Health Service System Research Articles

Enhancing security in smart healthcare systems: Using intelligent edge computing with a novel Salp Swarm Optimization and radial basis neural network algorithm

A smart healthcare system (SHS) is a health service system that employs advanced technologies such as wearable devices, the Internet of Things (IoT), and mobile internet to dynamically access information and connect people and institutions related to healthcare, thereby actively managing and responding to medical ecosystem needs. Edge computing (EC) plays a significant role in SHS as it enables real-time data processing and analysis at the data source, which reduces latency and improves medical intervention speed. However, the integration of patient information, including electronic health records (EHRs), into the SHS framework induces security and privacy concerns. To address these issues, an intelligent EC framework was proposed in this study. The objective of this study is to accurately identify security threats and ensure secure data transmission in the SHS environment. The proposed EC framework leverages the effectiveness of Salp Swarm Optimization and Radial Basis Functional Neural Network (SS-RBFN) for enhancing security and data privacy. The proposed methodology commences with the collection of healthcare information, which is then pre-processed to ensure the consistency and quality of the database for further analysis. Subsequently, the SS-RBFN algorithm was trained using the pre-processed database to distinguish between normal and malicious data streams accurately, offering continuous monitoring in the SHS environment. Additionally, a Rivest-Shamir-Adelman (RSA) approach was applied to safeguard data against security threats during transmission to cloud storage. The proposed model was trained and validated using the IoT-based healthcare database available at Kaggle, and the experimental results demonstrated that it achieved 99.87 % accuracy, 99.76 % precision, 99.49 % f-measure, 98.99 % recall, 97.37 % throughput, and 1.2s latency. Furthermore, the results achieved by the proposed model were compared with the existing models to validate its effectiveness in enhancing security.

Recovery at 30: Perspectives from Psychiatry Clinicians and Senior Faculty.

According to William Anthony's "Recovery from mental illness: the guiding vision of the mental health service system in the 1990s," mental health recovery means "changing one's attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness." This seminal work served as an overarching goal, a call to action, and a roadmap for the enhancement of psychiatric recovery. Unfortunately, from many viewpoints, the goals encouraged by Anthony have not been achieved. Through semi-structured interviews with psychiatry clinicians and senior faculty members, this article aims to elucidate the current status of psychiatric recovery, how the movement progressed to this point, and where we could go from here. The development of the recovery movement will be discussed, along with its assumptions and explicit goals. The interviews focus on the extent to which these goals have been achieved, barriers to progress, whether goals should be revised, and how to achieve these goals.

LMIC-22. TOWARD A COMPREHENSIVE PEDIATRIC BRAIN TUMOR REGISTRY: ESTABLISHING FUNDAMENTAL VALUE IN INDONESIA TERTIARY HOSPITAL

Abstract BACKGROUND Systematic documentation and research on pediatric brain tumor (PBT) have been underreported in Indonesia. Precise and readily available epidemiological data hold significant value in enhancing the PBT service of any center, each with its own distinctive characteristics. We aim to evaluate our PBT registry and service after Cipto Mangunkusumo National General Hospital utilized the St. Jude (SJ) Cares Registry program. METHODS A retrospective observational longitudinal study, carried out at Cipto Mangunkusumo National General Hospital, utilizing primary registry data encompassing patients’ profiles, diagnoses, and follow-up issues from January 2022 to December 2023, was performed. An evaluative review was then carried out to delineate our center’s unique problems and solutions to improve the overall PBT health services. RESULTS A total of 103 patients participated, dominated by females (55.3%), with a median age of 8 (IQR 4-12). The most identified diagnoses were gliomas (48.6%), germ cells (16.5%), and medulloblastomas (8.7%), with high-grade gliomas contributing to the most death (48.4%). The main symptoms contributing to the most extended diagnosis delay (from onset to diagnosis) were puberty issues, motoric paresis, vertigo, macrocephaly, proptosis, disequilibrium, and headache. Some critical findings from this registry evaluation were the mapping of patients’ key clinical symptoms and most diagnoses to be anticipated, factors related to diagnosis delay, and the numerous ineffective yet revisable health service systems that led to incomplete patient data and loss of follow-up. These led to our team’s effort to implement more effective multidiscipline communication (through regular synchronous and asynchronous meetings), orbit the pediatrician to become the St. Jude virtual fellow and recruit more trained data registry specialists. CONCLUSION In conclusion, as each center has unique problems in its own PBT health services, it is essential to have accurate registry data to be the fundamental value and starting point for comprehensively delineating and improving PBT service.

