Recent Health Care Research Articles

Environmental Health: Translating Policy Into Action.

Environmental Health: Translating Policy Into Action.

Recruitment of general practitioners in China: a scoping review of strategies and challenges.

BackgroundChina is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.MethodsWe searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O’Malley’s framework and the PRISMA ScR reporting guidelines.ResultsA total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual’s background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years’ working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.ConclusionsLong-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives.Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-022-01854-0.

Introducing m-Health and Digital Diabetes Apps in Clinical Pharmacy Education in Germany

Germany was the first country worldwide to introduce prescription and reimbursement of digital health apps. To keep pace with recent digital healthcare developments and to prepare our pharmacy students for the digital pharmaceutical care services, the Institute of Clinical Pharmacy and Pharmacotherapy Heinrich Heine University (HHU) Düsseldorf introduced a one-of-a-kind elective practical course in m-Health and diabetes.

A Multi-Layer Acoustic Neural Network-Based Intelligent Early Diagnosis System for Rheumatic Heart Disease

Rheumatic Heart Disease (RHD) is a disorder of heart caused by streptococcal throat infection followed by the organ damage, irreversible valve damage and heart failure. Acute Rheumatic Fever (ARF) is a precursor to the disease. Sometimes, RHD can occur without any signs or symptoms, and if there are any symptoms, they occur with the infection in the heart valves and fever. Due to these issues, respiratory problems occur with chest pain and tremors. Additionally, the symptoms include faint, heart murmurs, stroke and unexpected collapse. The techniques available try to detect the RHD as early as possible. Although the recent medical health care department uses crucial techniques, they are not accurate in terms of symptom classification, precision and prediction. On the scope, we are developing Multi-Layered Acoustic Neural (MLAN) Networks to detect the RHD symptoms using heart beat sound and Electrocardiogram (ECG) measurements. In this proposed MLAN system, the novel techniques such as multi-attribute acoustic data sampling model, heart sound sampling procedures, ECG data sampling model, RHD Recurrent Convolutional Network (RRCN) and Acoustic Support Vector Machine (ASVM) are used for increasing the accuracy. In the implementation section, the proposed model has been compared to the Long Short-Term Memory-based Cardio (LSTC) data analysis model, Cardio-Net and Video-Based Deep Learning (VBDL) techniques. In this comparison, the proposed system has 10%–17% higher accuracy in RHD detection than existing techniques.

Stability and predictors of somatic symptoms in men and women over 10 years: A real-world perspective from the prospective MONICA/KORA study

ObjectiveTo assess the stability of somatic symptoms in community-dwelling participants. MethodsThe study included 2472 participants (1190 men, 1282 women; mean age 44.3 ± 10.9) from the prospective population-based MONICA-S3 cohort (1994/95) and the 10-year follow-up KORA-F3 cohort. Somatic symptoms were assessed by an adapted version of the Somatic Symptom Scale-8 (SSS-8a) with scores ranging from 0 to 24. Somatic symptom stability was assessed by weighted kappa values (κ). Generalized Estimating Equation models assessing symptom stability were adjusted for sociodemographic, lifestyle, clinical and psychosocial risk factors, as well as pre-existing medical conditions. ResultsThe mean (±SD) SSS-8a was lower in men (S3: 6.88 ± 3.87, F3: 6.60 ± 3.86) than women (S3: 8.43 ± 4.0, F3: 8.31 ± 4.2) at both time points. However, somatic symptoms remained moderately stable in both genders over 10 years (κ =0.42 in men and κ = 0.48 in women), with the largest stability observed in trouble sleeping for men (κ =0.41) and pain in the joints for women (κ =0.41). Pre-existing somatic symptoms were significantly associated with increasing symptoms at follow-up [men: β = 0.82 (SE 0.12), women: β = 0.85 (SE 0.12)], followed by age and psychosocial factors, whereas higher education and recent health care utilization were inversely associated with increasing symptoms. Although hypertension and obesity were associated with increasing somatic symptoms in men, pre-existing medical conditions were not associated with increasing somatic symptoms in men nor women. ConclusionsThe current findings indicate that somatic symptoms remain moderately stable in the general population during 10 years of follow-up, mainly driven by sociodemographic and psychosocial factors.

