Abstract: This article is based on observation of a cross-disciplinary, cross-institutional team that worked on an intervention called ‘Memory Mate’ for use in a UK Cancer Centre. This aimed to improve treatment outcomes for patients who had comorbid dementia or other memory impairment. Comorbid patients present ambiguous, spoiled identities, problematising the boundaries of health specialisms and frames of understanding. Memory Mate is theorised as a boundary object facilitating service transformation by changing relations between oncology and mental health care practice. It crosses the boundaries between oncology and mental health. Its introduction signifies an important step in reconfiguring relations between the specialisms. As a boundary object, it contains parallel, even contesting worlds, with potential to enable an eventual synthesis of the double stigma of cancer and dementia. Memory Mate comprises physical things, such as an animation, but its principal value is in the interaction it initiates across disciplines and services. It supports evolution of practices to address a newly emergent challenge for health service provision, namely the cancer patient with comorbid dementia/cognitive impairment. Getting clinicians from different disciplines working together on a practical solution generates a dialogue that can shift professional identity and change the culture of practice.
Abstract: The classification of periodontal diseases has changed significantly in favor of simplifying the protocol of diagnosis and periodontal treatment. This review study aims to highlight the latest publications in the new periodontal disease classification, talking about the most significant differences versus the old classification with the tendency to express the advantages or disadvantages of clinical application. The aim of the study also includes the growing tendency to link the way of classification of periodontal diseases with predetermined protocols of periodontal treatment of the diagnoses included in the classification. The new classification of periodontal diseases is rather comprehensive in its subdivisions, as the disease is viewed in its entirety, with the biological dimensions of the disease, the degree of aggravation and progression of the disease, in relation to risk factors, predisposition to patient susceptibility and impact of periodontal disease to the general health status of the patient.
Abstract: Rheumatoid Arthritis patients have swelling and pain in joints of the hand. The regions where the patient feels pain also show increased body temperature. Thermal cameras can be used to detect the rise in temperature of the affected regions. To monitor the progression of Rheumatoid Arthritis, patients must visit the clinic regularly for scanning and examination. After scanning and evaluation, the dosage of the medicine is regulated accordingly. To monitor the disease progression over time, the correlation of the images between different visits must be established. It has been observed that the thermal measurements do not remain the same over time, even within a single scanning, when low-cost thermal cameras are used. In some situations, temperatures can vary as much as 2◦C within the same scanning sequence. In this paper, it has been shown that although the absolute temperature varies over time, the relative difference between different regions remains similar. Results have been computed over four scanning sequences and are presented.
Abstract: This study examines the ways in which cancer patient narratives are portrayed and framed on the websites of three leading U.S. cancer care centers – The University of Texas MD Anderson Cancer Center in Houston, Memorial Sloan Kettering Cancer Center in New York, and Seattle Cancer Care Alliance. Thirty patient stories, 10 from each cancer center website blog, were analyzed using qualitative and quantitative textual analysis of unstructured data, documenting common themes and other elements of story structure and content. Patient narratives were coded using grounded theory as the basis for conducting emergent qualitative research. As part of a systematic, inductive approach to collecting and analyzing data, recurrent and unique themes were examined and compared in terms of positive and negative framing, patient agency, and institutional praise. All three of these cancer care centers are teaching hospitals, with university affiliations, that emphasize an evidence-based scientific approach to treatment that utilizes the latest research and cutting-edge techniques and technology. The featured cancer stories suggest positive outcomes based on anecdotal narratives as opposed to the science-based treatment models employed by the cancer centers. An analysis of 30 sample stories found skewed representation of the “cancer experience” that emphasizes positive outcomes while minimizing or excluding more negative realities of cancer diagnosis and treatment. The stories also deemphasize patient agency, instead focusing on deference and gratitude toward the cancer care centers, which are cast in the role of savior.
Abstract: The Balanced Scorecard (BSC) is a continuous strategic monitoring model focused not only on financial issues but also on internal processes, patients/users, and learning and growth. Initially dedicated to business management, it currently serves organizations of other natures - such as hospitals. This paper presents a BSC designed for a Portuguese Acute Pain Unit (APU). This study is qualitative and based on the experience of collaborators at the APU. The management of APU is based on four perspectives – users, internal processes, learning and growth, and financial and legal. For each perspective, there were identified strategic objectives, critical factors, lead indicators and initiatives. The strategic map of the APU outlining sustained strategic relations among strategic objectives. This study contributes to the development of research in the health management area as it explores how organizational insufficiencies and inconsistencies in this particular case can be addressed, through the identification of critical factors, to clearly establish core outcomes and initiatives to set up.
Abstract: Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients’ waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.