FACTORS ASSOCIATED WITH THE QUALITY OF LIFE OF HYPERTENSION PATIENTS

Objective: This study aimed to analyze factors related to the quality of life of hypertensive patients in the working area of the Mulyorejo Community Health Center, Deli Serdang Regency. Theoretical Framework: Complications of hypertension and variables related to the quality of life of hypertensive patients have a major impact on the burden borne by various parties including patients, the economic burden, society and health services. Method: This study used an explanatory survey design, with a population of all hypertensive patients seeking treatment in the working area of the Mulyorejo Community Health Center, Deli Serdang Regency. The sample size was measured using a single population proportion hypothesis test formula of 445 hypertensive patient respondents using a consecutive sampling technique. Results and Discussion: Research respondents were categorized according to age, gender, education, occupation, marriage, duration of suffering from hypertension, comorbidities, cigarette consumption, blood pressure checking, physical activity, salt consumption, body mass index, blood pressure, regular consumption of antihypertensive drugs, support family, self-efficacy, stress and quality of life. Conclusion: Findings showed that there were ten factors that were significantly related to the quality of life of hypertension including stress, self-efficacy, family support, regularity in taking anti-hypertension medication, blood pressure, BMI, salt consumption, physical activity, checking blood pressure and comorbidities. Research Implications: There needs to be a joint commitment through the management of an integrated health service system to handle and prevent factors related to the quality of life of hypertensive patients.

Analysis Of Determinants Related To Work Accidents In Nurses In Hospital Dr. Mm Dunda Limboto

Labor is a human resource which is a very important asset and is an inseparable element in the process of production service activities and other supporting elements (Mudjimu, 2019). Hospitals as a part of the health service system generally provide services to the community in the form of health services including medical services, medical support services, medical rehabilitation, and nursing services. This research aims to analyze the determinants of factors related to work accidents among nurses at RSUD. Dr. M.M Dunda Limboto . Analytical survey research method with a cross-sectional study design. The population is all RSUD ASN nurses. MMDunda Limboto has as many as 152 people. Sampling used Simple Random Sampling, the sample size was 110 people which was calculated using the Slovin formula. Analysis was carried out using the chi-square test and linear regression test. The results of the chi-square test research showed age (ρ value 0.000), obesity (ρ value 0.018), education (ρ value 0.000), years of service (ρ value 0.000), knowledge (ρ value 0.000), attitude ( ρ value 0.000). The linear regression test obtained the variable gender and length of service, F counts 13.972 and ρ value 0.000, R=0.455 and R Square =0.207. This research concludes that there is a relationship between age, obesity, education, length of service, knowledge, attitude, and work accidents among nurses at RSUD. Dr. M.M Dunda Limboto . Gender and length of service are the variables most related to work accidents among nurses at RSUD MM Dunda Limboto at 20.7%, a medium level of significance. Therefore, it is recommended that nurses use PPE such as gloves, masks, eye protection, and protective gowns when necessary and take part in regular safety training.

Quality Improvement Support Agencies as a systemic quality strategy: France and Québec

AbstractIn a high‐quality health and social services system, policymakers encourage action at all levels of change to ensure the consistency of quality strategies. This is especially important at the systemic level, in which the other three levels of change are nested. This study aims to present an analysis of Quality Improvement Support Agencies as a systemic strategy, which has been successfully implemented in several jurisdictions. A comparative study of two critical cases in different jurisdictions was carried out: Haute autorité de santé in France (HAS) and Institut national d'excellence en santé et services sociaux (INESSS) in Québec, Canada.