Mapping progress in intravascular catheter quality surveillance: An Australian case study of electronic medical record data linkage.

Background and significanceIntravascular (IV) catheters are the most invasive medical device in healthcare. Localized priority-setting related to IV catheter quality surveillance is a key objective of recent healthcare reform in Australia. We sought to determine the plausibility of using electronic health record (EHR) data for catheter surveillance by mapping currently available data across state-wide platforms. This work has identified barriers and facilitators to a state-wide EHR surveillance initiative.Materials and methodsData variables were generated and mapped from routinely used EHR sources across Queensland, Australia through a systematic search of gray literature and expert consultation with clinical information specialists. EHR systems were eligible for inclusion if they collected data related to IV catheter insertion, care, or outcomes of hospitalized patients. Generated variables were mapped against international recommendations for IV catheter surveillance, with data linkage and data export capacity narratively summarized.ResultsWe identified five EHR systems, namely, iEMR, MetaVision ICU®, Multiprac, RiskMan, and the Nephrology Registry. Systems were used across jurisdictions and hospital wards. Data linkage was not evident across systems. Extraction processes for catheter data were not standardized, lacking clear and reliable extraction techniques. In combination, EHR systems collected 43/50 international variables recommended for catheter surveillance, however, individual systems collected a median of 24/50 (IQR 22, 30) variables. We did not identify integrated clinical analytic systems (incorporating machine learning) to support clinical decision making or for risk stratification (e.g., catheter-related infection).ConclusionCurrent data linkage across EHR systems limits the development of an IV catheter quality surveillance system to provide timely data related to catheter complications and harm. To facilitate reliable and timely surveillance of catheter outcomes using clinical informatics, substantial work is needed to overcome existing barriers and transform health surveillance.

Evaluation of Patient Experience with Veterans Affairs Clinical Pharmacist Practitioners Providing Comprehensive Medication Management

Patient experience is considered an important dimension of health care quality and thus is included as part of the quadruple aim of health care. The VHA Clinical Pharmacist Practitioner (CPP) operates as an advanced practice provider (APP) providing comprehensive medication management (CMM) with authority to initiate, discontinue or modify medication under a scope of practice (SOP). The VHA CPP practices in many different outpatient clinical areas to include but not limited to primary care, mental health, pain management, cardiology, substance use disorder and anticoagulation. While literature regarding the ability of the VHA CPP to increase access and quality of care is well published, very little information exist regarding patient experience with the VHA CPP. We sought to report the patient experience with VHA CPP as measured electronically over 1 year by Veterans. Patient experience surveys were electronically sent to randomly selected Veterans via email to evaluate a recent outpatient healthcare encounter at a VA medical center or outpatient clinic with a CPP with scoring on a Likert scale of 1-5 with 5 being optimal. A total of 743 Veteran surveys were completed for a response rate of 20%. For individual domains of patient experience based on respondent scores of 4 or 5, ease and simplicity were rated at 94.4%, quality 91.9%, employee helpfulness 94.9%, satisfaction 95.0% and confidence/trust 91.9%. Results demonstrate that Veterans’ experience with the CPP in every patient care experience domain was positive with scores ranging from the low to high 90th percentile.

IoT framework for brain tumor detection based on optimized modified ResNet 18 (OMRES)

Brain tumors are a serious health issue that affects many people’s lives. Such a tumor, which is either benign or malignant, can be fatal if malignant cells are not correctly diagnosed. According to the most recent human health care analysis system, the number of brain tumor patients has climbed dramatically and is now the 10th top cause of death. As a result, detecting brain tumors in their early stages can considerably improve the patient’s prospects of complete recovery and therapy. Thanks to improvements in information and communication technology, the Internet of things (IoT) has reached an evolutionary stage in the development of the modern health care environment. This paper provides a detailed examination of brain tumor detection approaches. Moreover, two different scenarios for detecting brain tumors will be proposed. On one hand, the first scenario depends on applying a deep convolutional neural network directly to brain images. On the other hand, the second scenario presents an IoT-based framework that adopts a multiuser detection system by sending the images to the cloud for early detection of brain tumors, which makes the system accessible to anyone and anywhere for accurate brain tumor categorization. The proposed CNN structure can be considered a modified version of the pre-trained ResNet18 CNN. Additionally, two key hyper-parameters are used to fine-tune the OMRES model, firstly different optimizers are tested using different learning rates, batch sizes, and a constant number of epochs, and secondly, the impact of changing dropout rates is made. Finally, comparisons between the OMRES model and traditional pre-trained models are discussed. Based on simulation findings, the RMSProp algorithm with a dropout rate of 0.5 verifies the best outcomes over other algorithms, where the suggested model achieves superior improvement with the highest rated accuracy of 98.67% compared to the conventional CNNs.

