Seamless Patient Care Research Articles

Synergy of AI and Blockchain to Secure Electronic Healthcare Records

ABSTRACTIn this article, we delve into the intersection of blockchain technology and artificial intelligence (AI) to fortify the security of electronic health records (EHRs). Existing EHR systems face challenges like interoperability issues, user interface complexities, and data security concerns, hindering seamless patient care and healthcare delivery. This article thoroughly explores the hurdles associated with EHR security and investigates the potential of employing blockchain and AI solutions to mitigate these challenges. The review underscores the necessity for resilient, interoperable systems to protect sensitive health information by pinpointing opportunities for collaborative strategies. In essence, this article contributes valuable perspectives on the dynamic landscape of EHR security, guiding future research and development at the crossroads of blockchain; we presented a case study on EHR security, customized care, predictive analytics, and more efficient healthcare delivery. Using case studies as illustrative examples, the article scrutinizes practical applications, shedding light on successful implementations and areas requiring refinement. Several outcomes for the predictive analytics of patients' surgeries are shown in this case study. Next, we compare blockchain‐based EHR systems with existing, non‐blockchain‐based EHR systems. Finally, we present the concluding remarks with future directions for integrating blockchain, AI, and EHR systems.

Design and implementation of a mobile medical and continuing care system based on wireless sensor networks

The Android system has good compatibility, freedom, rich hardware resources and a good development environment. At the same time, it can also work with Google services to obtain external support. Android is an open source operating system platform, which is similar to the iOS platform. In contrast, developers have more room for development, making the Android platform more people use. This article aims to develop a mobile medical system based on the Android operating system that integrates search engines, maps, and hospital HIS systems. The users are mainly patients, doctors and system administrators. Patients can register online and use mobile healthcare to pay online. They can also upload various physical indicators to record their daily health status. The establishment of health files is convenient for doctors to make health assessments and provide patients with medical consultation and medical health protection. Patients can also realize hospital navigation, intra-hospital navigation, and view various hospital inspection reports through the APP. The design of mobile medical service system is to design user behavior in the system based on the concept of service design. Therefore, in the process of system design, it is necessary to comprehensively consider service design principles and related factors, and propose behavior design principles that conform to service design theory. This study uses a mutual continuation care platform to implement seamless care for patients. Patients and medical staff can realize the continuation of the relationship and the continuity of information, and the patients can receive comprehensive guidance in a timely and effective manner. It can provide a reference basis for improving the continuity management and information management of patients in China, and provide reference value for the standardization and standardization of patients' continuation of nursing care standards and procedures.

Negative impact of intensive care on family caregivers

Relatives of intensive care patients make an important contribution to recovery and perform a variety of tasks. Due to the demands on the relatives and their services in the ICU and after their discharge, stressful psychological, physical, social, and financial consequences can arise or worsen. Relatives often compensate deficiencies in treatment, especially through a lack of communication and a lack of continuity of care. Seamless care for patients in the ICU and afterwards reduces avoidable consequences for relatives. Structured communication between relatives and the treatment team as well as active involvement in nursing treatments can alleviate stress symptoms and the feeling of powerlessness. Prescient discharge management for ICU patients and their relatives reduces PICS risk. Specific and comprehensive offerings of advice and support for relatives can help to perform and process the effort between everyday life and care tasks.

Post-discharge Follow-up Care: Nurses' Experience of Fostering Continuity of Care: A Qualitative Study

Background In contemporary healthcare, ensuring continuity of care beyond hospitalization is imperative for optimizing patient outcomes. Post-discharge Follow-up Care (PFC) has emerged as a crucial component in this endeavor, especially with the integration of virtual platforms. Objective This study aims to thoroughly investigate nurses' experiences in providing Post-discharge Follow-up Care (PFC) to improve its implementation. Methods A descriptive qualitative study was conducted to explore nurses’ experiences of conducting nurse-led follow-up care. This study was conducted at University Hospital, involving nine nurses with experience in administering PFC. Data were collected through focus group interviews. Thematic analysis was performed to identify recurring patterns and themes within the data. Results The thematic analysis yielded four overarching themes: 1) “Caring nurse virtually,” emphasizing nurses' dedication to compassionate virtual care, 2) “Constraints and limitations of continuing care,” highlighting challenges in resource management and coordination, 3) “Continuous documentation and coordination,” underscoring their vital role in seamless patient care, and 4) “Nurses’ expectation of technology features,” showing nurses' hopes for advanced features to enhance PFC. Conclusion This study provides deep insights into the experiences of nurses in delivering PFC through virtual platforms. It underscores the significance of maintaining emotional connections with patients, even in a virtual environment. The challenges faced in resource management and coordination highlight areas for potential improvement. Additionally, the study highlights the crucial role of accurate documentation and inter-team coordination in ensuring the continuity and quality of care. The nurses' expectations for technological advancements emphasize the need for ongoing innovation in healthcare delivery. These findings collectively contribute to the ongoing evolution of virtual follow-up care practices, ultimately enhancing patient outcomes and experiences beyond the hospital setting.