A cancer center department of supportive oncology: Patient demographic characteristics.

e13518 Background: Supportive Oncology is critical to whole-person, modern cancer care. Our Department of Supportive Oncology (DSO) provides the following services: palliative medicine, senior oncology, integrative oncology, cancer survivorship, genetics, cancer rehabilitation, oncology nutrition, patient navigation, and psycho-oncology. Little is known on the patient population who access these services which makes program development difficult. We describe the key demographic variables in a Supportive Oncology Department (DSO) for age, payor, gender, language preference, and race across our health system, geographical locations, and DSO services. Methods: Patient encounters, as noted in the EMR, were analyzed in a Microsoft PowerBI (www.microsoft.com) database using visits from July 1, 2022 through December 31, 2023. Variables were pre-defined by the healthcare system. Descriptive statistics in grouped frequency distribution tables were used. Results: Female, White, English-speakers (respectively) were the top utilizers across our healthcare system (57%,62%,94%), the oncology service line (64%,69%,97%), and DSO (68%,68%,96%). By gender, females were predominant users (84%) of Integrative Oncology & Survivorship services. Males used Senior Oncology & Palliative Medicine most often of all DSO services (45%). Differences in race were noted in geography (Black urban 26% vs rural 18%). In DSO services, Black patients access for senior oncology/palliative medicine (combined) was highest at 26%. Lowest utilization for Blacks was psycho-oncology & genetics at 18 and 13% respectively. While the overall system had more managed care (55%), both the oncology service line and DSO had more Medicare and less Medicaid. DSO had more managed care (46%) than the service line (42%). In rural settings, DSO patients (39%) were more likely to be in managed care than those in the service line (34%). DSO had more patients in younger age groups (ages 45-64, 42%) than both the oncology service line (35%) and the health system (24%), regardless of urban/rural location. In both the health system and the oncology service line, younger patients were more likely to be in urban locations and older were more likely rural. For DSO services, younger patients (ages 18-44) were more involved in psychology (27%), genetics (26%), and integrative & survivorship care (19%). Older patients were more likely to utilize palliative medicine and senior oncology (ages > 65, 47%). Conclusions: This Supportive Oncology population reveals variation in service access related to demographic characteristics that can inform future program development. Important similarities and differences were noted compared to the wider oncology service line and health system. Age, gender, geographic, payor, and racial disparities may influence service utilization in Supportive Oncology.

Users' Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges.

Evaluating the access to and quality of healthcare services from the users' perspective is an important assessment process to identify priorities. This study assessed the profile of health service usage and the views of the Unified Health System (SUS) users about the access to and quality of SUS public health services. A cross-sectional study was conducted with participants from the Coastal Lowlands Region of the Rio de Janeiro State/Brazil, between August and November 2023. The association between categorical variables was analyzed using the Pearson Chi-Square test, using R software 4.3. A total of 200 individuals were interviewed using a 66-question survey instrument. Participants who reported using SUS services more frequently rated this system as essential (p-value = 0.031). However, overall, 64% of participants rated the quality of care to be very bad/bad and 34.9% rated access as very bad/bad. Access was considered poor by respondents who used public services rarely or sometimes (p-value = 0.002). In terms of accessing SUS services consultations provided by specialists (e.g., neurologists), these were available only in another municipality (p-value = 0.001). Many participants were SUS dependent for health services, and gaps and weaknesses were observed regarding users' perspectives of the access to and quality of SUS health care. Policymakers should prioritize evaluations and dialogue with the community to make SUS services responsive and to optimize value-for-money in health service planning.

Use of Long-Term Care Services by Older Persons with Limited English Proficiency

ABSTRACT Older migrants face special difficulties in the access and use of long-term care services and supports (LTSS). Our study was designed to examine how older persons with limited English proficiency (LEP) in two groups of migrants (Spanish or Chinese speaking) interact with the LTSS system. Focus groups were used to elicit information from members of these groups. We discovered Chinese elders were likely to believe that the LTSS services could, if managed properly, meet their needs, while the Spanish speakers were more skeptical. These differences were associated with the presence of trusted intermediaries among the Chinese elders who could represent their interests, while most Spanish speakers did not report having such intermediaries. In this way, trust, or lack of it, was uncovered as the key element defining older adults’ interactions with the formal health and social service systems. Findings will be used to develop a modeling method that will allow us to analyze results in a manner that can be extended to use with other migrant groups.

Knowledge and Skills Needed for Future Health Administrators: A Systematic Review.

