Patient Care System Research Articles

Consequences of Hospital Closures for the Health Insurance Industry in the United States

Hospital and health system bankruptcies and closures continue to rise in the United States. They are troubling news not only for patients and communities but also for insurance companies. Hospital closures often lead to higher costs for insurers due to increased claim denials, delayed payments, reduced provider network and access to care, higher out-of-network costs, and a disruption of our healthcare system. These factors ultimately impact the health insurance companies’ bottom lines as well as their ability to manage patient care effectively with the risk of causing customer/patient dissatisfaction. Insurance companies can help prevent hospital closures, especially in rural areas, by implementing some of the following mechanisms: timely and adequate payments; improved patient-centric payment systems; and standby capacity payments to cover minimum fixed costs. Such early strategic investments have the potential to offset the higher costs for insurance companies associated with hospital closures and improve the sustainability of the U.S. healthcare system.

Length of stay in the pediatrics emergency department and associated factors among pediatrics patients in Eastern Ethiopia public hospital, Ethiopia 2022.

Patient length of stay is a crucial measure of the emergency department, and it is a vital indicator of health services to evaluate its efficacy, patient care, organizational management, and health care system. Despite this, there are a few studies conducted on pediatric emergency length of stay in developing countries. Therefore, this study serves as input for evidence of pediatric emergency length of stay and associated factors in public hospitals. An institution-based cross-sectional study was conducted among children who attended in pediatric emergency department of Eastern Ethiopia public hospital from May 01 to Jun 31, 2022. A total of 761 children were selected by systematic sampling technique and interview using structured questionnaires. After data is collected and cleaned, entered using Epi data version 4.6 and then exported to Stata version 14.1 for analysis. Finally, an AOR with a 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant factors for prolonged length of stay. The prevalence of prolonged length of stay in the emergency ward was 214 (72%). Living in a rural residence ([AOR = 1.65, 95% CI (1.10-2.48)], having a duration of pain > = 12 ([AOR = 1.92, 95% CI (1.13-3.25)], waiting time > = 5 minute ([AOR = 2.24, 95% CI (1.1-4.248541)], having comorbid illness ([AOR = 1.92, 95%CI, 1.13-3.25)], and higher acuity level and absence of medication in the hospital were ([AOR = 2.26, 95%CI (1.02-2.46]) were significantly associated factors for prolonged length of stay. This study revealed that more than two-thirds of children admitted to pediatric emergency had prolonged lengths of stay. This result indicated that higher proportion of the length of stay in pediatric emergency in Eastern Ethiopian public hospitals compare to national. Hence, it is better to give priority to strengthening the focused evaluation of important variables and manage accordingly.

Secure Health Hub with Blockchain Enhanced (Blockchain-Enhanced Hospital Management)

Abstract: This article aims to address the critical need for asecured and patient-centric blockchain-based healthcare system. The research focuses on developing a hospital management system utilizing patient and doctorinformationon the Ethereum platform using a systematic approach. Smart contracts are used in Solidity to manage data. Local testing on Hardhat is conducted, and once successful the system is to be deployed on Ethereum. Security audits are performedto ensure robustness.

General Versus Interventional Gastroenterologists: A Comparative Analysis of Follow-Up Outcomes After Endoscopic Mucosal Resection of Colorectal Polyps.

Introduction Colorectal cancer (CRC) represents a major global health burden, significantly impacting mortality rates and healthcare systems worldwide. CRC screening through colonoscopy enables early detection and removal of precancerous polyps. While standard polypectomy suffices for small polyps, larger ones require endoscopic mucosal resection (EMR). Though post-EMR surveillance is crucial for preventing recurrence, it remains unclear whether follow-up by general gastroenterologists yields comparable outcomes to surveillance by interventional specialists. This distinction carries significant implications for resource allocation, particularly given the limited availability of interventional gastroenterologists whose expertise is needed for other complex procedures. Our study examines this unexplored question by comparing post-EMR surveillance outcomes between these provider groups. Methods We conducted a retrospective study at the Saint Louis Veterans Affairs (VA) Health Care System of patients presenting for follow-up of colorectal polyp EMR between January 2019 and December 2022. Pre-defined variables extracted from the electronic medical record system were then analyzed to discern significant differences between general and interventional gastroenterologists' outcomes. The primary outcome includes the rate of biopsy of scars after EMR between both groups. Additional outcomes include the number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy and mode of polypectomy, recommended surveillance interval suggested by the endoscopist, and the pathology of the EMR site biopsy. Results A total of 59 (N = 59) patients (median age: 67, mean age: 66.5 ± 6.6 years) met the inclusion criteria of our study. General gastroenterologists were more likely to biopsy the EMR site compared to interventional gastroenterologists (65% vs. 40%, p = 0.047). There was no difference in overall pathology detected when comparing general and interventional gastroenterologists (p = 0.074). While no EMR site biopsies were obtained in 16 patients (27.1%), there were no differences in the pathology of patients undergoing biopsy of the scar. Additionally, no significant differences were found in the Boston Bowel Preparation Score, number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy, or recommended surveillance interval. Conclusion Our study provides evidence that the outcomes of post-EMR follow-up are largely comparable between general and interventional gastroenterologists. Although general gastroenterologists exhibit higher rates of EMR site biopsy, the associated pathology shows no significant difference.