Challenges in Care for Non-COVID-19 Patients with Severe Chronic Illnesses during COVID-19 Pandemic: A Qualitative Study of Healthcare Providers Working around Acute Care Hospitals in South Korea.

The COVID-19 epidemic has afflicted patients with severe chronic illnesses who need continuous care between home and hospitals. This qualitative study examines the experiences and challenges of healthcare providers around acute care hospitals who have cared for patients with severe chronic illness in non-COVID-19 situations during the pandemic. Eight healthcare providers, who work in various healthcare settings around acute care hospitals and frequently care for non-COVID-19 patients with severe chronic illnesses, were recruited using purposive sampling from September to October 2021 in South Korea. The interviews were subjected to thematic analysis. Four overarching themes were identified: (1) deterioration in the quality of care at various settings; (2) new emerging systemic problems; (3) healthcare providers holding on but reaching their limit; and (4) a decline in the quality of life of patients at the end of their lives, and their caregivers. Healthcare providers of non-COVID-19 patients with severe chronic illnesses reported that the quality of care was declining due to the structural problems of the healthcare system and policies centered solely on the prevention and control of COVID-19. Systematic solutions are needed for appropriate and seamless care for non-infected patients with severe chronic illness in the pandemic.

Perspectives on seamless collaboration between primary and secondary care for oral anticancer treatments

ABSTRACT Patients who take oral anticancer drugs (OACD) alternate between the hospital and the community setting. Little is known about how general practitioners (GPs) and community pharmacists (CPs) from primary care (PC) can be involved in providing seamless care. In an exploratory qualitative study, semi-structured interviews with healthcare professionals from primary and secondary care (SC) and (N = 26) were performed to investigate perceptions of seamless collaboration for patients on OACD. Seamless collaboration initiated by SC was restricted to informing GPs about treatment-initiation and delegating limited tasks to them in treatment monitoring. CPs are currently not informed by SC about the treatment. PC expressed willingness for seamless collaboration. However, collaboration is currently impeded due to an expressed lack of trust and desire for control by SC. Moreover, SC expressed unfamiliarity with the organization of PC. Findings suggest that healthcare professionals from SC and PC need to get to know each other and to discuss expectations in the seamless care for patients on OACD. A possible strategy is to elaborate a shared care model based on a partnership between PC and SC, in which the specific expertise of each partner contributes to patient-centered care and the qualitative and safe use of OACD.

Intelligent Garment based ECG Monitoring with AI support for Elderly

Abstract Smart underwear was designed to meet the demands of elderly people be monitored in outpatient environments. Especially the demands of women have been addressed, who have heart failure but who still want to live in their home. The smart bra comprises textile electrodes and an ECG event recorder. The recorder transmits the data to the doctor only if artificial intelligence (AI) has discovered critical events in ECG signals. An implemented convolutional neural network, which uses the wavelet transformation of the ECG as input and to determine an interference index for this ECG signal is implemented. The smart bra can be part of new remote monitoring services such as e-consultation or as a new home-based follow-up to ensure seamless patient care after hospital or rehabilitation stays. Healthcare personnel has better access to the patient´s digital ECG data without direct consultation, independently of where the patient lives and the patient can feel safer.

Invisible Work: Advanced Practice Providers’ Role in the Education of Surgeons

As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs. Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus. During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:1 APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.2 Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.3 Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.4 Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized. APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.

Basic Policy Surrounding the Promotion of Health Care Transition for Patients with Childhood-Onset Chronic Diseases of the Ministry of Health, Labour and Welfare in Japan

With the development of medical technology and improvements in medicine, many patients with childhood-onset chronic diseases transition into adulthood. As our society is facing new problems, how we provide necessary and seamless medical care for adult patients with childhood-onset chronic diseases, and how we promote their health care transition become important. The Ministry of Health, Labour and Welfare in Japan has demonstrated basic policies on health care transition and is building support systems for patients with childhood-onset chronic diseases.