The educational needs of future health administrators, prioritizing their needs, and developing a relationship between these needs and the needs of the community are very important to provide better responsiveness. We aimed to identify the knowledge and skills required for health care management students as future managers of the health community. In this systematic literature review, all studies conducted between 1990 and 2021 were searched in such databases as MEDLINE, Scopus, Web of Science, ProQuest Iran Medex, Magiran and Scientific Information Database (SID), and the collected data were analyzed via the thematic analysis method. Findings of this study were divided into two main categories and fourteen subcategories, including knowledge-related factors (awareness of the structure and processes in the field of health and knowledge of management science) and skill-related factors (planning, coordination, organization, leadership, control and evaluation, management of financial resources and budgeting, service management, communication and information management, human resource management, implementation of participatory and team activities, crisis management, entrepreneurship, innovation, marketing, policymaking, and decision-making). By identifying the knowledge and skills that students need, it is possible to empower them through necessary education. Therefore, by providing responsive education, developing skills, and improving capabilities, we can take an effective step to improve the quality of health system services.

Analysis of Storage Spaces to Support the Health Service System at Santosa Hospital Bandung Central in 2021

One of the health services provided by the hospital is the medical record service. The implementation of good medical file storage through systematic procedures is one of the keys to the success of health service, it is also one of this study was to determine the medical record storage space, the obstacles that occurred, and the effort made in the storage room at the Santosa Hospital Bandung Central. The research method used is descriptive qualitative research, by describing the relevant data. Data collection techniques in the form of interviews and document studies. From the results of the study it can be said that the layout and environment for storing medical records at Santosa Hospital Bandung Central is appropriate, the number of visits that continues to increase is not comparable to the medical record storage space contained in the storage room, the use of medical records is an effort made by Santosa Hospital Bandung Central. The use of electronic medical records overcomes problems in the storage space so as to minimize disruption of health services provided by the Santosa Hospital Bandung Central to patients.

Exploring the relationship between e-health literacy and online health information-seeking behaviour among pharmacy students in Indonesia

Background: Digital transformation has changed the health service system and how people search for health information. Digital health literacy provides basic knowledge that the prospective pharmacy workforce must have to provide comprehensive pharmacy service. Objective: This study aims to explore pharmacy students' eHealth literacy level and relate to their behaviour in accessing health information online. Methods: A cross-sectional survey was conducted on 314 pharmacy students at two pharmacy diploma schools in Jakarta and Bandung, Indonesia. A semi-structured questionnaire was administered to identify online health information-seeking behaviour and e-health literacy scores. Results: Out of 314 students, most were women (86.3%) and sophomores (43.3%). More than half have health applications installed on their smartphone and access health information online more than twice a week. There was a significant relationship between e-health literacy scores and student entry year (p = 0.000), the frequency of online health information-seeking practice (p = 0.001), and installed health apps on smartphones (p = 0.002). Conclusion: A future altered curriculum and the appropriate study materials on digital health must be implemented to equip pharmacy students with adequate skills before graduation.

Drawing up the public national Rational Pharmacotherapy Action Plan as part of social and health services reform in Finland: a bottom-up approach involving stakeholders

BackgroundEnsuring equal access to medicines and their appropriate and safe use at reasonable costs are core functions of health systems. Despite that, few descriptions of national medicines policies' development processes and implementation strategies have been published. This study aimed to describe the government program-based development of the Rational Pharmacotherapy Action Plan in Finland as a part of the undergoing major health and social service system reform, also covering the implementation of rational pharmacotherapy in the reformed system and processes.MethodsThe data of this qualitative study consisted of public reports and Steering Group meeting memos related to the development of the national Rational Pharmacotherapy Action Plan that the Ministry of Social Affairs and Health coordinated. Qualitative content analysis applying systems theory and the conceptual framework of integrated services as theoretical frameworks was used as an analysis method.ResultsThe national Rational Pharmacotherapy Action Plan covering 2018–2022 was created in a bottom-up development process involving a wide range of stakeholders. Rational pharmacotherapy was redefined by adding equality as the fifth pillar to complement the previously defined pillars of being effective, safe, high-quality, and cost-effective. The Action Plan formed a normative framework for long-term development, with a vision and principles focusing on people-centeredness, better coordination and management of the medication use processes, the continuity of treatment paths and the flow of patient and medicines information through partnerships, and evidence-informed policies and practices.ConclusionThrough intensive stakeholder participation, the bottom-up approach created a national vision and principles of rational pharmacotherapy along with strong commitment to implementing the goals and measures. The concern lies in ensuring the continuity of the Action Plan implementation and achieving a balanced long-term development aligned with the integrated and reformed national social and health services system. The development of the pharmaceutical system has several national and EU-level dependencies requiring political long-term commitment. While the Action Plan differs from the national medicines policy, it forms a good basis for long-term development covering important parts of medicine policy at the micro, meso, and macro levels of the service system.

