinical setting, clinical lead, collocation of other specialties, primary care role, population managed, use of teleservices, and whether the model was practice- or systems-based. Using this framework, 10 representative practice-based and 3 systems-based models of care were identified. Published literature often lacked key model details, data were insufficient to assess model outcomes, and there was overlap between and variability within models. Definitions of long COVID and care models are evolving. Research is needed to optimize models and evaluate outcomes of different models. Agency for Healthcare Research and Quality. (Protocol posted at https://effectivehealthcare.ahrq.gov/products/long-covid-models-care/protocol.).

The Significance of Quality in Health Services

Introduction: Businesses and organizations in the current period strive to thrive in a fiercely competitive environment by attracting a maximum number of consumers. Purpose: This review study seeks to examine the definition of quality in health care with the goal of promoting health. Materials and Methods: The methodology employed involved doing a comprehensive literature search of review and research studies in internationally recognized databases such as Medline, Pubmed, and Cinahl. The articles were excluded based on the criterion that they were written in a language other than English. Results: The concept of health is intricate, making it challenging to establish a precise and unambiguous definition of excellence in healthcare. Quality in healthcare is an essential focus for scientists, organizations, and healthcare personnel, as well as for individuals who receive these services. Conclusions: Undoubtedly, quality in health services is an increasingly demanding first-priority need.

Exploring the path to optimal diabetes care by unravelling the contextual factors affecting access, utilisation, and quality of primary health care in West Africa: A scoping review protocol.

The prevalence of diabetes in West Africa is increasing, posing a major public health threat. An estimated 24 million Africans have diabetes, with rates in West Africa around 2-6% and projected to rise 129% by 2045 according to the WHO. Over 90% of cases are Type 2 diabetes (IDF, World Bank). As diabetes is ambulatory care sensitive, good primary care is crucial to reduce complications and mortality. However, research on factors influencing diabetes primary care access, utilisation and quality in West Africa remains limited despite growing disease burden. While research has emphasised diabetes prevalence and risk factors in West Africa, there remains limited evidence on contextual influences on primary care. This scoping review aims to address these evidence gaps. Using the established methodology by Arksey and O'Malley, this scoping review will undergo six stages. The review will adopt the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines to ensure methodological rigour. We will search four electronic databases and search through grey literature sources to thoroughly explore the topic. The identified articles will undergo thorough screening. We will collect data using a standardised data extraction form that covers study characteristics, population demographics, and study methods. The study will identify key themes and sub-themes related to primary healthcare access, utilisation, and quality. We will then analyse and summarise the data using a narrative synthesis approach. The findings and conclusive report will be finished and sent to a peer-reviewed publication within six months. This review protocol aims to systematically examine and assess the factors that impact the access, utilisation, and standard of primary healthcare services for diabetes in West Africa.

Health and wellbeing status of the long-lived individuals of the Spanish LONGECYL cross-sectional study

BackgroundThe increase in life expectancy and long-lived individuals is a challenge for public health and provides an opportunity to understand the determinants of longevity. However, few studies have addressed the factors associated with the health status and quality of life in a long-lived individual population. We described the perceived health, clinical status, quality of life, and dependency for activities of daily living in a representative population in Castile and Leon, Spain.MethodsA sample of 759 long-lived individuals aged 95 years and older was studied by the Health Sentinel Network of Castile and Leon (Spain) through a health examination and a structured questionnaire covering quality of life (EQ-5D-3), lifestyle habits, diet, working life and family health. A blood sample was taken for the study of biological and genetic markers. Chi Square and logistic regression OR with 95% confidence intervals were used to analyze the determinants of the long-lived individuals’ health status. The significant level for the bivariate analysis was established at 0.05.ResultsPerceived health was good, very good or excellent in 64.2%, while only 46.0% had a quality-of-life index above 0.5 (ranging from 0 to 1) and 44.1% maintained acceptable independence for activities of daily living. Quality-of-life index was higher in the oldest, (OR 7.98 [2,32-27.41]) above 100 years compared to those under 98, and men had better values for independence than women (OR 2.43 [1.40–4.29]). Cardiovascular diseases were the most prevalent (85.5%), but neurological and mental diseases and vision problems had the highest impact on quality of life and independence.ConclusionThe long-lived individuals of Castile and Leon have a relatively well-preserved health status, although the perception of health is higher than that describing their quality of life and dependence. The quality of life was higher in the oldest age group and showed differences according to sex, with a better quality of life in men. Public health policies and programs should take in account the differences by sex and age as well as the prevention and control of the main conditions related with poor quality of life or dependence. Future research must include the interaction among genetic, socioeconomic, environmental, and other clinical factors in the quality of life and disability of long-lived individuals.