Rural Homecare Nurses' Challenges in Providing Seamless Patient Care in Rural Japan.

Homecare nurses manage patients with extreme homecare dependence through interprofessional collaboration. The quality of the collaboration depends on situations, and the difficulties of homecare nurses are complicated in rural settings because of a few healthcare resources. This study determined rural homecare nurses’ difficulties during interprofessional collaboration in providing seamless patient care. Focus groups, followed by one-on-one interviews, were conducted with 13 rural homecare nurses working in rural Japan. Using thematic analysis, four themes were extracted: collaboration with physicians, the collaboration with the government, the collaboration with care workers, and the collaboration among hospital nurses. Rural homecare nurses have difficulties in their working relationships with other professionals, with vague definitions of each professional’s roles and responsibilities, and with information-sharing. Interprofessional education and information-sharing should respect rural professional and cultural backgrounds. Respect can accomplish mutual understanding among professional care, leading to seamless patient care in rural home care.

Three decades of shared care guidelines: are we any further forward?

In the early 1990s, David M Eddy, the physician, mathematician and healthcare analyst, was fundamental in the introduction of a national approach to the development of evidence-based clinical practice guidelines...

Role of Hospice Care at the End of Life for People With Cancer.

Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer.Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient's death compared with people who did not have access to these services.Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.

A Secured Medical Booking System Using Qr-Code Authentication

In recent times due to the ever-increasing fast pace of life the number of missed appointments in medical institutions in Nigeria has caused problems, hence the need for a web based healthcare platform to intervene and provide seamless care for patients. Medical appointment scheduling, as the starting point of most non-urgent health care services, is undergoing major developments to support active involvement of patients. Medical appointment scheduling system lies at the intersection of providing efficiency and timely access to health services. By using the Internet as a medium, patients are given more freedom in decision making about their preferences for the appointments and have improved access. In this work a Web-based appointment scheduling system is designed to meet the needs under the current health care environment. The security of patients has been taken under consideration, QR code is been used as the e-authentication technique to protect patients’ and hospital information from unauthorized individuals. The system was developed using PHP, QR code authentication technique, VScode environment, apache and MySQL. This is to ensure that the application is robust, cheap, secured and is able to run on different platforms. The system provides the platform to facilitate the booking and management of patients’ appointment bookings. Patients can also view their appointment reports and progress. The system also provides healthcare workers an easy secured access to manage patients’ appointments, medical records and to generate relevant reports.

Negotiating Lay and Clinical Issues: Implementing a Lay Navigation Program in Cancer Care.

Patients with cancer face daunting coordination problems at a vulnerable time. Lay navigation programs offer 1 approach to address these problems, but how to best implement these programs presents challenges. We sought to describe those implementation challenges at 1 academic cancer center to inform future efforts. We performed a mixed methods study using standard implementation outcomes 1 year after program initiation. Quantitative data from the electronic medical record and qualitative data from in-depth interviews, focus groups, and ethnographic observations were included in analyses. The study took place at a National Cancer Institute-designated comprehensive cancer center across 12 tumor-specific clinics. Supportive care concerns, scheduling, and clinical-related issues were the most frequent issues navigators encountered. Effective navigation required continuous, time-consuming, invisible work, including building and maintaining a broad knowledge base of resources and health system processes, as well as cultivating relationships with diverse and changing clinical teams. The acceptability and appropriateness of lay navigator activities were mixed among clinic and social work staff, related to negotiating lines between clinical and nonclinical care. After 1 year of implementation, lay navigators still found it difficult to interpret and prioritize complex patient needs in a way that all clinical staff found appropriate. Negotiating these issues has made it difficult to develop the strong relationships with clinical teams that are needed for an integrated approach to patient care. To successfully coordinate patient care, it seems that lay navigation programs should be integrated with clinical teams to provide more seamless patient care.