Abstract: COVID-19 has been associated with stroke and neurological complications. The patient was a 59-year-old male presented with sudden left hemiparesis and diplopia due to cavernous sinus thrombosis (CST) on 28/03/2020. The COVID-19 test was positive. Multislice computerized tomography (MSCT) showed ischemic infarction. He underwent surgical sinectomy 9 days after admission. Physiotherapy began for him on August 2020. Our game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and function for stroke. After 6 weeks of VR therapy plus conventional physiotherapy exercises (18 sessions, three times per week, 60 minutes each session), there were significant improvements in Brunnstrom Motor Recovery Stage (from “4” to “5”), Fugl-Meyer Scale score of upper extremity section (from 49 to 54), and Modified Barthel Index (from 15 to 18). There were no adverse effects. This case with stroke post COVID-19 due to the CST showed the usefulness of VR therapy used as an adjunct to conventional physiotherapy in improving affected upper extremity.
Abstract: Health and Social care (HSc) services planning and scheduling are facing unprecedented challenges, due to the pandemic pressure and also suffer from unplanned spending that is negatively impacted by the global financial crisis. Data-driven approaches can help to improve policies, plan and design services provision schedules using algorithms that assist healthcare managers to face unexpected demands using fewer resources. The paper discusses services packing using statistical significance tests and machine learning (ML) to evaluate demands similarity and coupling. This is achieved by predicting the range of the demand (class) using ML methods such as Classification and Regression Trees (CART), Random Forests (RF), and Logistic Regression (LGR). The significance tests Chi-Squared and Student’s test are used on data over a 39 years span for which data exist for services delivered in Scotland. The demands are associated using probabilities and are parts of statistical hypotheses. These hypotheses, as their NULL part, assume that the target demand is statistically dependent on other services’ demands. This linking is checked using the data. In addition, ML methods are used to linearly predict the above target demands from the statistically found associations and extend the linear dependence of the target’s demand to independent demands forming, thus, groups of services. Statistical tests confirmed ML coupling and made the prediction statistically meaningful and proved that a target service can be matched reliably to other services while ML showed that such marked relationships can also be linear ones. Zero padding was used for missing years records and illustrated better such relationships both for limited years and for the entire span offering long-term data visualizations while limited years periods explained how well patients numbers can be related in short periods of time or that they can change over time as opposed to behaviours across more years. The prediction performance of the associations were measured using metrics such as Receiver Operating Characteristic (ROC), Area Under Curve (AUC) and Accuracy (ACC) as well as the statistical tests Chi-Squared and Student. Co-plots and comparison tables for the RF, CART, and LGR methods as well as the p-value from tests and Information Exchange (IE/MIE) measures are provided showing the relative performance of ML methods and of the statistical tests as well as the behaviour using different learning ratios. The impact of k-neighbours classification (k-NN), Cross-Correlation (CC) and C-Means (CM) first groupings was also studied over limited years and for the entire span. It was found that CART was generally behind RF and LGR but in some interesting cases, LGR reached an AUC = 0 falling below CART, while the ACC was as high as 0.912 showing that ML methods can be confused by zero-padding or by data’s irregularities or by the outliers. On average, 3 linear predictors were sufficient, LGR was found competing well RF and CART followed with the same performance at higher learning ratios. Services were packed only when a significance level (p-value) of their association coefficient was more than 0.05. Social factors relationships were observed between home care services and treatment of old people, low birth weights, alcoholism, drug abuse, and emergency admissions. The work found that different HSc services can be well packed as plans of limited duration, across various services sectors, learning configurations, as confirmed by using statistical hypotheses.
Abstract: Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. This work evaluates the association between the average risk score and measures of socioeconomic status (index of multiple deprivation) and health (index of health and disability). The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, suggesting that females are more at risk from this kind of multiple medication. The risk may be monitored and controlled in a healthcare management system that is well-equipped with tools implementing appropriate techniques of artificial intelligence.
Abstract: Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of virtual reality (VR) beside conventional rehabilitation versus conventional rehabilitation alone on the spasticity and motor function in stroke patients. Materials and methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were Modified Ashworth scale, Recovery Stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in combination group (P = 0.003). Only wrist extension was varied between groups and was better in combination group. The variables generally had statistically significant difference (P < 0.05). Conclusion: VR plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.
Abstract: Orthodontic restorative materials are widely used for the direct restoration of teeth or for cosmetic dentistry purposes. These materials have helped to solve many dental problems, providing healthy and beautiful smiles for many patients. In this study, we aimed to investigate whether the pH value has an effect on the surface structure of a nanohybrid composite material. Five different types of highly consumed beverages were selected to examine their effect on the surface structure of the nanohybrid composite material. The beverages had different pH values in the range of 3–6, i.e., they were all acidic. The material was investigated under the hardest conditions of surface exposure to the drinks by immersing the material for a long period. The specimens were examined using scanning electron microscopy (SEM) at different magnifications to investigate the effect of these beverages on the morphology of the nanohybrid composite material discs. All specimens showed an effect including pores, cracks, protrusions, and surface roughness as a result of the beverages. The degree of effect differed from one experimental group to another, but there was no relationship between the pH (acidity) value and the degree of effect on the surface structure of the specimens.
