Health Care Systems In World Research Articles

A novel light GBM framework combined with gain optimization for predicting dementia severity of Alzheimer’s disease

ABSTRACT Introduction Alzheimer’s disease (AD) is a severe brain disorder, which comprises almost 75% of all types of dementia cases. As per the latest report, the global count of Alzheimer’s disease patients is 131 million, due to which the treatment of Alzheimer’s disease is becoming a major burden to the world healthcare system. However, Alzheimer’s disease still remains incurable due to its multifactorial nature of symptoms. Therefore, early-stage diagnosis of Alzheimer’s disease is essential, which helps in the treatment and recovery of patients to a greater extent. Background In the existing literature, few research attempts are carried out for Alzheimer’s disease prediction using machine learning algorithms; yet, most of the existing techniques fail to focus on aspects such as gain-optimisation, dementia severity identification and accuracy enhancement. Methodology To solve these issues, this article presents a light gradient boosting machine-based framework, which employs a gain-optimisation algorithm using multi-category factors for the early stage prediction of Alzheimer’s disease. Further, the proposed framework introduces a detailed feature analysis for identifying the key features needed for the disease prediction and thereby classifies the Alzheimer’s disease patients into different dementia severity types. Results The extensive evaluations of the proposed framework on different dataset sizes using real-world MRI datasets of patients, clearly demonstrate the performance of the proposed work in terms of gain-optimised accuracy metrics. Further, experimental evaluations clearly prove the better performance of the proposed framework when compared to that of other ML techniques including LR, RFC, SVR, SVC and existing methods in terms of Recall, F1-score and accuracy metrics.

Cost, Cost-effectiveness and Survival Impact Assessment for A Better Management of Colorectal Cancer Patients: A Single Centre Comprehensive Analysis.

The world healthcare systems are currently challenged by the accumulating burden of colorectal cancer (CRC), and cancer registries represent an important segment for prevention and developing management plans, being useful in providing data regarding incidence, mortality, survival, exposure to carcinogens, lifestyle. Retrospective data from CRC patients in Romania was used to assess survival impact, costs, and cost-effectiveness considering three crucial aspects: pharmacology, chemo-/radio-therapy, and hospitalization for care and management of these patients. 423 CRC patients from the Institutional Cancer Registry of the Prof. Dr. Ion Chiricuta Institute of Oncology in Cluj-Napoca, Romania were included in the cost analysis. For the assessment of cost efficiency of the primary treatment strategy, we collected data regarding direct medical costs associated with surgery, radiotherapy and medication, as well as the afferent day or continuous hospitalization, for each patient. For the cost-effectiveness analysis we used the method of estimation of incremental cost-effectiveness ratio. No compelling differences regarding survival time were observed in different therapeutic options per CRC stage. Substantial differences in cost effectiveness among therapeutic options in the same stage of several thousand Euros in stages I-III, while for stage IV, the ICER was more than 100,000 Euros per life saved. Systematic evaluation of costs, cost-effectiveness, and survival impact, helps healthcare systems can make informed decisions to improve the management of colorectal cancer patients, optimizing outcomes while minimizing financial burden.

CO-PRODUCTION OF A PEER SUPPORT PROGRAMME FOR ADULTS LIVING WITH CHRONIC NON-CANCER PAIN USING INTERVENTION MAPPING

BackgroundChronic pain is a significant burden and represents a major issue for world healthcare systems. Interventions include medication, surgery, pain management programmes, and social support through peer support groups. These groups are often informal, providing informational, emotional, and social support to members. The aim of this project is to co-produce guidance on how to establish a peer support programme for people living with chronic, non-cancer pain that is informed by evidence, theory, and stakeholder experience.MethodsThis project is using Steps 1–4 of the Intervention Mapping (IM) approach to inform the research. Online workshops consisting of people living with chronic pain, third sector representatives, healthcare professionals, and researchers are being used to co-produce the guidance.ResultsTo date, 2 of the 4 planned workshops have been conducted. These have identified the needs of people living with chronic pain, goals for the peer support programme, and expectations of how a peer support programme should be executed. Topics for inclusion in the programme and their content have been identified, with further workshops to refine this planned. The final stage of this project will identify methods of delivery, specific resources that should be developed, and the training to be provided to peer support volunteers.ConclusionThe project has identified the diverse needs of people living with chronic pain and how these may be addressed by a peer support programme. It has identified flexible options that can be recommended to those who want to set up a programme and a variety content that may be included.Conflicts of InterestNoneSources of FundingRobert Gordon University

Implementation of Intrahospital Transfer Strategy During COVID-19 and Identify Success Factors Based on DEMATEL Technique.