A global review of current and emerging education and training to advance integrated systems of care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Peripartum Cardiomyopathy

The care of women with peripartum cardiomyopathy (PPCM) presents unique nursing challenges. It is imperative that the health care team has a solid understanding of cardiac disease and pregnancy. All nurses know that cardiac disease impacts the maternal–fetal dyad, but few nurses possess the degree of knowledge required to provide optimal care to women with PPCM throughout the perinatal continuum of care. A formal needs assessment was conducted with the nursing staff of the heart failure center and obstetric units. Results indicated a perceived increase in the incidence of the diagnosis, an overwhelming need for education regarding the care of a woman with PPCM, and a desire to form an alliance between cardiac and perinatal advanced-practice nurses to provide seamless care for patients with PPCM. Education was provided to cardiac and obstetric nurses. The following resources were created: inpatient care guidelines; a heart failure stoplight specific for use during pregnancy; a list of safe medications in pregnancy–breastfeeding; contraception options, and patient education. Education was provided to nurses in both units. Pretest score mean was 50.7%. All nurses demonstrated improvement in posttest scores after education (posttest score M = 95.3%; 100% nurses scored more than 85% on posttest). Since inception of this program, we have provided care for 10 patients with PPCM. Equally as important as increased knowledge is the now-present open line of consultation and collaboration among the heart failure nurses, obstetric nurses, and perinatal clinical nurse specialist. A diagnosis of PPCM is frightening, unexpected, and overwhelming. As the shock of the diagnosis subsides and the reality of the disease’s impact on daily living sets in, it becomes clear that added levels of support are necessary. That, in part, is why this initiative was developed. Knowledge empowers nurses and patients. Knowledge enables nurses to provide the requisite intricate care for this high-risk population. Knowledge assists the patients in decreasing stress and anxiety, thereby allowing them to concentrate on caring for themselves and their newborns. This type of holistic care can only be provided through multidisciplinary collaboration.

Connecting and maintaining seamless patient care between hospitals and homes for respiratory patients

Connecting and maintaining seamless patient care between hospitals and homes for respiratory patients

UK must follow Scotland's lead on prescribing equality

Many nurses qualify as nurse prescribers, yet they are not granted the same prescribing powers as doctors or dentists. This can prevent nurses from providing seamless patient care, and forces them to find loopholes in legislation in order to ensure adequate patient care. In this article, Helena Collier discusses the recent change in Scottish legislation and calls for the rest of the UK to follow this lead

Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study.

BackgroundTechnology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work.ObjectiveThe objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges.MethodsA qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion.ResultsFirst, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care.ConclusionsThis study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients.

Assessing healthcare professionals' experiences of integrated care: do surveys tell the full story?

Integrated care is the combination of different healthcare services with the goal to provide comprehensive, seamless, effective and efficient patient care. Assessing the experiences of healthcare professionals (HCPs) is an important aspect when evaluating integrated care strategies. The aim of this rapid review was to investigate if quantitative surveys used to assess HCPs' experiences with integrated care capture all the aspects highlighted as being important in qualitative research, with a view to informing future survey development. The review considered all types of health professionals in primary care, and hospital and specialist services, with a specific focus on the provision of integrated care aimed at improving the patient journey. PubMed, CINAHL and grey literature sources were searched for relevant surveys/program evaluations and qualitative research studies. Full text articles deemed to be of relevance to the review were appraised for methodological quality using abridged critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from included studies using standardized data extraction templates. Findings from included studies were grouped into domains based on similarity of meaning. Similarities and differences in the domains covered in quantitative surveys and those identified as being important in qualitative research were explored. A total of 37 studies (19 quantitative surveys, 14 qualitative studies and four mixed-method studies) were included in the review. A range of healthcare professions participated in the included studies, the majority being primary care providers. Common domains identified from quantitative surveys and qualitative studies included Communication, Agreement on Clear Roles and Responsibilities, Facilities, Information Systems, and Coordination of Care and Access. Qualitative research highlighted domains identified by HCPs as being relevant to their experiences with integrated care that have not routinely being surveyed, including Workload, Clear Leadership/Decision-Making, Management, Flexibility of Integrated Care Model, Engagement, Usefulness of Integrated Care and Collaboration, and Positive Impact/Clinical Benefits/Practice Level Benefits. There were several domains identified from qualitative research that are not routinely included in quantitative surveys to assess health professionals' experiences of integrated care. In addition, the qualitative findings suggest that the experiences of HCPs are often impacted by deeper aspects than those measured by existing surveys. Incorporation of targeted items within these domains in the design of surveys should enhance the capture of data that are relevant to the experiences of HCPs with integrated care, which may assist in more comprehensive evaluation and subsequent improvement of integrated care programs.