Abstract: Stroke affects not only the individual, but has significant impacts on the social and family context. Therefore, it is necessary to know the peculiarities of each region, in order to contribute to regional public health policies effectively. Thus, the present study discusses biomarkers in a post-stroke population, admitted to a stroke unit (U-stroke) of reference in the southern region of Brazil. Biomarkers were analyzed, such as age, length of stay, mortality rate, survival time, risk factors and family history of stroke in patients after ischemic stroke. In this studied population, comparing men and women, it was identified that men were more affected than women, and the average age of women affected was higher, as they also had the highest mortality rate and the shortest hospital stay. The risk factors identified here were according to the global scenario; with systemic arterial hypertension (SAH) being the most frequent and those associated with sedentary lifestyle in women the most frequent (dyslipidemia, heart disease and obesity). In view of this, the importance of studies that characterize populations regionally is evident, strengthening the strategic planning of policies in favor of health care.
Abstract: Bipartite medial cuneiforms are relatively rare but may play a significant role in biomechanical and gait abnormalities. It is believed that a bipartite medial cuneiform may alter the available range of motion due to its larger morphological variant, thus limiting the metatarsal plantarflexion needed to achieve adequate hallux dorsiflexion for normal gait. Radiographic and clinical assessment were performed on two patients who reported with foot pain along the first ray. Both patients had visible bipartite medial cuneiforms on MRI. Using gait plate and Metascan ™ analysis, both were noted to have four measurements far beyond the expected range. Medial and lateral heel peak pressure, hallux peak pressure, and 1st metatarsal peak pressure were all noted to be increased. These measurements are believed to be increased due to the hindrance placed on the available ROM of the first ray by the increased size of the medial cuneiform. A larger patient population would be needed to fully understand this developmental anomaly.
Abstract: Background: Antenatal care can be defined as the care provided by skilled healthcare professionals to pregnant women and adolescent girls to ensure the best health conditions for both mother and baby during pregnancy. The components of Antenatal Care (ANC) include risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion. The aim of this study: to assess the knowledge, attitude, and practice of pregnant women regarding ANC. Methodology: A descriptive knowledge, attitude, and practice (KAP) study was conducted in public hospitals in Sana'a City, Yemen. The study population included all pregnant women that intended to the prenatal department and clinical outpatient department; the final sample size was 371 pregnant women. A self-administered questionnaire was used to collect the data, statistical package for social sciences SPSS was used to data analysis. The results: Most (79%) of pregnant women had correct answers in total knowledge regarding ANC, and about two-thirds (67%) of pregnant women had performance practice regarding ANC and two-third (68%) of pregnant women had a positive attitude. Conclusions: More than three quarter of pregnant women had good knowledge level, most of pregnant women had moderate practice level, and more than two-thirds of pregnant women had a positive attitude regarding antenatal care. There was a statistically significant association between overall knowledge and practice level toward ANC and demographic characteristics of pregnant women, at P-value ≤ 0.05. Recommendations: we recommended more education and training courses, lecturers, and education sessions in clinical facilitators focused on ANC, which relies on evidence-based interventions provided to women during pregnancy by skilled healthcare providers such as midwives, doctors, and nurses.
Abstract: Medical methods to completely treat glaucoma are yet to be developed. Therefore, ophthalmologists manage patients mainly to delay disease progression. Patients with glaucoma are mainly elderly individuals. In elderly people's houses, having an equipment that can provide medical treatment and care can release their family from their care. For elderly people with the glaucoma to live by themselves as much as possible, we developed a support robot having five functions: elderly people care, ophthalmological examination, trip assistance to the neighborhood, medical treatment, and data referral to a hospital. The medical and nursing care robot should approach the visual field that the patients can see at a speed suitable for their eyesight. This is because the robot will be dangerous if it approaches the patients from the visual field that they cannot see. We experimentally developed a robot that brings a white cane to elderly people with glaucoma. The base part of the robot is a carriage, which is a Megarover 1.1, and it has two infrared sensors. The robot moves along a white line on the floor using the infrared sensors and has a special arm, which does not use electricity. The arm can scoop the block attached to the white cane. Next, we also developed a direction detector comprised of a charge-coupled device camera (SVR41ResucueHD; Sun Mechatronics), goggles (MG-277MLF; Midori Anzen Co. Ltd.), and biconvex lenses with a focal length of 25 mm (Edmund Co.). Some young people were photographed using the direction detector, which was put on their faces. Image processing was performed using Scilab 6.1.0 and Image Processing and Computer Vision Toolbox 4.1.2. To measure the people's line of vision, we calculated the iris's center of gravity using five processes: reduction, trimming, binarization or gray scale, edge extraction, and Hough transform. We compared the binarization and gray scale processes in image processing. The binarization process was better than the gray scale process. For edge extraction, we compared five methods: Sobel, Prewitt, Laplacian of Gaussian, fast Fourier transform, and Canny. The Canny method was the optimal extraction method. We performed the Hough transform to search for the main coordinates from the iris's edge, and we found that the Hough transform could calculate the center point of the iris.
