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Background: In low-middle income countries, healthcare providers primarily use paper health records for capturing data. Paper health records are utilized predominately due to the prohibitive cost of acquisition and maintenance of automated data capture devices and electronic medical records. Data recorded on paper health records is not easily accessible in a digital format to healthcare providers. The lack of real time accessible digital data limits healthcare providers, researchers, and quality improvement champions to leverage data to improve patient outcomes. In this project, we demonstrate the novel use of computer vision software to digitize handwritten intraoperative data elements from smartphone photographs of paper anesthesia charts from the University Teaching Hospital of Kigali. We specifically report our approach to digitize checkbox data, symbol-denoted systolic and diastolic blood pressure, and physiological data. Methods: We implemented approaches for removing perspective distortions from smartphone photographs, removing shadows, and improving image readability through morphological operations. YOLOv8 models were used to deconstruct the anesthesia paper chart into specific data sections. Handwritten blood pressure symbols and physiological data were identified, and values were assigned using deep neural networks. Our work builds upon the contributions of previous research by improving upon their methods, updating the deep learning models to newer architectures, as well as consolidating them into a single piece of software. Results: The model for extracting the sections of the anesthesia paper chart achieved an average box precision of 0.99, an average box recall of 0.99, and an mAP0.5-95 of 0.97. Our software digitizes checkbox data with greater than 99% accuracy and digitizes blood pressure data with a mean average error of 1.0 and 1.36 mmHg for systolic and diastolic blood pressure respectively. Overall accuracy for physiological data which includes oxygen saturation, inspired oxygen concentration and end tidal carbon dioxide concentration was 85.2%. Conclusions: We demonstrate that under normal photography conditions we can digitize checkbox, blood pressure and physiological data to within human accuracy when provided legible handwriting. Our contributions provide improved access to digital data to healthcare practitioners in low-middle income countries. [ABSTRACT FROM AUTHOR]

The AUD2IT-algorithm is a tool to structure the data, which is collected during an emergency treatment. The goal is on the one hand to structure the documentation of the data and on the other hand to give a standardised data structure for the report during handover of an emergency patient. AUD2IT-algorithm was developed to provide residents a documentation aid, which helps to structure the medical reports without getting lost in unimportant details or forgetting important information. The sequence of anamnesis, clinical examination, considering a differential diagnosis, technical diagnostics, interpretation and therapy is rather an academic classification than a description of the real workflow. In a real setting, most of these steps take place simultaneously. Therefore, the application of the AUD2IT-algorithm should also be carried out according to the real processes. A big advantage of the AUD2IT-algorithm is that it can be used as a structure for the entire treatment process and also is entirely usable as a handover protocol within this process to make sure, that the existing state of knowledge is ensured at each point of a team-timeout. PR-E-(AUD2IT)-algorithm makes it possible to document a treatment process that, in principle, does not have to be limited to the field of emergency medicine. Also, in the outpatient treatment the PR-E-(AUD2IT)-algorithm could be used and further developed. One example could be the preparation and allocation of needed resources at the general practitioner. The algorithm is a standardised tool that can be used by healthcare professionals of any level of training. It gives the user a sense of security in their daily work. [ABSTRACT FROM AUTHOR]

Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient. Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are a common and debilitating condition posing not only a huge health care but also socioeconomic burden. Surgical management for a neck of femur fracture is typically with arthroplasty in the form of total hip arthroplasty or hip hemiarthroplasty. Serial radiographs are typically performed routinely as part of follow-up to look for complications, although their clinical utility in asymptomatic patients is yet to be validated. Our paper therefore aims to review the utility and necessity of radiographic follow-up following arthroplasty for NOF fractures. Materials and Methods: Patients who underwent operative management for acute fragility neck of femur fractures in the year from 1st January 2018 to 31st December 2018 at the author's institution were identified. All patients who underwent surgery, and had at least one pre and one post-operative plain film radiograph of the affected hip were included in this study. Exclusion criteria included patients who had undergone surgery for chronic fractures, avascular necrosis of the femoral head, mortality within 1 year, peri-prosthetic fractures, pathological fractures from metastases, had concomitant injuries, or had inaccessible or incomplete records. Clinical records were assessed for the number of visits, an abnormal presenting history or clinical examination, as well as changes in management of the patient. The number and type of radiographs were also assessed, and each radiograph analyzed for abnormal findings. Results: A total of 157 patients were included in our study with a mean age of 79.5 at the time of surgery, and a mean follow up of 17.3 months. Data was collected from 626 clinical visits and a total of 973 radiographs. The 3 abnormal radiographic series identified with a corresponding normal consult did not result in a change of management for the patient. A negative change in management was only observed in 1 patient with an abnormal consult and a corresponding normal radiograph. Conclusion: Post-operative complications following arthroplasty for NOF fractures are likely to result in a symptomatic presentation of the patient. Routine radiographic follow-up provides limited utility in asymptomatic patients and should only be performed if clinically indicated. [ABSTRACT FROM AUTHOR]