The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.

Is asymptomatic bacteriuria a noticeable risk factor for periprosthetic joint infection following total joint arthroplasty? A systematic review and meta-analysis.

Total joint arthroplasty (TJA) is a common procedure that improves the quality of life for severe arthritis patients. The rising demand for TJA places enormous financial strain on the world's healthcare systems, which is exacerbated by postoperative readmissions for complications such as periprosthetic joint infections (PJIs). We conducted a systematic review and meta-analysis to determine if asymptomatic bacteriuria (ASB) increases infection risk. We conducted searches in three databases: PubMed, Scopus, and Web of Science. Screening steps have been carried out according to PRISMA guidelines. The study focused on patients who had undergone TJA and exhibited ASB. Two reviewers independently screened, assessed quality, and extracted data. Meta-analysis used Mantel-Haenszel method. Following full-text screening, 12 studies were deemed eligible for inclusion in the systematic review, encompassing a total of 42,592 patients. A heightened occurrence of PJI was observed among TJA patients with ASB in comparison to controls (OR [95%CI] = 3.47 [1.42-8.44]). However, microorganisms responsible for the PJIs differed from those identified in the urine cultures of ASB. Additionally, analyses indicate that preoperative antibiotic treatment for ASB does not significantly affect the subsequent risk of PJI (OR [95% CI] = 1.00 [0.42-2.39]). Unlike surgical site infection (SSI), which did not show a difference in the rate of occurrence between the two groups, TJA patients with ASB were more likely to experience superficial wound infection (OR [95%CI] = 3.81 [2.02-7.21]). This review and meta-analysis confirm that ASB correlate with heightened risks of PJI and superficial infection in TJA patients. However, no relationship was found between ASB and PJI microorganisms which raise doubts about the role of ASB microorganisms as the direct cause of infection following TJA.

Impact of the war in Ukraine on the epidemic situation with tuberculosis as a challenge for the world community

ABSTRACT. Since wars have a powerful impact on public health and the health care system, the purpose of this analysis of available scientific sources is to examine the impact of the war in Ukraine on the state of the tuberculosis problem in the world. The review presents the epidemic situation with tuberculosis before the start of the war in Ukraine. It is especially emphasized that Ukraine ranks second in Europe in terms of the burden of HIV infection / acquired immunodeficiency syndrome and fifth in the world in terms of the number of confirmed cases of tuberculosis with multiple drug resistance. It is emphasized that the COVID-19 pandemic has seriously undermined the progress achieved in the fight against tuberculosis worldwide. The expected worsening of the epidemic situation with tuberculosis in Ukraine due to the war and its impact on the world health care systems are substantiated, and attention is focused on the urgent need to coordinate the efforts of the world community to overcome such a challenge. Problematic issues regarding the readiness of international health care systems to combat tuberculosis in the conditions of war in Ukraine are analyzed. Studying the current state of the problem “tuberculosis and the war in Ukraine” will allow us to act in the direction of reducing the negative impact of the war on the epidemic situation with tuberculosis both in Ukraine and partially in the whole world.