Inequity in psychiatric healthcare use in Australia

BackgroundDespite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia’s mixed public–private health care system is lacking.ObjectiveTo present a novel method to measure inequity in the delivery of psychiatric care.MethodsData came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity.ResultsThe results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively.ConclusionsThis study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.

Legal aspects regarding the use and integration of electronic medical records for epidemiological purposes with focus on the Italian situation

The "Observational Studies" working group of the Italian Association of Medical Statistics and Clinical Epidemiology (SISMEC) has undertaken to study the impact of recent healthcare sector regulations on the legal and organisational aspects of managing all EMR databases with emphasis on Legislative Decree No. 196/2003 (the Italian Personal Data Protection Law). This paper examines six issues relating to theirs legal implications. The first section, “Confidentiality”, provides definitions and the regulatory context for the terms "confidentiality" and "personal data". In the second, “Nature of data held in electronic medical record archives”, we discuss the problem of sensitive data and procedures to make the identification code anonymous. In “Data ownership” we highlight the difference between the data controller and the database controller. The fourth section, “Conditions for processing”, discusses problems associated with using research data from one study in other investigations. In the fifth, “Patient consent”, we address the problems related to patient consent. Finally in “Penalties” we outline the main civil and criminal liability issues applied in case of non-compliance with the provisions of the Personal Data Protection Code. Where possible, we provide suggestions on how to comply with the legal requirements of managing medical record archives in order to make it easier for researchers to remain in compliance with the relevant provisions.

Changes in the care of peripheral vascular disease at the University of Szeged

Introduction and aims. In recent decades health care changes have accelerated enormously. Previously, by learning an effective procedure, the doctor could guarantee his patients the highest level of care for many years. Nowadays, due to the dynamics of development, the renewal cycles of the methods have been shortened, without continuous learning and training, it is already inconceivable to provide the up-to-date care required by patients. Patients and methods. Instead of vascular replacements with prosthetic grafts, which played an important role in vascular reconstructions, the primacy of endovascular techniques has become decisive. It can be significant for aortic aneurysms that can be operated with high invasiveness. The learning of catheter techniques by vascular surgeons made it possible to treat more successfully those limb-threatening cases, which are often associated with extensive vascular involvement, through the so-called hybrid operations. In addition to the increasing prevalence of diabetes worldwide, the higher proportion of critical limb ischemia and the highlighted pathogenic role of multi-resistant bacteria in the disease caused the marginaliation of the use of previously preferred prosthetic grafts. The effectiveness of the treatment of graft infections, which thus become less frequent, is improved by the use of homografts and negative pressure therapy. An effective method of preventing stroke is carotid endarterectomy, the morbidity of which is reduced by the introduction of locoregional anaesthesia allowing direct neuromonitoring. Results/conclusions. Although the acquisition and implementation of new methods has posed acontinuous challenge for our specialists and doctors over the past 10 years, our achievements have made our department one of the leading vascular surgery centres in the country.

Older persons experiences of healthcare in rural Burkina Faso: Results of a cross sectional household survey.

Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. We performed a cross-sectional household survey including socio-demographic; morbidities; and patient-reported health system utilization, responsiveness, and quality outcomes in individuals 40 and older in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent healthcare visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in providers' skills, labelled Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.