Objective: To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods: The Joanna Briggs Institute's scoping review methodology was used. Results: The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions: The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research. What is known about the topic? A socio-economic status (SES) gradient is well established for cardiovascular disease (CVD). Research has generally applied two approaches to classifying SES: at an individual level using income, education or occupation data, and at an area level using a range of existing socio-economic information, including the Australian Bureau of Statistics (ABS) Socio-Economic Indexes for Areas (SEIFA). What does this paper add? This review examined how SEIFA has been applied to measure SES in Australian peer-reviewed CVD research and to identify any variations in research practice. What are the implications for practitioners? It is recommended that researchers provide a clear explanation in the methods section of research papers as to which SEIFA version and index was applied, how it was applied, at what spatial unit, and whether the spatial unit was an ABS or non-ABS unit. [ABSTRACT FROM AUTHOR]

Wireless communications play an important role in ensuring ease of access to shared electronic health records (EHR) across health service providers which is essential and significant for prompt patients' care, especially in cases of emergency medical conditions. With the need to support anytime, anywhere access to, potentially bandwidth hungry, medical records, electronic healthcare applications will continue to benefit from advanced wireless network technologies such as 5G and beyond. With sharing, it is crucial to provide patients with security and privacy guarantees, and allow them to certain control of access to their data. Existing solutions mostly assume that patients are available to authorize requests to access their EHR, which is impractical as the patient may be unconscious. This paper proposes a secure and privacy protecting protocol whereby the patient can pre-delegate the authorization for the access of his/her EHR. Our patient(user)-centric proposal combines Self-Sovereign Identity (SSI) concepts and model with Secure Multi-party Computation (SMPC) and Threshold Cryptography (TC) to enable secure identity and authorization verification. A block cipher encryption sharing approach is adopted for the threshold SMPC which extends the AES-GCM symmetric encryption model into a full-fledged cryptographic platform. Two mechanisms are implemented for the block cipher encryption, namely XOR and Cascade, and experiments are conducted to compare them. We conclude that the XOR mechanism can scale for larger thresholds, while Cascade performed better for a lower threshold (≤ 3). This paper also performs a threat analysis of the protocol and approach, and validates its correctness and complexity. We conclude that the approach can achieve the security and privacy protection of the patient's personal EHR, as well as the autonomy of the patient to control the authorization for the access and sharing. [ABSTRACT FROM AUTHOR]

Background: Sonder's In-Home Withdrawal Service (IHWS) has been providing a unique home-based, multidisciplinary, wraparound withdrawal option for people with low-to-moderate levels of substance dependence since September 2019. This paper provides an evaluation of the service's overall impact on reducing substance use among clients through the delivery of this innovative service model. The evaluation explores the acceptability and feasibility of the service via client, stakeholder, and staff perspectives. Methods: A mixed-method design was used to evaluate the IHWS. Descriptive analysis of quantitative data was conducted using clinical assessments from client records and online feedback surveys. Qualitative data from client, staff, and stakeholder feedback surveys were analysed thematically. Results: Overall, 1166 referrals were received over the lifespan of the service, and a data set of 96 clients was included in the analysis. Self-reported measures showed that most clients decreased their substance use (89%), improved their psychological health status (75%), improved their physical health (65%), improved their quality of life (69%), and improved their understanding and ability to manage their alcohol and other drugs (AOD) use (84%). Client feedback suggests the service is providing a unique option for AOD withdrawal. Stakeholders commend the service's home-based setting, multidisciplinary and person-centred approach to care, and recommended expansion of the service to increase access for clients and reduce demand on inpatient settings. Conclusions: The IHWS is having a significant impact in reducing substance use and highlights the need for increased access to holistic approaches to withdrawal. This includes pre- and post-withdrawal support and the inclusion of multidisciplinary teams, and engaging lived experience practitioners. A focus on funding primary-based services is required to meet the rising costs of tertiary-based care and to better meet the needs of consumers. Individuals with low-to-moderate levels of substance dependence require targeted services to safely manage their withdrawal. This paper evaluates a holistic approach to withdrawal that broadens the common medicalised approach through pre- and post-withdrawal stages of care and support from a multidisciplinary team including lived experience practitioners. The service reduces levels of substance use while also improving overall quality of life, demonstrating the need for more withdrawal services to consider the inclusion of holistic approaches to substance dependence support. [ABSTRACT FROM AUTHOR]

In the healthcare sector, predictive analytics plays a vital role, presenting a challenging task but offering potential benefits in making informed decisions about patient health and treatment based on big data. This research paper delves into the realm of predictive analytics in healthcare, employing four distinct machine learning algorithms. The experiment involves the utilization of a dataset comprising patients' medical records, upon which the four algorithms are applied. A comprehensive analysis is conducted using a diverse range of algorithms, including logistic regression, decision trees, random forests and support vector machines. These algorithms' effectiveness is assessed using important measures like precision, recall, precision, accuracy and F1-score. By comparing the different machine learning techniques employed in the present study, the analysis aims to determine the most suitable algorithm for predicting diabetes. [ABSTRACT FROM AUTHOR]