Association between social capital and utilization of essential public health services among elderly migrants: a multilevel logistic study based on the 2017 China migrant dynamic survey (CMDS)

BackgroundAs the number of elderly migrants in China continues to grow, it is necessary to pay closer attention to their health and health services. Some studies have confirmed that social capital plays a significant role in the utilization of health services. Therefore, an in-depth exploration of the relationship between social capital and the utilization of essential public health services (EPHS) by elderly migrants will not only contribute to improving their overall health but also facilitate a more balanced development of public health service system in China.MethodsBased on the cross-sectional data from the 2017 China Migrants Dynamic Survey (CMDS), this study examined the impact of social capital on the utilization of EPHS among elderly migrants. We evaluated social capital at two distinct levels: the individual and the community, and considered two dimensions of social capital: structural social capital (SSC) and cognitive social capital (CSC). The study aimed to delve into the impact of these forms of social capital on the utilization of EPHS among elderly migrants, and whether the migration range moderates this impact by multilevel logistic regression analysis.ResultsA total of 5,728 migrant elderly individuals were selected. The health records establishment rate and health education acceptance rate were approximately 33.0% and 58.6%, respectively. Social capital influenceed the utilization of EPHS among elderly migrants. Specifically, individual-level SSC and CSC have impacts on both the establishment of health records (OR = 1.598, 95%CI 1.366–1.869; OR = 1.705, 95%CI 1.433–2.028) and the acceptance of health education (OR = 1.345, 95%CI 1.154–1.567; OR = 2.297, 95%CI 1.906–2.768) among elderly migrants, while community-level SSC only affected the acceptance of health education (OR = 3.838, 95%CI 1.328–11.097). There were significant differences in individual-level SSC, health records, and health education among different migration range subgroups among elderly migrants. Migration range moderated the effect of social capital on the utilization of EPHS, crossing provinces could weaken the relationship between SSC and health education.ConclusionsSocial capital is associated with a higher utilization rate of EPHS among elderly migrants. It is necessary to encourage them to actively participate in social activities, strengthen public services and infrastructure construction in the area, and improve their sense of belonging and identity.

Technical efficiency and its convergence among village clinics in rural China: evidence from Shanxi Province.

Village clinics (VCs) are the foundation of the three-tiered health service system in China, delivering basic and routine outpatient services to citizens in rural China. VC technical efficiency and its convergence play a critical role in policy decisions regarding the distribution of health service resources in rural China. This study measured VC technical efficiency (using the slacks-based measure model), its convergence (using the convergence model), and the factors that influence the convergence in Shanxi Province, China. Data were obtained from the Shanxi Rural Health Institute 2014-2018 Health Statistics Report, which involved 3,543 VCs. The results showed that VC technical efficiency was low and differed by region. There was no α convergence in VC technical efficiency, but evidence of β convergence was found in Shanxi. The main factors that influence convergence were the building area of each VC (BA), proportion of government subsidies (PGS), and ratio of total expenditure to total income of each VC (RTETI). The government should increase investments in VCs and improve VC technical efficiency. Meanwhile, the government should be aware of and take measures to curb the inequity in VC technical efficiency among different regions and take suitable measures to curb this disparity.

Effects of internal migrants' health on economic resilience in China's Yangtze River Delta urban agglomeration: moderating effects of basic public health services.