Critical Care Nursing Response to the Maui Wildfire Disaster: Narrative Review and Case Study.

Climate change has increased the frequency and severity of natural disasters, including the 2023 wildfires in Maui, Hawai'i. The no-notice disaster affected hospital operations at the sole acute care hospital that serves the community, requiring immediate interventions and reallocation of resources. The purpose of this article is to explore the role that critical care nurses play in responding to wildfires. Literature related to the nursing role in managing wildfire injuries and the events on Maui are explored and a case study presented. Results are organized into themes: environmental limitations, disaster response and code triage activation, no-notice preparation for critical care nurses, preparation to increase patient capacity and maintain patient safety standards, hospital staffing and staff affected by the disaster, management of patient care and hospital system operations, and disaster medical tent. Preparation for no-notice events requires critical care nurse involvement to effectively facilitate care for patients affected by disasters.

Assessment of burnout and perceived stress among health professionals: the role of the hospital work environment in Sidi Slimane, Morocco

ABSTRACT Healthcare worker burnout has serious implications for patient care and healthcare systems. This study examines burnout and stress among healthcare professionals in Sidi Slimane, Morocco, focusing on the impact of the hospital work environment. Using a mixed-methods approach combining the Maslach Burnout Inventory (MBI), the perceived Stress Scale (PSS), and in-depth interviews, we assessed 78 healthcare professionals between December 2017 and February 2018. The results show that 8.97% of caregivers are in a pathological state of burnout, with significant correlations between perceived stress and burnout dimensions. Recent studies indicate increasing burnout rates in Moroccan healthcare settings. Our findings provide crucial baseline data for understanding systemic vulnerabilities and distinguishing between burnout-related performance issues and negligence. The study emphasises the need for culturally appropriate interventions within the specific context of the Moroccan healthcare system.

Luspatercept: a treatment for ineffective erythropoiesis in thalassemia.

Patients with β-thalassemia continue to have several unmet needs. In non-transfusion-dependent patients, untreated ineffective erythropoiesis and anemia have been associated with a variety of clinical sequelae, with no treatment currently available beyond supportive transfusions. In transfusion-dependent forms, lifelong transfusion and iron chelation therapy are associated with considerable clinical, psychological, and economic burden on the patient and health care system. Luspatercept is a novel disease-modifying agent targeting ineffective erythropoiesis that became recently available for patients with β-thalassemia. Data from randomized clinical trials confirmed its efficacy and safety in reducing transfusion burden in transfusion-dependent patients and increasing total hemoglobin level in non-transfusion-dependent patients. Secondary clinical benefits in patient-reported outcomes and iron overload were also observed on long-term therapy, and further data from real-world evidence studies are awaited.

Navigating tomorrow's healthcare: Exploring the future of healthcare navigation with VR, AR, and emerging technologies: A comprehensive review

Effective navigation is critical to optimizing patient outcomes and improving the patient experience in today's rapidly growing healthcare landscape. The potential influence of VR, AR, and other emerging technologies on healthcare navigation is examined in this article. Patients may meet medical experts, participate in their treatment plans, and better apprehend their conditions through the immersive adventures offered by virtual and augmented reality. In addition to augmented and virtual reality, wearable technologies, AI, and the IoT are transforming real-time health monitoring and customization, augmented reality, virtual reality, and healthcare navigation. This study synthesizes the literature, examines case studies, and looks at real-world scenarios to provide insights into the potential, difficulties, and opportunities of utilizing these technologies to develop a patient-centric healthcare system. Academic databases were examined, including PubMed, Google Scholar, IEEE, and other relevant public health, medicine, and healthcare technology journals. The data gathered from case studies, actual-life scenarios, and literature reviews is synthesized to provide a comprehensive overview of the current landscape, opportunities, challenges, and prospects of leveraging VR, AR, and emerging technologies in healthcare navigation, including key terms such as emerging technologies, VR, AR, and healthcare navigation. The main discussion topics are targeted treatment, data visualization, medical research, and virtual and augmented reality. Additional worries are raised about privacy, data security, and ethical ramifications. Though these technology has some exciting aspects, problems like unequal access and technical constraints must be overcome before it can be extensively used. In order to overcome these obstacles and pave the way for a more effective, patient-centered healthcare system, virtual reality, augmented reality, and other cutting-edge technologies may be used to reform healthcare navigation.