Objective: In this paper we report how the United Kingdom's National Institute for Health and Care Excellence (NICE) search filters for treating and managing COVID-19 were validated for use in MEDLINE (Ovid) and Embase (Ovid). The objective was to achieve at least 98.9% for recall and 64% for precision. Methods: We did two tests of recall to finalize the draft search filters. We updated the data from an earlier peer-reviewed publication for the first recall test. For the second test, we collated a set of systematic reviews from Epistemonikos COVID-19 L.OVE and extracted their primary studies. We calculated precision by screening all the results retrieved by the draft search filters from a targeted sample covering 2020-23. We developed a gold-standard set to validate the search filter by using all articles available from the "Treatment and Management" subject filter in the Cochrane COVID-19 Study Register. Results: In the first recall test, both filters had 99.5% recall. In the second test, recall was 99.7% and 99.8% in MEDLINE and Embase respectively. Precision was 91.1% in a deduplicated sample of records. In validation, we found the MEDLINE filter had recall of 99.86% of the 14,625 records in the gold-standard set. The Embase filter had 99.88% recall of 19,371 records. Conclusion: We have validated search filters to identify records on treating and managing COVID-19. The filters may require subsequent updates, if new SARS-CoV-2 variants of concern or interest are discussed in future literature. [ABSTRACT FROM AUTHOR]

There are various economic costs included in medical treatment and its complications including direct, indirect, and opportunity expenditures. A substantive chunk constitutes indirect costs particularly those related to the process of generating medical records. This article dwells on the medical costs in general, indirect costs relating to the generation and archiving of an ever-increasing volume of patient records both in printed and electronic versions, and the economic market value of medical databases. The calculations and estimates provided in the article are based on data available on the Internet and the authors’ research and empirical evidence gathered in a tertiary surgical referral center. The analysis indicates that well-maintained electronic medical records can reduce the rate of treatment complications by up to 30% by lessening the administrative burden on physicians by making them more attentive to the tasks for which they are trained. A switch from paper-to-electronic medical records could save as many as over 33000 trees being cut down per year in Poland alone. On a world basis, electronic records obviate the potential rental costs for at least 800000 square meters of storage area for paperrun documents. The market value of medical databases covering the medical records of the entire world’s population is estimated at $100 billion. In conclusion, excessive generation of medical records indirectly results in an increased risk of surgical complications contributing to staff fatigue and burnout. It also increases direct treatment costs. Well-maintained medical records supported by artificial intelligence technologies may substantially reduce the number of complications and thus both direct and indirect costs. The generation of a large nationwide or global medical record database, aside from the underlying technological progress and advances in currently used treatments, may lead to substantial fiscal savings. [ABSTRACT FROM AUTHOR]

Objectives: Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods: A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results: Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions: Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs. What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

One of the major impacts of hearing disability that hinders the individual's effective participation in society and full enjoyment of human rights and fundamental freedoms is his/her ability to communicate with others. Sign language is one of the main methods of communication used by people with hearing disability. Therefore, improving access to sign language services and increasing the availability of interpreters contribute to better inclusion and integration of people with hearing disability into society. This paper explores the experience of a Jordanian university that launched a pioneering initiative by offering a sign language course for its students. It reports the findings of a study that evaluated this initiative from the perspective of students. Feedback was recorded during unstructured interviews with 23 student participants who had taken the course. The paper concludes that universities can play a significant role in integrating people with disabilities into the education system and promoting their participation in society. [ABSTRACT FROM AUTHOR]

Introduction: Vertical transmission of HIV remains a major challenge in Guinea, especially, in low-resource rural areas. This paper presents the results of a pilot project designed to enhance the prevention of vertical transmission through a comprehensive improvement plan implemented across 66 large-cohort sites. Methods: Data from 66 large-cohort of mother to child transmission prevention (PMTCT) sites from 2019 to 2022 were analysed to compare PMTCT metrics before (2019–2020) and after (2021–2022) the improvement initiative. Key indicators were reviewed, and trends were statistically analysed using Mann‒Whitney tests, with a p value less than 0.05 indicating statistical significance. Results: The implementation of this strategy significantly increased the antiretroviral therapy rate among HIV-positive pregnant women from 66 to 94%, and full antiretroviral prophylaxis coverage was achieved in infants. However, early infant diagnosis via polymerase chain reaction testing falls short of the national target, highlighting deficiencies in laboratory and specimen transport capacities. The study also revealed regional disparities in the use of PMTCT services. Conclusion: The improvement plan effectively enhanced antiretroviral therapy and prophylaxis use, demonstrating the benefits of structured interventions and capacity development. Despite improvements, challenges such as insufficient polymerase chain reaction (PCR) testing and uneven access to services remain. Future initiatives should aim to equip PMTCT sites with essential resources and promote community-driven health-seeking behaviours in underserved areas. [ABSTRACT FROM AUTHOR]

Background: Co-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings. Purpose: Our paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group. Methods: A randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c). Results: Of 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant. Conclusion: The SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation. [ABSTRACT FROM AUTHOR]