Internal migrants constitute a significant generality in the socioeconomic development of developing countries. With the frequent occurrence of major public health emergencies, obstacles to labor supply due to health issues among internal migrants not only affect their livelihood stability but also urban economic resilience. Moreover, the design of basic public health service systems tends to favor local residents over internal migrants, further exacerbating the health and employment risks of internal migrants. As a result, urban economic resilience faces significant challenges. The objective of this study was to deconstruct economic resilience into economic resistance and recovery abilities, investigate the net effect and its heterogeneity of internal migrants' health on economic resilience in China's Yangtze River Delta urban agglomeration (CYRD), and the mediating effect from labor participation rate and labor time supply, as well as the moderating effect of basic public health services. Based on the China Migrants Dynamic Survey data (CMDS), the study empirically estimated the effects of internal migrants' health on economic resilience in CYRD through microeconometric analysis methods, mediating and moderating effect model. Our findings indicate that internal migrants' health has a positive effect on economic resilience in CYRD. For each unit increase in migrants' health, it will drive up the average economic resistance ability by 0.0186 and the average recovery ability by 0.0039. Secondly, the net effects of migrants' health on economic resilience show significant structural differences, industry and city heterogeneity. The effect of migrants' health on economic resistance ability is significantly higher than that on economic recovery ability; The effect of migrants' health on economic resilience of the secondary industry is higher than that of the tertiary industry; The cities with high economic resistance and recovery abilities have more prominent positive effect from migrants' health. Thirdly, migrants' health not only has a direct effect on the economic resistance and recovery abilities, but also has a mediating effect on which through labor participation rate and labor time supply. Enhancing the accessibility and quality of basic public health services is beneficial for enhancing the positive effects of internal migrants' health on economic resilience.

Health Care System Application (Good Care) Android-Based at Primary Health Care (Case Study at Clinic of Wijaya Kusuma)

The development of information systems is currently experiencing very rapid development which we now recognize as the era of digitalization, one of which is in the field of health services. Primary healthcare is a type of medical health service that provides health services to individuals at the first level health service. The problem that most often arises is related to the registration system which is still done manually by recording in the registration book, thereby allowing the risk of errors occurring and the process of searching for visit data taking a long time. This research aims to improve better service for visits so it is necessary a good, systematic and integrated data handling and processing in a developing service system, even at the level of independent health service practice. This research method uses Field Observation, Library Research, Interviews, Study Research Literature (Research Literature Study), System Design, System Implementation and Testing. Application system from syntax errors and functionally produces functions as expected. The health service system application (Good Care) has been tested and can be used so that it can increase the effectiveness and efficiency of health services at the independent doctor's practice at Clinic of Wijaya Kusuma.

National Quality Policy and Strategy of the Health Services in Health Systems of Developing Countries: A Scoping Review.

It has always been argued that countries should not be inactive about the quality of health services. Therefore, a clear policy needs to be created regarding how quality of health services should be. The present scoping review was aimed to identify and map the available evidence regarding the National Quality Policy and Strategy (NQPS) of the health services in health systems of developing countries, graphically and tabularly. We followed the published methodological guidance of the Joanna Briggs Institute reviews. Also, we employed a narrative thematic synthesis integrated with the systematic analysis using the World Health Organization's approach of NQPS, and the multiple-streams framework of Kingdon. We included 33 records that met the inclusion criteria; these records were published between 2010 and 2019. Meanwhile, government documents were the most frequent records (61%). Zimbabwe, Indonesia, and Sudan were the most frequent locations (each one 8%). The Ministry of Health was in charge of the ultimate responsibility for developing the NQPS in all identified countries. Besides, 82% of the countries were in the development phase of NQPS formulation, and convergence of three streams was observed in Indonesia, Sudan, and Tanzania. It seems that the African countries were informed about their quality issues, and the need for having NQPS have been more popular with them. We recommend that future research focuses on examining NQPS in terms of prioritizing in the agenda-setting phase of the policy-making cycle, and also, document analysis of all identified NQPS based on the core eight interdependent elements related to the NQPS approach.

The Impact of Concomitant Neck of Femur Fractures and Upper Limb Fractures on Length of Stay and Key Performance Indicators: A Single-Centre Study.