Advancements in the Study of Dilated Cardiomyopathy Biomarkers

Dilated cardiomyopathy (DCM) is the leading cause of sudden cardiac death (SCD) and heart failure (HF) in children and adults worldwide, and it is also the main indication of heart transplantation. DCM remains a significant cause of heart transplantation despite recent improvements in treatment, which is related to the enormous financial strain placed on the world's healthcare system. Therefore, determining the prognosis of individuals with DCM is crucial for providing them with a customized course of treatment. Genetic testing, microvolt T-wave alternation, and late gadolinium-enhanced cardiac magnetic resonance imaging have developed into potent methods for predicting the occurrence of sudden cardiac death and optimizing patient selection. Despite the availability of numerous novel diagnostic techniques, further tests are still required to enhance or partially substitute current methods of risk categorization. As a result, biomarkers are robust and straightforward tools that can identify people at risk for unfavorable cardiovascular events. Thus, this article aims to review the state of the research on biomarkers for DCM.

Compounding pharmacy regulations: experience of the Latvian pharmaceutical market

The article aims to examine technological, organizational and regulatory aspects of drug quality and safety assurance system, as well as peculiarities in civil circulation of extemporaneous drugs in Latvian pharmaceutical market to improve approaches for statutory regulation of this special and socially significant type of activity of pharmaceutical organizations. This work continues a series of articles about compounding pharmacy practice in different world healthcare systems.

"Growth under pressure": The Experience of COVID-19 ICU Nurses - A Qualitative Study.

As an epidemic, COVID-19 has brought a new shock to the world's healthcare system. The crisis caused by this disease and the prolonged involvement of communities and healthcare systems have intensified the duties and psychological burden of nurses. The current study aimed to explain the experience of ICU nurses during the COVID-19 crisis. The present study was conducted using conventional content analysis in 2021. Twenty nurses of the COVID-19 ICU of Ahvaz hospitals were selected by purposive sampling. The main method of data collection was semistructured interview. The process of data analysis was done based on Granheim and Lundman's approach using MAXQDA-2020. For the scientific rigor of the findings, Guba and Lincoln's four criteria were abided by. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. After data analysis, 22 subcategories, eight categories, and one theme (growth under pressure) were extracted. The eight main categories included (psychological crisis, physical exhaustion, family conflicts, complex care, professional development, expertise, life enrichment, and full support). Despite the pressures that ICU nurses faced during the COVID-19 pandemic, they were able to grow by benefiting from positive experiences. These findings can lead to the development and implementation of effective interventions to improve adaptation strategies of nurses, especially those working in the intensive care unit, during the COVID-19 and other future crises.

Investigating efficacy of colchicine plus phenolic monoterpenes fraction as a potential treatment for patients diagnosed with COVID-19: A randomized controlled parallel clinical trial

BackgroundCOVID-19 now is a serious concern for the world healthcare system. This study aimed to investigate possible therapeutic effect of colchicine and phenolic monoterpenes accompanied by standard care of treatment (SCT) in patients diagnosed with COVID-19. MethodsIn this randomized controlled parallel clinical trial, a total number of 179 (of 200) patients with confirmed COVID-19 were enrolled according to the inclusion and exclusion criteria. The patients were allocated by simple randomization method into two groups control (receiving SCT with 71 patients) and intervention (receiving SCT plus colchicine and phenolic monoterpenes with 107 patients). The mortality ratio during hospitalization as well as a 2-week follow-up, ICU admission rate, and hospitalization duration were assessed as main outcomes. ResultsThe mortality ratio was 0.9% (1/108) and 8.45% (6/71) in the intervention and the control groups (p-value = 0.035) respectively, these ratios after a 14-day follow-up were 1.85% (2/108), and 9.85 (7/71) respectively (p-value = 0.031). Also, the ICU admission was significantly lower (p-value = 0.006) in the intervention group 2/108 (1.85%) compared with controls 10/71 (14.08%). Moreover, the duration of hospitalization followed a similar pattern to ICU admission with 4.17 ± 1.34 vs. 6.39 ± 2.59 days in the intervention and control groups respectively (p-value< 0.001). Furthermore, no significant side effect was found between the groups. ConclusionAccording to the results, the combination of colchicine plus phenolic monoterpenes could be an additive treatment for the SCT. The authors strongly recommend further trials on this combination with other SCTs.

Identification of complex III, NQR, and SDH as primary bioenergetic enzymes during the stationary phase of Pseudomonas aeruginosa cultured in urine-like conditions.