Maintaining a healthy diet is essential, particularly for diabetic patients who are affected by severe defects. Nutrition therapy is vital to avoid the effects of diabetes and maintain better health. However, high sugar, fatty foods are significantly avoided by the patients to find alternate food from the same group. Despite this, there are still variations in diet that affect diabetic patients. Therefore, this paper proposes an effective food recommendation system to suggest suitable dietary plans for patients affected by diabetes. The personal health information of patients and several food products gathered from the Internet of Medical Things (IoMT) dataset are taken as input data for the proposed integrated recommendation system. To boost unbiased detection, the data noise present in the IoMT dataset is eliminated and regularized using preprocessing steps, including data cleaning, data reduction, data transformation, data enrichment, and data validation. From the preprocessed data, significant feature characteristics that contribute more to diabetes detection and food product recommendation are selected using the Wingsuit Flying Search (WFS) algorithm. These selected features are then classified using the proposed Hybrid Ensemble Support Vector Deep Residual (HESDR) approach. This approach accurately classifies diabetes and non-diabetes patients and suggests top nutrient-dense food products for patients with diabetes. The analytical results show that the proposed HESDR approach achieves a high accuracy rate of about 98.3% compared to other methods. In conclusion, this paper proposes an effective food recommendation system that accurately classifies diabetic patients and suggests suitable dietary plans based on their health conditions. The approach effectively eliminates data noise and selects significant features using the WFS algorithm. The proposed HESDR approach accurately classifies diabetic patients and recommends nutrient-dense food products for them, achieving high accuracy rates. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence and clustering of NANDA‐International nursing diagnoses in patients assisted by pre‐hospital emergency teams. Design: Retrospective descriptive study of electronic record review. Methods: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two‐step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Results: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six‐cluster solution (n = 26.788) was found. Five clusters had a single high‐prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co‐occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Conclusion: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre‐hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Implications for the profession and/or patient care: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre‐hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre‐hospital clinical setting. Impact: What problem did the study address? There are different models of pre‐hospital emergency care services.The use of standardized nursing languages in the pre‐hospital setting is not homogeneous.Studies on NANDA‐I nursing diagnoses in the pre‐hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA‐I nursing diagnoses in the pre‐hospital care setting.Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance.Patients attended by pre‐hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre‐hospital setting, increasing the evidence of individualized and standardized care plans for pre‐hospital care. Reporting method: STROBE checklist has been used as a reporting method. No Patient or Public Contribution: Only patients' records were reviewed without further involvement. [ABSTRACT FROM AUTHOR]

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

With the advent of the information age, data storage has not only developed from paper information systems to electronic information system storage, but has also extended to cloud database storage methods. To date, we can see the application of big data and cloud in various fields and levels, making induction, arrangement, transmission, and exchange of data easier and faster. The electronic and systematisation of patient medical records in the medical environment is an example. The use of electronic medical records can help improve the quality of medical care, reduce duplication of treatment, and reduce the waste of examination resources. It has many advantages, but also many risks. Medical institutions may abuse electronic medical data without the consent of patients, leading to the leakage of patient privacy data and causing serious social impact. Therefore, this study proposes a medical record exchange and sharing mechanism based on the Hyperledger blockchain architecture combined with proxy reencryption. When pharmacists need to obtain medical records for related research, patients can decide whether to share medical records, and hospitals can also revoke pharmacist access rights at any time to achieve more private, secure, and convenient sharing of medical records. The proposed scheme meets various blockchain security requirements and the BAN (Burrows–Abadi–Needham) logic proof model (Burrows–Abadi–Needham) is applied to assess the correctness of the proposed scheme. The proposed scheme performs well in terms of computational and communication costs. [ABSTRACT FROM AUTHOR]

Purpose: Neurosurgical ablative procedures, such as cordotomy and cingulotomy, are often considered irreversible and destructive but can provide an effective and individualized solution for cancer-related refractory pain, when all other approaches have been unsuccessful. This paper provides an in-depth exploration of a novel approach to managing refractory cancer pain. It involves an interdisciplinary team led by a neurosurgeon at a renowned national referral center. Methods: a retrospective analysis of the medical records of all sequential patients who underwent their initial evaluation at our interdisciplinary refractory cancer pain clinic from February 2017 to January 2023. Results: A total of 207 patients were examined in the clinic for a first visit during the study period. All patients were referred to the clinic due to severe pain that was deemed refractory by the referring physician. The mean age was 61 ± 12.3 years, with no significant sex difference (P = 0.58). The mean ECOG Performance Status score was 2.35. Conservative measures had not yet been exhausted in 28 patients (14%) and 9 patients were well controlled (4%). Neurosurgical ablative procedures were recommended for 151 (73%) of the patients. Sixty-six patients (32%) eventually underwent the procedure. 91 patients (44%) received a negative recommendation for surgery. Thirty-five patients (17%) were referred for further invasive procedures at the pain clinic. Conclusion: An Interdisciplinary cooperation between palliative care specialists, pain specialists, and neurosurgeons ensures optimal patient selection and provides safe and effective neurosurgery for the treatment of refractory cancer-related pain. [ABSTRACT FROM AUTHOR]

Medical health records hold personal medical information and should only be accessed by authorized medical personnel or concerned patients. The importance of medical health records privacy is increasing as these records are shared in cloud environments. In this paper, we propose an enhanced system for securing patient data (Medical Health Records) embedded in multiple medical images in fragments for secure transmission and public sharing on the cloud or other environments. To protect the patient's privacy, Medical Records are first encrypted, and then the ciphertext is broken into several fragments based on the number of multimodal medical images of a patient. A key generator randomly selects medical images from the multimodal image data to embed the encrypted patient health record segment using a modified least significant bit embedding process. The proposed technique enables an extra layer of security as even if files fall into the wrong hands and a fragment of the file is decrypted, it will not present any understandable information until all fragments from other medical images are extracted and combined in the correct order. The experiments are performed using multimodal 3255 MRI scans of 21 patients. The robustness of the proposed method was measured using different metrics such as PSNR, MSE, and SSIM. The results show that the proposed system is robust and that image quality is also maintained. To further study the stego image quality, a deep learning-based classification was applied to the images, and the results show that the diagnosis using stego medical images and performance remains unaffected even after embedding the encrypted data. [ABSTRACT FROM AUTHOR]