Evaluating a novel online behavioural intervention to encourage cost-conscious strategies among US adults with chronic conditions who are enrolled in a high-deductible health plan: a proof-of-concept pilot study

ObjectivesPatients with chronic conditions enrolled in high-deductible health plans (HDHPs) face cost-related access barriers and high out-of-pocket spending. Our objectives were to develop a novel behavioural intervention to help HDHP...

The Relationship Between Fatigue and Quality of Life in the Turkish Mothers of Children with Autism Spectrum Disorder.

This study aimed to investigate the different effects of fatigue and health-related quality of life in the Turkish mothers of children with autism spectrum disorder (ASD) through comparisons with mothers of typically developing children, and to evaluate the relationship between different aspects of maternal fatigue, depression, and maternal health-related quality of life. The study included a total of 103 mothers, comprising 60 mothers of children with ASD and 43 mothers of typically developing children. The Nottingham Health Profile and Quality of Life in Autism Questionnaire-Parent Version were used to assess the health-related quality of life. Fatigue was assessed comprehensively with the Fatigue Impact Scale and the Fatigue Severity Scale. The Nottingham Health Profile total and physical mobility domain and the quality of life were the strongest factors, explaining with a variance of 66.7% the fatigue impact on cognitive function. The mothers' quality of life accounted for 64.8% of the variance in factors that explained fatigue. Physical mobility, social isolation and quality of life were associated with the physical impact of fatigue and were explained with a variance of 52.4%. Emotional reactions and quality of life were explained with a variance of 52.7% in the fatigue of psychosocial function. The current study has highlighted that the fatigue of Turkish mothers of children with ASD has a greater impact on cognitive, physical and psychosocial functions. Furthermore, the quality of life, physical mobility, social isolation, and emotional reactions of mothers have a significant impact on maternal fatigue.

Salivary levels of catalase, total antioxidant capacity and interleukin-1β and oral health-related quality of life after matcha and green tea consumption for patients with gingivitis: A randomized clinical trial.

To evaluate the changes in salivary levels of catalase (CAT), total antioxidant capacity (TAC) and IL-1β (primary outcomes) as well as gingival health and oral health-related quality of life (OHRQOL) 1 month after the consumption of matcha and green tea in adult patients with gingivitis. This study was a parallel randomized clinical trial. Forty gingivitis adult patients were randomly assigned to drink either matcha or green tea cup twice daily for a duration of 1 month. They were asked to keep their habitual oral hygiene measures. Plaque index (PI) and bleeding on probing (BOP) were recorded. In addition, saliva was collected at baseline and 1 month after tea consumption. Salivary levels of CAT, TAC and IL-1β were determined by ELISA. Each participant was asked to fill OHIP-14 questionnaire before and after tea consumption. Following tea intake, 40.6% of the study sample had healthy gingiva. Both groups similarly showed reductions in PI (0.32 ± 0.11-0.22 ± 0.08) and BOP (0.24 ± 0.08-0.13 ± 0.07) scores after tea consumption. There was a significant difference between mean TAC before and after matcha tea consumption only. Non-significant reductions in salivary levels of CAT and IL-1β were detected after tea consumption. OHRQOL of participants was improved after tea, both types, consumption. Despite study limitations, daily consumption of matcha and green tea might be beneficial as they potentially enhance OHRQOL of individuals with gingivitis and reduce the extent of gingivitis despite non-significant changes in salivary antioxidants and IL-1β levels.

A practical approach to implementing incremental haemodialysis.

The majority of end-stage kidney disease patients are treated with haemodialysis (HD). Starting HD can pose physical, social, and psychological challenges to patients, and mortality rates within the first 6 months are disproportionately high, with intensive HD regimens implicated as a potential factor. Starting HD with an incremental approach, taking residual kidney function (RKF) into account, potentially allows for a gentle start with reduced dialysis intensity. Dialysis intensity (session time or frequency) can then be proportionally increased as RKF reduces. This approach to starting HD has been reported in observational studies to result in better patient self-reported health quality of life and reduced costs, and now several definitive randomised controlled trials are underway comparing an incremental approach to the conventional thrice weekly paradigm. Physician concerns over the risk of inadequate dialysis, with consequent increased emergency admissions, and practical challenges of how to estimate RKF and implement incremental dialysis have impeded widespread adoption. Addressing these challenges is paramount to increasing the uptake of incremental HD. Careful patient selection lies at the heart of a successful incremental HD programme. Generally, patients with a residual urea clearance of > 3 ml/min/1.73 m2 can be considered suitable for starting with incremental HD provided they comply with fluid intake, salt and other dietary recommendations. Calculating RKF from regular interdialytic urine collections and appropriately adjusting sessional HD clearance targets are practical and conceptual challenges. In this report we aim to disentangle these complexities and provide a step-by-step guide for patient selection and adjusting dialysis sessional targets.