Pseudomonas aeruginosa is a common cause of urinary tract infections by strains that are often multidrug resistant, representing a major challenge to the world's health care system. This microorganism has a highly adaptable metabolism that allows it to colonize many environments, including the urinary tract. In this work, we have characterized the metabolic strategies used by stationary phase P. aeruginosa cells cultivated in urine-like media to understand the adaptations used by this microorganism to survive and produce disease. Our proteomics results show that cells rely on the Entner-Duodoroff pathway, pentose phosphate pathway, the Krebs cycle/ glyoxylate shunt and the aerobic oxidative phosphorylation to survive in urine-like media and other conditions. A deep characterization of the oxidative phosphorylation showed that the respiratory rate of stationary phase cells is increased 3-4 times compared to cells in the logarithmic phase of growth, indicating that the aerobic metabolism plays critical roles in the stationary phase of cells grown in urine like media. Moreover, the data show that respiratory complex III, succinate dehydrogenase and the NADH dehydrogenase NQR have important functions and could be used as targets to develop new antibiotics against this bacterium.

Significance of saline nasalirrigation for COVID-19 infection: observations and reflections from nursing care of nasopharyngeal carcinoma.

Coronavirus disease 2019 (COVID-19) has placed a tremendous burden on the world's healthcare systems, prompting medical professionals worldwide to diligently research and experiment with treatment methods to prevent infection and alleviate symptoms. Previous studies have shown the potential of nasal irrigation in reducing viral clearance time and alleviating local symptoms of COVID-19. However, views differ regarding its efficacy in improving systemic symptoms. Thus, we sought to examine whether saline nasal irrigation might play a role in treatment and self-care after COVID-19 infection, but further validation is still necessary. We conducted a retrospective analysis of 468 patients and 51 healthcare personnel concurrently. The participants were grouped based on whether they received saline nasal irrigation. We used χ2 tests and Fisher's exact tests to assess the differences in the rates of COVID-19 infection and the rates of developing a fever after COVID-19 infection among different groups. Additionally, we used independent samples t-tests and Mann-Whitney U tests to evaluate differences in the maximum fever temperature and fever duration among participants with fever in different groups. The rate of developing a fever after COVID-19 infection was lower (37.7%) in the patients who underwent saline nasal irrigation. Among all febrile patients, there was no difference in the highest fever temperature, but patients who underwent saline nasal irrigation had a shorter fever duration (1.72±1.05 days). Additionally, the rate of COVID-19 infection and the rate of developing a fever were higher, and fever symptoms were more severe in the healthcare worker group than in the patient group. Saline nasal irrigation can alleviate symptoms caused by COVID-19 infection.

Using Artificial Intelligence (AI) Technology in the Health Sector has Several Goals

In a broad sense, artificial intelligence (AI) refers to any computer or system behavior that resembles human behavior. A subfield of artificial intelligence called "machine learning" enables computers to learn from data without explicit human programming. One of the most significant contemporary trends in global healthcare is the use of artificial intelligence (AI) technologies in medicine. Technologies based on artificial intelligence are profoundly transforming the world's healthcare system, enabling a dramatic reconstruction of the medical diagnostics system while simultaneously lowering healthcare expenditures. Identifying the class of diseases to which a disease belongs is crucial before treating it. It is feasible to categorize the type of disease based on the feature space of the condition. Algorithms for machine learning can address this issue.

CNP blocks mitochondrial depolarization and inhibits SARS-CoV-2 replication in vitro and in vivo.