A Bedside Electronic Whiteboard System for Patient Care in Isolation Rooms: A Scenario-Based Preliminary Study.

To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse-patient communication and supporting data input. A cross-sectional study with quantitative and qualitative mixed methods. We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record-keeping but noted a learning curve for less tech-savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse-patient interactions are crucial considerations. Electronic whiteboards have usability and acceptability as a tool to improve nurse-patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Nurses perceive electronic whiteboards as user-friendly and as facilitating data input. TREND (Nonrandomised evaluations of behavioural and public health interventions). No patient or public contribution.

A team-based approach to type 2 diabetes and cardiovascular care.

The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program is an innovative, patient-centered system of care developed by the University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio in the US for the management of high-risk patients with type 2 diabetes (T2D) and prediabetes at high risk for cardiovascular-kidney-metabolic (CKM) syndrome and its consequences. At its core, CINEMA is a multidisciplinary team of care experts, working together outside of traditional silos. The patient meets with the entire team up to 4 times each year to address all aspects of cardiovascular (CV) and T2D care. At the first visit, the team formulates a personalized approach that is evidence based and centered on optimal strategies to improve the patient's lifestyle, reduce their risk of CV and kidney disease events, and increase their access and adherence to guideline-directed pharmacologic therapies. A community health worker is utilized to address social determinants of health as needed. The program has a substantial research component, with the intent of developing evidence for novel care paradigms. The multiyear results of the CINEMA program indicate that a multidisciplinary approach to management of high-risk patients is highly effective in reducing CKM syndrome risk factors and increases use of guideline-directed therapies. The aim of this review is to describe the structure, operation, and eligibility criteria for admission to the CINEMA program, provide an overview of how CKM syndrome risks are determined and managed for each patient, and discuss how the integrated approach to care is supported by current recommendations from professional societies and results from other coordinated care/multidisciplinary programs. Lastly, the scalability challenges of a wider rollout of the CINEMA program are considered.

Adaptive EWMA Control Chart by Adjusting the Risk Factors through Artificial Neural Network

ABSTRACTThis article focuses on operationalizing a quality improvement framework to improve the quality and safety of patients in hospitals. Assessing the effectiveness of health care services, especially utilizing various patient health statuses, poses several difficulties. The artificial neural networks model assesses patient risk factors and enhances proper management. Our proposed approach extends the exponentially weighted moving average (EWMA) control chart to a risk‐adaptive EWMA chart. This chart is developed from residuals estimated from the artificial neural networks model, thus allowing an assessment of actual data from the patients undergoing cardiothoracic surgery. For patient evaluation, we employ artificial neural networks to establish the suggested control chart. The results indicate that this chart outperforms other methods, such as the risk‐adjusted EWMA chart for shift detection, which may present improvements in the healthcare system's patient care.

The role of optometry in healthcare for visually impaired older adult populations: a Swiss case study.

Visual impairment (VI) is common among older adults aged 70 years and older, and its prevalence increases with advancing age. The optometry profession may play an important role in a patient-centred health system that incorporates medical and psychosocial aspects by working closely with low vision counselling services (LVCS). This paper investigates the current level of cooperation between optometry and LVCS by analysing the referral practice of optometrists to LVCS for the older population with VI, based on the PROVIAGE study. A national, telephone-based survey of individuals aged ≥70 years and an online survey of professionals in ophthalmology, optometry and LVCS was conducted in 2022 across Switzerland. The responses of 154 individuals with VI and 272 professionals (123 ophthalmologists, 126 optometrists and 23 staff of low vision rehabilitation consulting centres) were analysed. Among the respondents with age-related VI, 33.1% stated that they were aware of LVCS. Of these, however, only 11.7% reported that they had visited such centres during the last five years. Sixty-eight percent of respondents attended the ophthalmologist, but only 1.3% went to the optometrist for vision-related problems. Among ophthalmologists, 95.9% indicated that they had referred patients to LVCS, whereas only 58.8% of optometrists had done so. The results of this study highlighted the relationship between the different clinician referrals, patient needs, and potential barriers preventing referrals towards older adults in Switzerland. A stronger cooperation between professions in the care network will enhance vision care for the ageing population without the need for additional infrastructure.