The Fenice project to evaluate and improve the quality of healthcare in high-dependency care units: results after the first year.

High-Dependency care Units (HDUs) have been introduced worldwide as intermediate wards between Intensive Care Units (ICUs) and general wards. Performing a comparative assessment of the quality of care in HDU is challenging because there are no uniform standards and heterogeneity among centers is wide. The Fenice network promoted a prospective cohort study to assess the quality of care provided by HDUs in Italy. This work aims at describing the structural characteristics and admitted patients of Italian HDUs. All Italian HDUs affiliated to emergency departments were eligible to participate in the study. Participating centers reported detailed structural information and prospectively collected data on all admitted adult patients. Patients' data are presented overall and analyzed to evaluate the heterogeneity across the participating centers. A total of 12 HDUs participated in the study and enrolled 3670 patients. Patients were aged 68years on average, had multiple comorbidities and were on major chronic therapies. Several admitted patients had at least one organ failure (39%). Mortality in HDU was 8.4%, raising to 16.6% in hospital. While most patients were transferred to general wards, a small proportion required ICU transfer (3.9%) and a large group was discharged directly home from the HDU (31%). The expertise of HDUs in managing complex and fragile patients is supported by both the available equipment and the characteristics of admitted patients. The limited proportion of patients transferred to ICUs supports the hypothesis of preventing of ICU admissions. The heterogeneity of HDU admissions requires further research to define meaningful patients' outcomes to be used by quality-of-care assessment programs.

Implementasi Metode Prototype pada Pembuatan Web Portal TEFA House of Health Promotion

Health Promotion is a series of activities that strive for individuals to increase their knowledge related to health so that ultimately they can improve the quality of health. In order for the objectives of health promotion activities to be achieved, media is needed to support these activities. TeFa House of Health Promotion Polije is one of the TeFa (Teaching Factories) managed by the Health Promotion study program, Department of Health. TeFa was created as a forum for communication, information and health education, TeFa is also a means for lecturers to contribute to society by providing consultation services related to the development of public health promotion programs. To support this, a multifunctional platform is needed in the form of a webportal which is used to help TeFa. This research focuses on creating a web portal using one of the SDLC methods, namely prototype. The process of creating a web portal begins with extracting information through interviews with potential users. The results of this excavation process are information related to the features of the web portal, including articles, video, audio, pooling and chat. The process of creating a Web Portal is made using the PHP programming language and Laravel Framework. The testing process is carried out using the black box method to determine the functionality of each feature. The test results showed that the web portal was in accordance with the user's required features and each feature was functioning according to its function.

Catheter ablation for persistent atrial fibrillation: patterns of recurrence and impact on quality of life and health care utilisation.

Patterns of atrial fibrillation (AF) recurrence post catheter ablation for persistent AF are not well described. This study aimed to describe the pattern of AF recurrence seen following catheter ablation for persistent AF (PsAF) and the implications for healthcare utilisation and quality of life. This was a post-hoc analysis of the CAPLA study, an international, multi-centre study that randomised patients with symptomatic PsAF to pulmonary vein isolation plus posterior wall isolation or pulmonary vein isolation alone. Patients underwent twice daily single lead ECG, implantable device monitoring or three monthly Holter monitoring. 154 of 333 (46.2%) patients (median age 67.3 years, 28% female) experienced AF recurrence at 12-month follow-up. Recurrence was paroxysmal in 97 (63%) patients and persistent in 57 (37%). Recurrence type did not differ between randomisation groups (p=0.508). Median AF burden was 27.4% in PsAF recurrence and 0.9% in paroxysmal AF (PAF) recurrence (p<0.001). Patients with PsAF recurrence had lower baseline left ventricular ejection fraction (PsAF 50% vs PAF 60%, p<0.001) and larger left atrial volume (PsAF 54.2±19.3 ml/m² vs PAF 44.8±11.6 ml/m², p=0.008). Healthcare utilisation was significantly higher in PsAF (45 patients [78.9%]) vs PAF recurrence (45 patients [46.4%], p<0.001) and lowest in those without recurrence (17 patients [9.5%], p<0.001). Patients without AF recurrence had greater improvements in quality of life as assessed by the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (Δ33.3±25.2 points) compared to those with PAF (Δ24.0±25.0 points, p=0.012) or PsAF (Δ13.4±22.9 points, p<0.001) recurrence. AF recurrence is more often paroxysmal after catheter ablation for PsAF irrespective of ablation strategy. Recurrent PsAF was associated with higher AF burden, increased healthcare utilisation and antiarrhythmic drug use. The type of AF recurrence and AF burden may be considered important endpoints in clinical trials investigating ablation of PsAF.

Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States.

This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

The “House of Trust”. A framework for quality healthcare and leadership.

In healthcare, improvement leaders have been inspired by the frameworks from industry which have been adapted into control systems and certifications to improve quality of care for people. To address the challenge to regain trust in healthcare design and delivery, we propose a conceptual framework, i.e. the “House of Trust”. This House brings together the Juran Trilogy, the emerging concept of co-production in quality management and the multidimensional definition of quality, which describes core values as an integral part of the system to deliver person- and kin-centered care. In the “House of Trust” patients, their kin, healthcare providers, executives and managers feel at home, with a sense of belonging. If we want to build a care organization that inspires and radiates confidence to all stakeholders, highlighting the basic interactions between front- and back-office is required. An organization with both well-organized back- and front-offices can enable all to benefit from the trust each of them needs and deserves. A quality system does not depend on government inspection and regulations nor on external accreditation to develop itself into a House of Trust. Success will only be achieved if all involved continuously question themselves about the technical dimensions of quality and their core values during the “moment of truth”.

ENDOCARDITIS TEAM? DESIGNING AN ORIGINAL AND TAILORED CLINICAL PATHWAY

Abstract Infective endocarditis (IE) remains a poorly understood disease that primarily affects either native or prosthetic heart valves. Its incidence has increased over the past two decades, now affecting 3 to 10 individuals per 100.000/year in the general population. Despite advances in early diagnosis and surgical intervention, IE continues to pose a significant challenge, often leading to severe complications and carrying a substantial burden of morbidity and mortality. Data from the EURO–Endo registry show a drastic change in IE and provide an accurate picture of IE disease today. In European countries, it tends to affect older patients with a remarkable 12% of cases occurring in those aged ≥ 80 years. The traditional care pathway is often fragmented into multiple and potentially dangerous steps, resulting in delayed diagnosis and treatment. Such a “patchy” approach may cause suboptimal patient management, especially in the subset of frail patients with important concomitant diseases and high surgical risk. Clinical pathways (CPs) are an evidence–based multidisciplinary care plans involving diagnosis, treatment and rehabilitation phases, through which to follow patients from hospital admission to discharge, in order to manage a specific health condition, aiming to optimize patient and hospital/team outcomes, while contributing to a better organized care processes. In 2018, a working group composed by healthcare managers, infectious disease specialists, cardiac surgeons, cardiologists, anesthesiologists, geriatricians and other professionals involved in the care of IE patients have engineered a dedicated CP for IE at our institution. The CP introduced significant changes in the management of patients with IE. As a result, the quality of care and services offered increased, a faster and more appropriate diagnosis and treatment were achieved, patient outcomes and safety improved and a better coordination and continuity of care between different settings was guaranteed. The growing burden of IE in western countries demands an evidence–based multidisciplinary care plan. The creation of a territorial network ensures continuity and appropriateness of care in conjunction with the referring physicians/hospital and rationalization of resources. Although some controversies still exist, we believe that CP will have a positive impact on quality in health care.

Influence of VR-Assisted College Dance on College Students' Physical and Mental Health and Comprehensive Quality

With the development and the popularization of sports dance, sports dance teaching has become a required elective course in universities. Sports dance can not only improve students' comprehensive quality, but also affect college students' healthy psychology. The use of VR (Virtual Reality) technology in dance education will definitely develop and promote dance education. This paper studies an effective feature extraction method for the characteristics of dance movements based on VR. The edge features of all video images in each segment are accumulated into one image, and the directional gradient histogram features are extracted from it. The results show that compared with the current robust regression method and cascade regression method, our method has higher positioning accuracy on the pollution test set, and more than 75% of the sample errors in this method are within 0.1. This also verifies the effectiveness of this motion recognition algorithm for dance motion recognition. Dance can effectively resist the psychological barriers of college students and improve their comprehensive quality.