The COVID-19 pandemic has claimed over 6.5 million lives worldwide and continues to have lasting impacts on the world's healthcare and economic systems. Several approved and emergency authorized therapeutics that inhibit early stages of the virus replication cycle have been developed however, effective late-stage therapeutical targets have yet to be identified. To that end, our lab identified that 2',3' cyclic-nucleotide 3'-phosphodiesterase (CNP) inhibits SARS-CoV-2 virion assembly. We show that CNP inhibits the generation of new SARS-CoV-2 virions, reducing intracellular titers without inhibiting viral structural protein translation. Additionally, we show that targeting of CNP to mitochondria is necessary for inhibition, blocking mitochondrial depolarization and implicating CNP's proposed role as an inhibitor of the mitochondrial permeabilization transition pore (mPTP) as the mechanism of virion assembly inhibition. We also demonstrate that an adenovirus expressing virus expressing both human ACE2 and CNP inhibits SARS-CoV-2 titers to undetectable levels in lungs of mice. Collectively, this work shows the potential of CNP to be a new SARS-CoV-2 antiviral target.

Pattern of cephalosporin and carbapenem-resistant Pseudomonas aeruginosa: a retrospective analysis

ObjectivesDespite its financial cost on the world's health care system, Pseudomonas aeruginosa antibiotic resistance has been increasing. Therefore, the goal of this study was to assess the level of antimicrobial resistance to anti-pseudomonas medicines, specifically β-lactam medications such as cephalosporin and carbapenems. In addition, we evaluate the prevalence of multi-drug resistance to P. aeruginosa, particularly during the years of the COVID-19 pandemic. MethodsThis retrospective analysis covered the period from January 2019 to December 2022 and included cephalosporin- and carbapenem-resistant P. aeruginosa isolates. The real-time polymerase chain reaction Genexpert test (CARBA-R kit) was used for the detection of genes responsible for carbapenemase resistance. ResultsDuring the time of the study, 1815 clinical isolates of P. aeruginosa were identified and 160 (9%) were resistant to carbapenems and cephalosporins. The resistance rates were 32.5% (13/597) in 2019, 11.2% (44/393) in 2020, 7% (26/369) in 2021, and 11% (50/456) in 2022. Of those isolates, multidrug-resistant rates were 6.7%, 86.3%, 57.7%, and 56%, per year over the study period. Using Genexpert test, 88 (93.6%) of multidrug-resistant P. aeruginosa were negative for carbapenemase genes. ConclusionThis study emphasizes the alarming patterns of carbapenem and cephalosporin resistance among P. aeruginosa clinical isolates. Furhter surviellance from different centers and different regions is required.

World Healthcare System and Role of Pharmacist

World Healthcare System and Role of Pharmacist

Choquet integral based deep learning model for COVID-19 diagnosis using eXplainable AI for NG-IoT models

The COVID-19 outbreak has caused a global threat to the world healthcare system. The virus has mutated into different variants and mutations which spread more rapidly, are more deadly and have the lesser effect of vaccines. The number of cases is way more than the number of cases doctors can handle. Widely used methods of RT-PCR are tedious and time-consuming, Instant methods like antigen are very less effective and give incorrect results. Hence Artificial Intelligence (AI)-based Computer-aided Diagnosis (CAD) methods that help doctors in the correct and efficient diagnosis are the need of the hour. In this study, we propose a Deep Learning based XAI model for aiding clinical interpretation on Chest X-ray (CXR) images. The XAI diagnostic model can be integrated into NG-IoT devices using CAD models by provide accurate explainable diagnostics. We used deep-learning models with integrated Choquet integral as an aggregation function for more precise classification. Integrating it with the XAI model Grad CAM ++ increased its explainability. In our proposed work we used four different deep learning models ResNet-50, Inception V3, Densenet-121 and DCNN with integrated Choquet Integral function which increased the accuracy by 2% for Densenet-121 and DCNN and 1% for ResNet-50 and Inception V3. Using Grad CAM++ on the images increases the acceptance by medical professionals by clearly depicting how the models took the decision. We can depict that our proposed model Densenet 121 integrated with ChI outperformed all the other methods.