Evidence-Based Design in Hospital Renovation Projects: Design Implementation for Patient Privacy and Comfort

Evidence-Based Design (EBD) principles are researched and published widely throughout the design, engineering, and construction industry. However, few studies show the extent of the implementation of the principles on actual projects. This paper documents the implementation of EBD elements relating to patient privacy and comfort in hospital renovation projects. The goal of Evidence-Based Design is to make design and construction decisions based on the best possible outcome for the user of a given space. In healthcare, this outcome may be critical to the health, comfort, privacy, and overall well-being of hospital patients and staff. This paper compiles the list of design recommendations relating to privacy and comfort. These recommendations come from a review of existing EBD literature. To assess the implementation of these elements into actual projects, construction documents from 30 recent healthcare facility renovation projects across the United States were obtained and analyzed. This paper provides results for the levels of implantation in the EBD categories of privacy and comfort. EBD elements related to privacy and comfort are shown to have a high level of adoption into actual projects. This may demonstrate the effectiveness of EBD in influencing design decisions. The report does show that there are still areas of potential improvement. Suggestions are given to improve building design, codes, standards, and guidelines. The information found in this study will be helpful to owners, building contractors, and design professionals by providing insight into how well the industry is recognizing and implementing the known best practices of EBD. These findings likewise introduce new opportunities for further research which could lead to additional improvements in healthcare facilities of the future.

Exploring the Use of Wearable Sensors and Natural Language Processing Technology to Improve Patient-Clinician Communication: Protocol for a Feasibility Study.

BackgroundEffective communication is the bedrock of quality health care, but it continues to be a major problem for patients, family caregivers, health care providers, and organizations. Although progress related to communication skills training for health care providers has been made, clinical practice and research gaps persist, particularly regarding how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting and provide timely feedback about communication effectiveness and quality.ObjectiveOur interdisciplinary team of investigators aims to develop, and pilot test, a novel sensing system and associated natural language processing algorithms (CommSense) that can (1) be used on mobile devices, such as smartwatches; (2) reliably capture patient-clinician interactions in a clinical setting; and (3) process these communications to extract key markers of communication effectiveness and quality. The long-term goal of this research is to use CommSense in a variety of health care contexts to provide real-time feedback to end users to improve communication and patient health outcomes.MethodsThis is a 1-year pilot study. During Phase I (Aim 1), we will identify feasible metrics of communication to extract from conversations using CommSense. To achieve this, clinical investigators will conduct a thorough review of the recent health care communication and palliative care literature to develop an evidence-based “ideal and optimal” list of communication metrics. This list will be discussed collaboratively within the study team and consensus will be reached regarding the included items. In Phase II (Aim 2), we will develop the CommSense software by sharing the “ideal and optimal” list of communication metrics with engineering investigators to gauge technical feasibility. CommSense will build upon prior work using an existing Android smartwatch platform (SWear) and will include sensing modules that can collect (1) physiological metrics via embedded sensors to measure markers of stress (eg, heart rate variability), (2) gesture data via embedded accelerometer and gyroscope sensors, and (3) voice and ultimately textual features via the embedded microphone. In Phase III (Aim 3), we will pilot test the ability of CommSense to accurately extract identified communication metrics using simulated clinical scenarios with nurse and physician participants.ResultsDevelopment of the CommSense platform began in November 2021, with participant recruitment expected to begin in summer 2022. We anticipate that preliminary results will be available in fall 2022.ConclusionsCommSense is poised to make a valuable contribution to communication science, ubiquitous computing technologies, and natural language processing. We are particularly eager to explore the ability of CommSense to support effective virtual and remote health care interactions and reduce disparities related to patient-clinician communication in the context of serious illness.International Registered Report Identifier (IRRID)PRR1-10.2196/37975

Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities.