In modern healthcare systems, digitalizing medical records is crucial for optimizing patient care. This paper investigates the creation and execution of a website designed to merge patients' medical records, with the goal of offering a holistic and patient-focused approach to healthcare management. The platform aims to streamline the exchange of information among healthcare providers, enhance treatment decision-making processes, and empower patients to take an active role in their healthcare. By centralizing healthcare data on a digital platform, this initiative aims to revolutionize traditional healthcare practices and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS: What is already known on the subject: Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%–30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge: Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work?: Post‐treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination. [ABSTRACT FROM AUTHOR]

Background: Patient medical records are records relating to the patient's identity, diagnosis, action, and to the treatment that has been given to the patient. Thus, medical records must be protected from damage, but damage to medical records is still found in every hospital. Purpose: This study attempts to investigate the causes of damage to hospital medical record materials. Methods: this is literature review, and the research was obtained from google scholar and the portal garuda, using full text articles. The measured results were factors that cause damage to medical record documents. Results: The main factor were still officers with a low level of education, namely high school graduates. This has an impact on filing officers to be not disciplined in maintaining medical record documents, and the absence of implementation of training related to management and storage management in the filing section. The machine factor was that there was no medical record rack available in accordance with the number of medical record documents. The method factor was that there was no SOP for maintaining medical records. The material factor was the raw material for the map using thin paper. The media factor, namely the storage space, has not been avoided from the dangers of water, fire, and biological damage. Conclusion: Based on 5M factors, the factors that have the highest influence on damage to medical record documents are the elements of people, machine, and material. While the factor that causes the least damage to medical record documents is the method. [ABSTRACT FROM AUTHOR]

Aim: Studies of the effects of COVID‐19, especially post‐acute COVID‐19 syndrome, on psychological health in non‐severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality‐of‐life in three groups of outpatients, hospitalized and intensive care patients. Methods: A total 276 patients, previously confirmed with SARS‐CoV‐2 infection, attending the COVID‐19 follow‐up outpatient clinic from December 2020 to July 2021 were interviewed face‐to‐face. In this cross‐sectional, retrospective study, all participants were asked our self‐designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL‐BREF survey to evaluate quality of life. Results: In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post‐traumatic stress disorder symptoms at a rate of 28.6% and obsessive‐compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID‐19 infection had a higher risk of developing psychological symptoms and decreased quality of life. Conclusion: COVID‐19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness. Summary statement: What is already known about this topic? Post‐intensive care syndrome affects physical, cognitive and psychological health.It is associated with symptoms such as generalized weakness, memory disturbances, cognitive function impairment, depression, anxiety and post‐traumatic stress disorder.Some physical and psychological symptoms persist for over 12 weeks in some patients and have been classified as 'Post‐acute COVID‐19 Condition or Syndrome' (PCS). What this paper adds? At the post‐acute‐COVID‐19 period, a considerable number of outpatients with COVID‐19 infection were at higher risk for psychological distress symptoms than those who had been treated in the hospital or intensive care unit.Depression, anxiety, panic disorder and PTSD symptoms were found to be higher in outpatients and those with these symptoms were also shown to have a lower quality of life.Our findings highlight the significant psychological impact of COVID‐19 on patients, even after their reported recovery from the acute manifestations of this disease. The implications of this paper: Ongoing psychological symptoms in the post‐COVID period are not associated with the severity of the disease in the acute phase.It is important that healthcare professionals are equally concerned not only with physical condition of post‐COVID‐19 patients but also with their psychological state and the patient's psychology‐related quality of life. [ABSTRACT FROM AUTHOR]

Aims: We aim to analyse the effect of menthol on thirst intensity and thirst comfort in surgical patients. Background: Menthol has achieved good results in quenching thirst in patients in intensive care units, but its safety and reliability in perioperative fasting patients are unknown. Design: A systematic review with meta‐analysis of intervention studies was performed. Data Sources: We used Chinese and English databases from their dates of inception to May 2022. Literature was retrieved from PubMed, Web of Science, Cochrane Library, Embase, CINHAL, SinoMed, CNKI, Wanfang and VIP database. Review Methods: Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. Results: A total of seven studies were identified in this review, which included 537 surgical patients. Overall, menthol reduced thirst intensity in surgical patients and decreased thirst discomfort. Further subgroup analysis revealed that the menthol intervention significantly improved thirst intensity in surgical patients during preoperative and postoperative fasting periods. The Egger's tests showed no significant bias (p = 0.113 and 0.553, thirst intensity and thirst discomfort, respectively). Conclusion: Menthol intervention effectively improved thirst intensity and thirst discomfort during fasting in surgical patients, but more large‐scale, multicentre randomized controlled trials are required to confirm these findings further. Summary statement: What is already known about this topic? Thirst is a common symptom of discomfort during fasting in surgical patients.Thirst in surgical patients is an underappreciated, unmeasured and undertreated symptom. What this paper adds? It is safe and feasible to administer menthol immediately after surgery to patients undergoing surgery.Menthol intervention during fasting in surgical patients can significantly reduce thirst intensity and improve thirst discomfort.More high‐quality trials are essential to explore optimal menthol interventions during fasting in surgical patients. The implications of this paper Menthol provides a safe and effective thirst‐quenching method for perioperative fasting in surgical patients.Menthol reduces thirst intensity and thirst discomfort in surgical patients postoperative fasting periods. [ABSTRACT FROM AUTHOR]