Bullying, incivility, and intention to leave the job among novice nurses: A multicenter cross-sectional study

One of the major challenges in the world healthcare system is the bullying, incivility, and intention to leave the job among novice nurses. The study focused on bullying, incivility, and intention to leave the job and the relationship and factors associated with them among novice nurses. In a cross-sectional study, novice nurses working in 26 educational and treatment hospitals in northern Iran were enrolled. Data were collected via census sampling from March to April 2018 using a four-part questionnaire including demographic and work-related characteristic information form, workplace incivility scale, workplace bullying scale (EAPA-T), and intention to leave the job scale. A total of 600 out of 653 novice nurses were included in the study (response rate=91.8%). There were significant positive correlations between intention to leave the job score and scores of bullying (r=0.312, P&lt;0.001) and incivility (r=0.304, P&lt;0.001). There was also positive correlation between bullying and incivility scores (r=0.731, P&lt;0.001). Multiple linear regression analyzes showed that having more than one year of experience (b=0.160, P=0.046), lack of interest in nursing (b=0.489, P&lt;0.001), insufficient salary (b=0.281, P&lt;0.001), high bullying score (b=0.237, P=0.002) and high incivility score (b=0.127, P=0.032) were significantly related to high intention to leave the nursing profession. Nursing managers and policymakers need to eliminate factors associated with intention to leave the job such as bullying and incivility through educational measures. Also, increasing interest in the nursing profession and the salary of novice nurses, in general, can reduce their intention to leave the job.

The Antibacterial Effect of Tinospora Cordifolia (Guduchi) and Its Role in Combating Antimicrobial Resistance.

Tinospora cordifolia, often known as "Guduchi," has a variety of medicinal characteristics, including those that are anti-diabetic, ant-iinflammatory, anti-periodic, anti-arthritic, anti-oxidant, anti-allergic, and anti-stress. Drug development projects face significant obstacles because of the rapid rise in antimicrobial drug resistance in the world healthcare system and the introduction of multidrug-resistant (MDR) strains. In order to combat the MDR infections isolated from patients' bodies, the current study was conducted to evaluate and investigate the antibacterial capabilities of Tinospora cordifolia. Using the agar well diffusion method, Tinospora cordifolia extracts (aqueous, chloroform, and ethanol) were tested for their antibacterial effectiveness against 30 MDR pathogens, and the 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay was used to determine the minimal inhibitory concentration. To determine whether there were any medicinally useful and significant bioactive ingredients in the plant extract, phytochemical analysis was performed. In comparison to the aqueous extract which had little effect, the antibacterial activity of ethanol and chloroform extracts exhibited a potential antimicrobial effect against most of the tested bacterial isolates. Phytochemical analysis of Tinospora cordifolia extract showed alkaloids, carbohydrates, phytosterols, saponins, tannins, proteins, flavonoids, and terpenoids. Our findings show that Tinospora cordifolia plays a potential role in combating the antimicrobial resistance of clinical isolates.

Solved the enigma of pediatric severe acute hepatitis of unknown origin?

Hepatitis is an inflammation of the liver whose etiology is very heterogeneous. The most common cause of hepatitis is viral infections from hepatotropic viruses, including hepatitis A, B, C, D and E. However, other factors such as infections from other agents, metabolic disorders, or autoimmune reactions can also contribute to hepatitis, albeit to a lesser extent. On April 5, 2022, the United Kingdom Health Security Agency alerted the World Health Organization (WHO) on the increased incidence of severe acute hepatitis of unknown causes (not A-E) in previously healthy young children, with symptoms of liver failure that in some cases required liver transplantation. By July 2022, 1,296 cases were reported in 37 countries. Acute hepatitis of unknown causes is not an exceptional phenomenon: in fact, it represents more than 30% of cases of acute hepatitis in children, however in the present instance the large proportion of severe cases was surprising and alarming (6% of liver transplants and almost 3% mortality). Multiple hypotheses have been proposed to explain the etiology of such higher proportion of acute hepatitis, including their co-occurrence in the context of COVID-19 pandemic. This is a review of the history of a clinical threat that has put in check a world health care system highly sensitized by the current COVID-19 pandemics, and that it looks like has ended with the arguments that the severe acute pediatric hepatitis is caused by Adeno-associated virus 2 (AAV2) infection associated with a coinfection with a helper virus (human Adenovirus HAdV or human herpesvirus 6) in susceptible children carrying HLA-class II antigen HLA-DRB1*04:01.