Level of health laboratory service quality, service interruptions, and its predictors in public hospitals in Harar town, eastern Ethiopia.

Quality laboratory services are key in the healthcare system for successful diagnosis and patient care. Uninterrupted laboratory services are needed to meet the needs of all patients and clinical personnel, but studies in developing nations revealed that most clinicians were dissatisfied due to the lack of quality laboratory services and frequent interruptions. This study aimed to assess the level of health laboratory service quality, service interruptions, and its predictors in public Hospitals in Harar town, eastern Ethiopia. A facility-based cross-sectional study was conducted at Hiwot Fana Specialized University Hospital and Jugel General Hospital between January and April 2024. Data collection utilized Standardized Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklists and questionnaires based on the Ethiopian Hospital Standard Transformation Guidelines. Data were entered and analyzed by Statistical Package for the Social Sciences, version 26. Descriptive statistics such as frequencies, proportions, and means, were calculated. Binary and multivariable logistic regression models were applied to identify predictors with adjusted odds ratio (AOR) and a cut-off p-values <0.05 with 95% confidence interval (CI). Two public hospital laboratories and their 54 laboratory professionals were involved in our study. According to our study, the mean score of the two public hospitals was 168.5 (61%), while Hiwot Fana specialized university hospital scored 212 (77%) and Jugel General Hospital scored 127 (46.1%). The study also revealed that out of 72 tests, 31 (43.05%) were interrupted, with clinical chemistry tests being the most interrupted (16, 51.6%) followed by Serology (7, 22.6%) and Hematology (4, 12.9%) tests. Lack of timely management response (AOR = 7.78, 95% CI = 1.48-40.83) and shortage of supplies (AOR = 60.8, 95% CI = 1.07-32.83) were significantly associated predictors of laboratory service interruptions. Neither of the hospital's laboratories met the required score of the SLIPTA standard for quality clinical laboratory services. Moreover, laboratory service interruptions were very common in the two public hospitals in which clinical chemistry, serology and hematology tests were the most frequently interrupted. Shortage of reagents and supplies and inefficient laboratory management are the major causes of service interruptions. So, policymakers and other stakeholders should support continuous quality improvement for a better patient clinical outcome.

The liminal experience of awaiting for a cadaveric kidney donation: “I would not wish it on even my enemy!”

This study aims to explore the concept of liminality in the lives of chronic kidney disease (CKD) patients in Turkiye who are undergoing dialysis while awaiting kidney transplants. The research focuses on how patients experience this transitional state, being between life stages, and how they cope with the uncertainty of their condition while aspiring for a transplant. The research involved in-depth, semi-structured interviews and participant observations of 34 dialysis patients who had been registered on the national organ waiting list for over five years. The research was conducted between August 16, 2022, and November 11, 2022. The principal findings reveal that these patients experience profound uncertainty and hope, viewing potential transplants as a "second birthday" and symbolic rebirth. The study also highlights significant cultural and familial dynamics influencing the organ donation process, with many patients facing disappointment when relatives are unwilling or unable to donate. Additionally, patients report various physical and psychological challenges, including social isolation, strict dietary restrictions, and the emotional toll of dependence on hemodialysis. The significant conclusions indicate that the anticipation of receiving a cadaveric organ donation provides both hope and anxiety, motivating patients to adhere strictly to medical advice while coping with the emotional burden of uncertainty. The research underscores the complex interplay between cultural beliefs, medical practices, and the lived experiences of CKD patients. This paper contributes to knowledge by comprehensively understanding the cultural and emotional dimensions of the dialysis experience in Turkey. It offers valuable insights for healthcare providers and policymakers to improve patient care and support systems.