Introduction: Violence against healthcare workers in the workplace is a complex issue affecting various healthcare professionals. Workplace violence (WPV) poses significant occupational hazards to healthcare employees. Objectives: To identify the causes, types, and perpetrators of WPV and explore the effects of violence on healthcare workers' well-being. Methods: This literature review analyzes 15 selected research papers published between 2015 and 2020, focusing on WPV against healthcare workers, and gathers insights from healthcare professionals with prior experience of WPV. Through an analysis of the selected research papers, this study provides a comprehensive overview with WPV in the healthcare setting. The respondents in the included studies were healthcare professionals who had encountered WPV in their work. Results: While nurses remain particularly vulnerable to violence due to their constant patient interaction, this study reveals that verbal violence is the most prevalent type, significantly impacting the well-being of healthcare workers as a whole. The identified causes of WPV include long waiting times, understaffing, miscommunication, inadequate security measures, high patient expectations, and overcrowding. Respondents emphasized the importance of education, security enhancements, and administrative support to address or prevent WPV. Conclusion: The findings strongly highlight the crucial role of administrative support in reducing the incidence of WPV. It is crucial to implement broader measures to ensure the safety and well-being of all healthcare workers. [ABSTRACT FROM AUTHOR]

Objectives: Granulomatous mastitis is a rare benign inflammatory disease of the breast commonly seen in women at childbearing age. The aim of this study is to describe clinical and paraclinical characteristics of GM patients, to demonstrate the management and follow-up experience of our center, and review the literature on the topic. Methods: 30 GM cases were identified among the 3248 patients who applied to the breast health center of the Liv Bona Dea hospital between January 2018 and August 2023. Cases were identified as granulomatous mastitis histopathologically from the biopsy specimens. Patient data was evaluated from the database, and missing information was retrieved by calling the patients. Results: Among the 3248 patients who were admitted to our breast health center, 30 patients (0.9%) had a diagnosis of GM and were identified as applicable to our study. All the patients were female, with a median age of 33, ranging from 27 to 66. Of the 30 patients, 11 were overweight and 7 were obese at the time of diagnosis (mean BMI: 26.7). While the majority (n=23, 76%) of the patients presented with a breast lump, only 1 (3%) of the patient’s only symptom was breast lump. 8 (27%) of the cases had comorbidities, including Hashimoto Thyroiditis (n=1), Hypertension (n=6), Diabetes Mellitus type 1 (=1), Diabetes Mellitus type 2 (n=4), Major Depression (n=1). Of the lesions, 16 (53%) showed high suspicion with a Bi-Rads score ≥ 4, and 14 (47%) showed low suspicion with a Bi-Rads score ≤ 4. 18 (60%) of patients received only medical treatment, 11 (37%) patients received both surgery (excision) and medical treatment, and only 1 (3%) received surgery (excision) alone. Conclusion: Even though idiopathic GM is the most common GM type, results from the paper of Ercan Kokrut et al. suggest that Tuberculosis should not be skipped, especially in developing countries, with reported 20% as a cause of GM. A multidisciplinary team is crucial in the diagnosis and treatment of GM to be able to distinguish it from breast cancer To conclude, Granulomatous mastitis is a tricky condition that can cause high anxiety in physicians as high as in patients. Idiopathic GM is the most common type, but evaluation of other reasons, such as tuberculosis mastitis, must be on the checklist. More research regarding the outcome of different treatment modalities will give a straightforward approach for physicians. [ABSTRACT FROM AUTHOR]

Objective: Intensive Care Units are one of the areas with the lowest digitization rate. This study aims to measure the effect of digitizing medical records kept in paper forms in ICUs on time-saving and paper consumption. In our study, care forms in ICUs were transferred to digital media. In our research, care forms in ICUs were transferred to digital media. Methods: The time required to fill out the nursing care forms on paper and digital media was measured, the change in paper and printer costs was determined, and the results were compared. Two volunteer nurses working in the ICU of a university hospital in Istanbul measured the time it took to fill out the forms of patients on paper. Then, a future projection was made using digital form data of 5,420 care days of 428 patients hospitalized between October 2017 and September 2018. Only anonymous data of patients hospitalized in the general ICU were used, and other untempered were not included in the study. Results: When the forms were filled in digitally by the nurses, one nurse per patient per day saved 56.82 min (3.95% per day). Discussion: Health care services are provided in hospitals in Turkey with 28,353 adult intensive care beds and an occupancy rate of 68%. Based on the occupancy rate of 68%, the number of full beds is 19,280. When 56.82 min are saved per bed from the forms filled by the nurses, 760.71 care days are dedicated. Considering the salary of 1,428.67 US dollars per nurse, the savings to be achieved are estimated to be 13,040,804.8 US dollars per year. [ABSTRACT FROM AUTHOR]