Abstract: Recent advances in cognitive neuroscience have allowed a step forward in perceiving the processes involved in learning from the point of view of acquiring new information or the modification of existing mental content. The evoked potentials technique reveals how basic brain processes interact to achieve adequate and flexible behaviours. The objective of this work, using evoked potentials, is to study if it is possible to distinguish if a patient suffers a specific type of learning disorder to decide the possible therapies to follow. The methodology used in this work is to analyze the dynamics of different brain areas during a cognitive activity to find the relationships between the other areas analyzed to understand the functioning of neural networks better. Also, the latest advances in neuroscience have revealed the exis-tence of different brain activity in the learning process that can be highlighted through the use of non-invasive, innocuous, low-cost and easy-access techniques such as, among others, the evoked potentials that can help to detect early possible neurodevelopmental difficulties for their subsequent assessment and therapy. From the study of the amplitudes and latencies of the evoked potentials, it is possible to detect brain alterations in the learning process, specifically in dyscalculia, to achieve specific corrective measures for the application of personalized psycho-pedagogical plans that allow obtaining an optimal integral development of the affected people.
Abstract: Technological innovation plays a crucial role in virtual healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. As a result, telehealth represents an opportunity to redesign the way health services are delivered. The research objective is to discover a new business model for digital health services and related industries to participate with telehealth solutions. The business opportunity is valuable for healthcare investors as a startup company to further investigations or implement the telehealth platform. The paper presents a digital healthcare business model and business opportunities to related industries. These include digital healthcare services extending from a traditional business model and use cases of business opportunities to related industries. Although there are enormous business opportunities, telehealth is still challenging due to the patient adaption and digital transformation process within a healthcare organization.
Abstract: Diabetes disease that arises from the higher glucose level due to insulin shortage or insulin opposition in the human body has become a common disease in the world. No medicine can cure it completely. However, by taking medicine, maintaining diets, and having exercises regularly, a diabetes patient can keep his glucose level within the specified limits and in this way, he/she can lead a normal life like a healthy person. But to control glucose levels, a patient needs to monitor them regularly. Various techniques are being used over the last four decades. This modern review article aims to provide a comparative study report on various blood glucose monitoring techniques in a very concise and organized manner. The review mainly emphasizes working principles, cost, technology, sensors, measurement types, measurement accuracy, advantages, and disadvantages, etc. of various techniques and then compares among each other. Besides, the use of algorithms and simulators for the growth of this technology is also presented. Finally, current research trends of this measurement technology have also been discussed.
Abstract: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. To conduct the study, retrospective data of patients presenting acutely to the urology department were collected between January 13 to March 22, 2020 (pre-lockdown period) and March 23 to May 31, 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Included in the study were 1092 patients. The results show that an overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. The results of the study concluded that the admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.
Abstract: For emergency and relief service providers such as pre-hospital emergencies, quick arrival at the scene of an accident or any EMS mission is one of the most important requirements of effective service delivery. EMS Response time (the interval between the time of the call and the time of arrival on scene) is a critical factor in determining the quality of pre-hospital Emergency Medical Services (EMS). This is especially important for heart attack, stroke, or accident patients that seconds are vital in saving their lives. Location-based e-services can be broadly defined as any service that provides information pertinent to the current location of an active mobile handset or precise address of landline phone call at a specific time window, regardless of the underlying delivery technology used to convey the information. According to research, one of the effective methods of meeting this goal is determining the location of the caller via the cooperation of landline and mobile phone operators in the country. The follow-up of the Communications Regulatory Authority (CRA) organization has resulted in the receipt of two separate secured electronic web services. Thus, to ensure human privacy, a secure technical architecture was required for launching the services in the pre-hospital EMS information management system. In addition, to quicken medics’ arrival at the patient's bedside, rescue vehicles should make use of an intelligent transportation system to estimate road traffic using a GPS-based mobile navigation system independent of the Internet. This paper seeks to illustrate the architecture of the practical national model used by the Iranian EMS organization.