To compare parental reports of recent diagnoses of anxiety, depression, and/or behavioral/conduct disorder among former preterm (PT) and term adolescents by race/ethnicity and evaluate receipt of mental healthcare within the past year among those adolescents with any of these conditions. A total of 20,871 Non-Hispanic white (NHW), Non-Hispanic black (NHB), and Hispanic adolescents were evaluated using data from the 2017/2018 National Survey of Children's Health. PT birth and race/ethnicity disparity in the diagnosis of these emotional/behavioral problems and receipt of mental healthcare among adolescents with any of these diagnoses were analyzed using logistic regression. The unadjusted prevalence (95% CI) of these diagnoses was significantly higher among former PT (0.19 [0.17-0.22]) compared to term (0.15 [0.14-0.16]) adolescents. Despite having higher rates of adverse socioeconomic measures, former PT and term NHBs and Hispanics had lower unadjusted prevalence of these diagnoses in comparison to NHWs. After adjusting for differences in demographic, clinical, and socioeconomic characteristics,NHBs (0.47 [0.36-0.64]) and Hispanics (0.40 [0.30-0.54]) remain at lower odds of the composite measure of the emotional and/or behavioral problemscompared to NHWs, while PT birth did not have a significant impact on this outcome measure. Only 53% of adolescents with these diagnoses received recent mental healthcare. No significant differences in the adjusted odds of receipt of mental healthcare were noted across the groups based on PT birth or race/ethnicity. In contrast to PT birth, race/ethnicity had a significant impact on the adjusted odds of emotional/behavioral disorders during adolescence. Among adolescents with these diagnoses, PT birth and race/ethnicity did not significantly influence the adjusted odds of receipt of mental healthcare.

Research and implementation of a whole-genome sequencing surveillance system for outbreak detection

Background: Traditional infection prevention (IP) methods for outbreak detection often rely on geotemporal clustering confined to single locations. We recently developed the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT), which combines whole-genome sequencing (WGS) surveillance and machine learning of the electronic health record (EHR). Our retrospective research findings show potential transmissions averted and cost savings using EDS-HAT in real time. Here, we describe the process and initial findings from EDS-HAT real-time implementation. Methods: Real-time whole-genome sequencing surveillance began on November 1, 2021. Patient cultures positive for select bacterial pathogens who were hospitalized for ≥3 days or had a recent healthcare exposure in the prior 30-days were collected. Isolates were deemed genetically related if ≤15 single-nucleotide polymorphisms (SNPs) were identified for all organisms except Clostridioides difficile (≤2 SNPs). Clusters were manually investigated by both research and IP teams, and interventions were performed by the IP team. Data on collection, analysis, notification, and intervention dates were gathered. Results: As of January 11, 2022, 413 isolates had undergone whole-genome sequencing. Among them, 18 unique patient isolates were genetically related to ≥1 other isolate, comprising 7 clusters (range, 2–6 patients). Notable findings include a Pseudomonas aeruginosa cluster possibly related to a shared bronchoscope, a pseudo-outbreak of Serratia marcescens related to autopsy blood culture practice, and a cluster of vancomycin-resistant Enterococcus faecium on a shared transplant unit. Only 1 cluster of 2 isolates of Klebsiella pneumoniae had no known possible transmission routes. The median turnaround time from patient’s culture date to IP notification was 19 days (range, 13–28), with noted delays over the winter holiday. Concusions: Real-time WGS can identify small clusters including potentially interruptible transmission routes. Rapid turnaround time, coordination between clinical and genomic laboratories, and a robust IP team are key factors in implementing a WGS surveillance program. Real-time WGS surveillance has the potential to reduce costs for hospitals, improve patient safety, and save lives.Funding: NoneDisclosures: None