My Turn is software used to manage several Covid-19 mass vaccination campaigns in California. The objective of this article is to describe the use of My Turn at two points of dispensing in California and comment on process improvements to reduce manual tasks of six identified processes of vaccination–registration, scheduling, administration, documentation, follow-up, and digital vaccine record–and paper. We reviewed publicly available documents of My Turn and patients vaccinated at George R. Moscone Convention Center in San Francisco and Oakland Coliseum Community Vaccination Clinic. For publicly available documents of My Turn, we examined videos of My Turn on YouTube, and documentation from EZIZ, the website for the California Vaccines for Children Program. For patients, we examined publicly available vaccination record cards on Instagram and Google. At the George R. Moscone Convention Center, 329,608 vaccines doses were given. At the Oakland Coliseum Community Vaccination Clinic, more than 500,000 vaccine doses were administered. The use of My Turn can be used to reduce manual tasks and paper for mass vaccinating patients against Covid-19. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report 12 years of experience in the development of a quality assurance system in radiation oncology in a university hospital. Material and Methods: We developed the Quality Assurance Program in Radiation Oncology (QUAPRO) in 2008 to detect treatment deviation in the radiotherapy (RT) process with three steps of near-miss detection: simulation and prescription (primary check, PC), treatment planning (secondary check, SC), and treatment delivery process (tertiary check, TC). We transferred our paper-based medical records to electronic-based radiotherapy information systems (RTISs) in 2013. QUAPRO was completely integrated into RTIS in 2017. Since then, electronic-based incident reporting has been conducted. The program is called the Radiation Incident Learning System (RILS). The near-miss rates were compared during the three time periods: 2008–2012, 2013–2017, and 2017–2020. Results: Five years of paper-based QUAPRO for 2008–2012 demonstrated a fluctuation in the checking ratio, with a gradually increasing rate of near misses of 3.5–19.7%. After electronic-based medical records were developed in 2013, the results revealed a dramatic increase from a rate of 2.7 to 4.2 in the number of checks per patient and achieved an increased rate of near misses of 24.7% for PC, SC, and TC. The rate of near misses gradually decreased to 5.3% after 2017 because of RT workflow improvement. Conclusion: The analysis of 12 years in near-miss data reflected the effectiveness of our quality assurance program. The QUAPRO system can detect near-miss incidents in the whole RT workflow and illustrate the detection improvement when integrated into electronic-based medical records. Regular feedback and exploration of near-miss reporting are recommended for proper RT workflow improvement. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The purpose of this study is the analysis of bibliometric studies of the medical most-cited papers. Materials and Methods: This applied and the scientometric study was conducted using retrospective bibliometric analysis methods. AScopus search was conducted and 883 articles were retrieved. After reviewing the titles and abstracts, 432 articles related to the purpose of this research were identified. Items such as year, journal, country, and institution were considered. Medical subject heading and NLM were applied for the subject categorization of articles. Given the dynamics of subject areas over time, only the content of 117 articles published in 2020 and 2021 were analyzed. These 117 articles have been reviewed with 11,700 most-cited articles. By reviewing 117 articles, the most productive journal, country, and institute in producing 11,700 articles were identified. Results: The findings have shown a significant number of these publications review 100 most-cited articles in the field of medicine. Articles pertaining to the Nervous System, Musculoskeletal System, Dentistry, Radiology, and Cardiovascular System are the most numerous among the publications. Conclusion: The results of this study allow readers to know the most productive countries, institutions, and journals of various subject areas, as well as the most influential fields and research trends in that subject area. The results of this study also identify subject areas for which the characteristics of their core articles have not yet been explored to plan future research. [ABSTRACT FROM AUTHOR]

Sustainable smart city initiatives significantly improve the living standards of citizens and bring significant changes in economic, environmental, and social well-being. Sustainable and remote medical services are vital attributes of modern smart health infrastructure. Smart remote health infrastructure uses interconnected devices to gather and exchange health data. In smart health infrastructure, massive quantities of health data are gathered as Personal Health Records (PHR). Clinical images form a major part of the accumulated PHR. As medical images are confidential and sensitive, secure storage and transmission are significant. Hence, different cryptographic techniques are used to enhance medical image security. The conventional cryptographic schemes are complex and generate a single cipher image corresponding to a plain image. The cipher images are stored in a single database. Such storage makes the cryptosystem weak against single-point attacks. This paper discusses a simple, keyless, and distributed secure storage mechanism for medical images called SecMISS. SecMISS uses Random Grid-based Visual Secret Sharing (RGVSS) along with super-resolution for secure encryption with distributed storage and better reconstruction. The security parameters such as SSIM (≈ 0), correlation of adjacent pixels (≈ 0), PSNR (≤ 8 dB), and entropy (= 1) between share and initial image show that SecMISS provides highest level of security. Similarly, different Human Visual System (HVS) parameters between the initial and reconstructed images show an improvement in the reconstruction. Experimental results show that SecMISS outperforms the existing technique in terms of security and reconstruction. Thereby SecMISS can be efficiently used for securing medical image in sustainable smart hospitals and health infrastructures. [ABSTRACT FROM AUTHOR]