Background Hip fractures are one of the most common serious injuries seen today and constitute one of the most serious healthcare problems affecting the elderly worldwide. Due to the elderly population, associated falls and osteoporosis increase theincidence of hip fractures. Patients may remain hospitalized for several weeks, leading to one and a half million hospital bed days used each year.The reported incidence of a concurrent upper limb and a lower limb fracture is between 3% and 5%. It has been shown in the literature that patients who sustain both a hip fracture and an upper limb fracture have difficulties with rehabilitation which causes prolonged stays. The available literature on concomitant hip fracture and upper extremity fracture is limited. This study aimed to review patients with concurrent upper limb injury and hip fractures and to analyse the pattern of associated upper limb fractures, management of these fractures, length of hospital stay, mortality rates, and complications. Methodology We performed a retrospective data collection of all patients with a concomitant upper limb fracture and hip fracture from January 2017 to December 2020 at the University Hospital of Wales, Cardiff, United Kingdom. Patients were identified from the registers maintained in the ward. All patients aged over 60 years with a fragility hip fracture (managed operatively) and a concurrent upper limb fracture were included in the study. Patients aged less than 60 years were excluded. The local research department registered and approved this study as a service evaluation and therefore did not need ethical committee approval. The anatomical location of the upper limb and hip fractures was confirmed using the imaging database (Synapse). Results Of the 760 patients admitted with neck of femur fractures during this period, 39 (5.1%) patients had concomitant upper limb fractures. Only one upper limb fracture was managed with fixation, and for this study, that patient was excluded. Our retrospective search identified 38 patients, of whom 11 were men and 27 were women. Distal radius fractures were the most commonly associated upper limb fractures (55%). There was a significant increase in length of stay(43.6 days vs. 16.6 days) and delay in mobilization (58.9% vs. 81%) compared to an isolated hip fracture. There was no difference in the 30-day mortality rates.We were unable to collect the data for the Key Performance Indicator (KPI) of the National Institute for Health and Care Excellence compliant surgery, and this KPI was excluded from our study. Of the remaining five KPIs, our group of patients displayed better averages in three of the five categories, including prompt orthogeriatric review (92%), not delirious postoperatively (87%), and return to original residence (79%). Conclusions Due to the ageing population, hip fractures are increasing, and within one year of operation, have shown higher mortality rates. Annually, reports show that the worldwide incidence of fractures in the adult population ranges between 9.0 and 22.8 per 1,000. These fractures are more frequent in osteoporotic patients with weak bone quality. Following hip fractures, upper extremity fractures are the second most common among the osteoporotic, elderly population, with distal radius fractures being the most common. With the length of stay almost tripled (from 16.6 to 44.4 days), one can see this has a very big effect on costs in the National Health Service system.

Survey on the Demand for Elderly Care Services of Community Residents in Beijing and Analysis of Influencing Factors

Objective: To investigate the current situation of the demand for geriatric care services of community residents in Beijing and analyse the factors affecting it, so as to provide a reference basis for meeting the demand for diversified and professional geriatric care services. Methods: A random sampling method was used, employing a self-made questionnaire to randomly survey 1558 elderly individuals at community health service centers in eight urban districts where elderly care centers are planned to be built, analyzing the influencing factors of different characteristics of the elderly care service needs from three aspects using a dichotomous logistic regression model: predisposing, enabling, and need factors.Results: 69.7% of the elderly had the need for home care services, 22.8% wanted to get care services at elderly care centres, 15.9% wanted to get care services at nursing homes, 12.3% had the need for community care services, and 7.4% didn't know where to get care services; 68.5% had the need for care services for the elderly with disabilities/semi-disabilities, 58.0% for care services for the elderly with dementia, 58.0% for care services for the elderly with common diseases, and 58.0% for care services for the elderly with dementia. 58.0 per cent, 54.7 per cent for care for the elderly with common or frequent illnesses, 34.9 per cent for rehabilitation training, 33.0 per cent for plumbing care, and 7.5 per cent for hospice/hospice care. At the same time, there were urban-rural differences in the demand for elderly care services, with suburban elderly having a higher demand for care services than urban ones (P < 0.05). Elderly people's demand for care services was mainly related to age, place of residence, and gender in the causative factors, mode of residence and physical condition in the able factors, and mode of care services and care needs in the need factors(P <0.05). Conclusion: The demand for elderly care services is differentiated by the factors of residence, age and gender; accurately matching the demand for elderly care services, innovating the mode of elderly care services and improving the quality are important strategies to improve the elderly health service system.