Opioid trends in Finland: a register-based nationwide follow-up study

The opioid epidemic in the U.S has gotten payers, prescribers, and policymakers alike interested in trends in opioid use. Despite no recognized opioid crisis in Europe, several countries have reported an increase in opioid-related deaths, which has further prompted discussion on the need of monitoring of opioid prescriptions. This study was conducted to offer information on opioid use during the escalation of the U.S. opioid epidemic in Finland, a Nordic country with universal tax-based health care. This is a nationwide retrospective register-based cohort study on all individuals in Finland who were dispensed opioids in 2009–2017 (n of unique patients = 1,761,584). By using the unique personal identification code assigned to every Finnish resident, we linked data from nationwide registers on dispensed drugs, medical history, and socio-demographic parameters. We report a wide set of patient demographics, dispensing trends for all opioid Anatomical Therapeutic Chemical (ATC) classes, and reasons for opioid initiation based on diagnostic coding for the most recent health care visit. For a cohort of incident opioid users with a four-year wash-out period (n = 1 370 057), we also present opioid use patterns in a three-year follow-up: the likelihood of becoming a persistent user or escalating from weak to strong opioids. A steady 7% of the Finnish population were dispensed opioids annually in 2009-2017. The mean annual quantity of dispensed opioids per opioid patient increased between 2009 and 2017 by 33%, reaching 2 583 oral morphine equivalent mg (OMEQ)/patient/year in 2017. The median quantity of dispensed opioids was lower: 315 OMEQ/year/patient. Depending on the opioid ATC class, there were either increasing or decreasing numbers of patients who had been dispensed said opioid class, and also in the mean quantity. The most common reason for opioid initiation was post-surgical pain (20%), followed by musculoskeletal pain (15%), injury (8.3%), and non-postsurgical dental pain (6.2%). 94% of new opioid initiators started with a weak opioid, i.e. codeine or tramadol. 85% of the patients who had been dispensed a weak opioid were not dispensed an opioid subsequently 3–6 months after the first one, and 95% of them had not escalated to a strong opioid in a 3-year follow-up. The number of patients dispensed opioids in Finland did not change during the escalation of the opioid epidemic in the U.S., but there were changes in the quantity of opioids dispensed per patient. Opioid therapy was typically initiated with weak opioid, the initial dispensed prescription was relatively small, and escalation to strong opioids was rare. A considerable share of patients had been prescribed opioids for chronic non-cancer pain - a type of pain where the risk-benefit ratio of opioids is controversial.

Dental tissue remineralization by bioactive calcium phosphate nanoparticles formulations

Recent health care products are based on formulations claimed to provide enamel remineralization and dentinal tubules occlusion through calcium-phosphate bioactive nanocompounds (ion-doped hydroxyapatite and precursor, amorphous calcium phosphate nanoparticles). This study aimed to characterize, test, and compare for the first time the structure and performance of a representative, market-available sample of remineralizing toothpastes and topical mousses. Formulations were characterized to determine their composition and investigate the presence of bioactive compounds and doping elements. A conventional fluoride-containing toothpaste was used as reference. The enamel remineralization and efficacy of dentinal tubules occlusion by tested formulations were investigated ex vivo on human hard tissues. All formulations containing Ca-P bioactive nanocompounds showed remineralizing ability by epitaxial growth of a layer showing the morphology and composition of human hydroxyapatite. Such layers also embedded nanosilica clusters. The presence of doping elements or casein phosphopeptide seemed essential to allow such performances, especially when hydroxyapatite and amorphous calcium phosphate compounds were doped with small amounts of CO32−, F−, Mg2+, and Sr2+. Topical mousse formulations showed a higher tubules occlusion capability than toothpastes, independently from their composition. Therefore, all tested formulations could be useful in restoring tooth structures in a biomimetic way, contrasting dental demineralization processes leading to caries.

Assessment of medication discrepancies with point prevalence measurement: how accurate are the medication lists for Swedish patients?

BackgroundMedication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements.MethodsParticipants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used.ResultsIn total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029).ConclusionMedication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.

Effectiveness of Health Insurance Project; Women Satisfaction Regarding Quality of Ante-natal Services

Objective: This study aimed to evaluate the effectiveness of the universal health insurance project regarding the quality of health care with antenatal care services. Materials and methods: A descriptive comparative study carried out at ten Primary Health Care (PCH) centers affiliated to Port-said and Damietta governorates. Multi-stage sampling probability technique used for selecting these centers, simple random sample of 460 women chosen. Data was collected through two tools; women's satisfaction questionnaire, and Support Tool for Improving Quality of Antenatal Care. Results: the study results revealed that 69.1% of women were unsatisfied with the antenatal care services and available resources provided by the traditional insurance. On the other hand, 79.1% of women receiving universal health insurance were satisfied with the services provided. Conclusion: level of satisfaction was higher among women using universal health insurance regarding the recent health care services, cleanness, arrangement of medical facilities, availability of resources and criteria of service. Keywords: Antenatal care, Satisfaction, Quality measures, Universal Health Insurance System.