The Role of Healthcare Workers in Modern Medicine: A Comprehensive Review of Challenges, Contributions, and Future Directions

Healthcare workers are essential to the functioning and sustainability of modern healthcare systems. This review explores the diverse roles, contributions, and challenges faced by healthcare professionals, including physicians, nurses, pharmacists, allied health professionals, and support staff. Each role contributes uniquely to patient care quality, system efficiency, and overall health outcomes. However, healthcare workers encounter numerous obstacles, including high workloads, resource shortages, mental health strain, and interdisciplinary coordination challenges. This review also highlights significant contributions that healthcare workers make toward enhancing patient safety, operational efficiency, and public trust. Through case studies and analysis, we examine strategies for supporting healthcare workers, including training, mental health resources, and improved resource allocation. Finally, we provide recommendations for future directions to bolster healthcare worker resilience and efficiency, ensuring that healthcare systems remain adaptable and capable of delivering quality care. This article emphasizes the need for holistic support systems to sustain a resilient and effective healthcare workforce.

The Effect of Ambient Artificial Intelligence Notes on Provider Burnout.

Healthcare provider burnout is a critical issue with significant implications for individual well-being, patient care, and healthcare system efficiency. Addressing burnout is essential for improving both provider well-being and the quality of patient care. Ambient artificial intelligence (AI) offers a novel approach to mitigating burnout by reducing the documentation burden through advanced speech recognition and natural language processing technologies that summarize the patient encounter into a clinical note to be reviewed by clinicians. To assess provider burnout and professional fulfilment associated with Ambient AI technology during a pilot study, assessed using the Stanford Professional Fulfillment Index (PFI). A pre-post observational study was conducted at University of Iowa Health Care with 38 volunteer physicians and advanced practice providers. Participants used a commercial ambient AI tool, over a 5-week trial in ambulatory environments. The AI tool transcribed patient-clinician conversations and generated preliminary clinical notes for review and entry into the electronic medical record. Burnout and professional fulfillment were assessed using the Stanford PFI at baseline and post-intervention. Pre-test and post-test surveys were completed by 35/38 participants (92% survey completion rate). Results showed a significant reduction in burnout scores, with the median burnout score improving from 4.16 to 3.16 (p=0.005), with validated Stanford PFI cutoff for overall burnout 3.33. Burnout rates decreased from 69% to 43%. There was a notable improvement in interpersonal disengagement scores (3.6 vs. 2.5, p<0.001), although work exhaustion scores did not significantly change. Professional fulfillment showed a modest, non-significant upward trend (6.1 vs. 6.5, p=0.10). Ambient AI significantly reduces healthcare provider burnout and may enhance professional fulfillment. By alleviating documentation burdens, ambient AI can improve operational efficiency and provider well-being. These findings suggest that broader implementation of ambient AI could be a strategic intervention to combat burnout in healthcare settings.

Abstract 211: Building a Stroke Program in Urban Tanzania: Needs Assessment and a Plan to Move Forward

Introduction Stroke is a leading cause of morbidity and mortality globally with high social and economic burden that disproportionately effects low‐ and middle‐income countries (LMICs). Mechanical thrombectomy (MT) is an effective treatment for stroke but is not available in the majority of LMICs. Tanzania (TZ) lacks MT and has limited access to thrombolytics with very few patients receiving any intervention for acute ischemic stroke (AIS). Key stakeholders in TZ are motivated to build a stroke program and provide treatment of AIS, including MT. Here we present the initial needs assessment and model for developing a system of stroke care in TZ. Methods A needs assessment was performed in TZ through discussion with a multidisciplinary team. Key leaders from the national hospital leadership, Emergency Medicine, Neurology, Neurosurgery, Radiology, Interventional Radiology, and international stroke teams were involved in discussions regarding current stroke management and goals for the future. Key stakeholders provided insight into the current state of stroke management within their health system, including the referral system within TZ, review of data from an existing stroke registry, review of standard operating procedures (SOPs) in place for patients presenting with AIS. Recommendations for improving access to acute stroke treatment were identified and discussed. Results Existing infrastructure and systems within TZ designed to care for patients with AIS include: two newly established, thrombolysis ready stroke units; AIS registry which involves 8 referral hospitals. The barriers to providing AIS treatment include: delayed presentation to healthcare due to lack of public awareness; lack of affordable and rapid access to appropriate imaging; lack of established consulting service between emergency physicians and stroke neurology; lack of epidemiological data as to the true incidence of AIS at the district level, lack of access to endovascular treatment. A model to develop AIS program in TZ was identified consisting of three partially overlapping avenues and targeted at the public, healthcare systems and medical teams. Public: sensitization of the public with media campaigns and education will be focused on identification of stroke symptoms and knowledge about treatments. Healthcare systems: development of a formalized consultation service between district emergency teams and stroke neurology; development and implementation of new SOPs for diagnosis and access to imaging at the district level; expansion of stroke registry to include district level hospitals. Medical teams: continued mentorship through the World Stroke Organization for neurology on identification and acute management of patients with stroke; development of the first endovascular neuro‐intervention training program in collaboration with Mission Thrombectomy 2020. Conclusions There is significant need for a system of stroke care for patients in TZ. Key stakeholders are motivated to establish this system and bring acute interventions, including thrombolysis and MT. to patients suffering from AIS in TZ. This endeavor will require significant effort by many groups, but concurrent efforts in these three domains can help bring this important care to the people of TZ.

Cardiovascular mortality rate between 2018 and 2022 in Kyrgyz Republic

Abstract Background Cardiovascular diseases (CVD) are the number one cause of death in low- and middle-income countries (LMICs), including Kyrgyz Republic. According to official statistics, CVD ranks first in the structure of overall mortality, accounting for more than half (52.1% according to 2022 data) of all deaths. Purpose to analyze the cardiovascular mortality rate in the Kyrgyz Republic, from 2018 to 2022. Methods Medical and statistical information on mortality from CVD in the population was obtained from the Centre for Electronic Health (CEH) of the Ministry of Health. To conduct a comparative analysis, relative indicators per 100 thousand population were calculated. A retrospective epidemiological study of mortality from CVD including different nosological forms over period for 2018–2022 was conducted, calculating the rate of increase (decrease). An analysis of the epidemiological situation of the disease in nine administrative-territorial units of the Kyrgyz Republic was also carried out with the calculation of the average 5-year mortality ratefor the period from 2018 to 2022. Results Despite the decrease in morbidity, a high proportion of mortality from CVD remains in all years, more than 50%. In terms of the percentage indicator for recent years, all this time it has maintained the highest position, in contrast to diseases of other organs and systems. In the last decade, from 2012 until 2020, there was a gradual decrease in the mortality rate. Since 2020, we have seen a sharp increase in the CVD mortality rate per 100 thousand population by 19.6% compared to 2018, by 19.4% since 2019, which is associated with the influence of Covid-19 pandemic, in 2021 this indicator amounted to 297.6 cases, in 2022 - 234.5. The main contribution to population death from CVD is made by coronary heart disease (65.90%), including acute myocardial infarction, cerebrovascular diseases (21.4%), arterial hypertension (5.9%). If we analyze the mortality rate from CVD by nine administrative-territorial units, the highest rates in 2022 are observed in the Chui and Talas regions, 291.9 and 266.3 per 100 thousand population respectively; the lowest in the Osh region (207.3), Osh city (196.1) and Bishkek (208.6), which is explained by the better organization of health services in these areas. Conclusion CVD remains the main cause of mortality in the population of the Kyrgyz Republic. Although over the past year there has been a good decline in this indicator, in almost all regions, particularly the greatest successes have been achieved in Naryn and Issyk-Kul regions. In connection with the above, there is requirement for a clear identification of priorities when determining the strategy of treatment and preventive interventions. It is necessary to create an effective National system of care for patients with CVD with a focus on emergency cardiac care and prevention issues.

Analyzing the Maharashtra Ambulance Service “108”: The Prospect and Challenges

ABSTRACT The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service’s success, assisting the policymakers and health administrators in identifying and further improving the service.

"So You Made a Mistake" - The Path Forward Through Surgical Pathology Errors by Extreme Ownership and a Focus on the Patient.

Our goal for medicine is to make zero mistakes, yet the reality is that mistakes are an unfortunate part of medical practice. And when it comes to surgical pathology, it is a special case where the diagnostic "bottom line" is provided starkly and directly for all to see in the final diagnosis of the pathology report. When this diagnosis is wrong, particularly when it has serious adverse consequences for the patient, the resulting physical, mental, and emotional effects on patient, provider, pathologist, and health care system can be extremely serious. Head and neck surgical pathology, based on large second review-type studies, is a subspecialty area with average rates of major diagnostic error, but with potential for severely negative impacts on patients. Studies have shown between 1% and 7% major error rates for head and neck practice. How then, as the pathologist, can we react to and manage things when we have made a serious diagnostic mistake? Through personal experience over more than two decades, the hard-won answer is through extreme ownership and a focus on the needs of the patients, who, in the words of William J. Mayo, should have their "needs come first". The emotional impact on us as pathologists and on the clinicians we work with should also be acknowledged and managed. This article will serve as a thorough and open examination of these mistake scenarios and, focusing specifically on diagnostic errors, serve as a practical guide for what you can do, moving forward, to "make things right" to the best of your ability.