Copyright of Przegląd Elektrotechniczny is the property of Przeglad Elektrotechniczny and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Without proper security mechanisms, medical records stored electronically can be accessed more easily than physical files. Patient health information is scattered throughout the hospital environment, including laboratories, pharmacies, and daily medical status reports. The electronic format of medical reports ensures that all information is available in a single place. However, it is difficult to store and manage large amounts of data. Dedicated servers and a data center are needed to store and manage patient data. However, self-managed data centers are expensive for hospitals. Storing data in a cloud is a cheaper alternative. The advantage of storing data in a cloud is that it can be retrieved anywhere and anytime using any device connected to the Internet. Therefore, doctors can easily access the medical history of a patient and diagnose diseases according to the context. It also helps prescribe the correct medicine to a patient in an appropriate way. The systematic storage of medical records could help reduce medical errors in hospitals. The challenge is to store medical records on a third-party cloud server while addressing privacy and security concerns. These servers are often semi-trusted. Thus, sensitive medical information must be protected. Open access to records and modifications performed on the information in those records may even cause patient fatalities. Patient-centric health-record security is a major concern. End-to-end file encryption before outsourcing data to a third-party cloud server ensures security. This paper presents a method that is a combination of the advanced encryption standard and the elliptical curve Diffie-Hellman method designed to increase the efficiency of medical record security for users. Comparisons of existing and proposed techniques are presented at the end of the article, with a focus on the analyzing the security approaches between the elliptic curve and secret-sharing methods. This study aims to provide a high level of security for patient health records. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' observation of patients in seclusion is essential to ensure patient safety.Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy.Direct observation and video monitoring are widely used in observing patients in seclusion.Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients.Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness.Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized.Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion.Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs.A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision.Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients.Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness.More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations.Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room.When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. Introduction: A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim: The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method: A retrospective phenomenological approach, using semi‐structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results: Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion: The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice: Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion. [ABSTRACT FROM AUTHOR]

Aim: To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. Design: bibliometric analysis. Methods: The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. Results: A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. Conclusion: The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024. [ABSTRACT FROM AUTHOR]

Recent advances in the field of large language models (LLMs) underline their high potential for applications in a variety of sectors. Their use in healthcare, in particular, holds out promising prospects for improving medical practices. As we highlight in this paper, LLMs have demonstrated remarkable capabilities in language understanding and generation that could indeed be put to good use in the medical field. We also present the main architectures of these models, such as GPT, Bloom, or LLaMA, composed of billions of parameters. We then examine recent trends in the medical datasets used to train these models. We classify them according to different criteria, such as size, source, or subject (patient records, scientific articles, etc.). We mention that LLMs could help improve patient care, accelerate medical research, and optimize the efficiency of healthcare systems such as assisted diagnosis. We also highlight several technical and ethical issues that need to be resolved before LLMs can be used extensively in the medical field. Consequently, we propose a discussion of the capabilities offered by new generations of linguistic models and their limitations when deployed in a domain such as healthcare. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up. Methods: This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps. Results: Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory. Conclusions: Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence. [ABSTRACT FROM AUTHOR]

Background: Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. Methods: An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. Key Results: A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. Conclusions: AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling. [ABSTRACT FROM AUTHOR]

This paper presents a fuzzy logic based heart disease risk prediction system. The system collects patient medical data using a user-friendly GUI and processes the same with fuzzy logic soft computing technique. The prediction model also introduces three supreme attributes, viz., Serum creatinine, Echocardiogram (LVEF) and Breathlessness that inform about the diminished blood flow, deteriorated heart muscles and severity while breathing respectively. The proposed system works on 47 logical operations processed over 10 clinical inputs. The study reveals 5 distinct levels of heart risks as output and final results matches with probable cardiac risk. The study yielded an accuracy of 96% along with specificity and sensitivity of 94.73 and 96.67% respectively. Comparison with previous research papers and presentation of ROC and PR-curves highlights the effectiveness of fuzzy logic in the medical science. [ABSTRACT FROM AUTHOR]

Chronic low back pain is a leading cause of disability worldwide. A clinical model for its cause is lacking. Defining a cause based clinical model and a framework of understanding back pain in terms of peripheral structural and central functional pain is essential for optimal management. We describe the results of the largest published audit of 41 chronic low back pain patients, receiving outpatient sublingual ketamine therapy for defined central functional pain along with conventional peripheral structural pain management. Our clinical model assigns Movement Dysfunction as the primary cause for low back pain symptoms and restores it with Movement Therapy focused rehabilitation which is also defined. Patients were derived from a tertiary single neurosurgical specialist practice in Brisbane Australia over a three year period. Severe pain and disability measurements more than halved and only 13% of patients ceased ketamine prematurely due to predominantly non-sinister side effects common to all pharmaceutical therapies. All other surveyed metrics of utility were highly favourable in this challenging cohort of chronic back pain patients biased to poor outcomes. Outpatient ketamine maintains high efficacy and safety used in conjunction with a unique clinical model that describes chronic low back pain. This paper builds on our previous publications that describe the disease of movement dysfunction as an integral factor to the development of a cause based clinical model for the condition of chronic low back pain symptoms. Our clinical application of this model, applying the necessary dual approach of controlling symptoms arising from peripheral structural pain and central functional pain in conjunction with elimination of root causation has shown favourable outcomes in patients with high levels of pain and disability based on their tertiary referral origin and high Oswestry Disability Scores. Removing chronic low back pain from its position as one of the world's leading causes of pain and disability is more likely if the rehabilitation industry can replicate and test treatment algorithms based around established clinical models of disease which is the important subject of this paper. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources. Design/methodology/approach: An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study's objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach. Findings: The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources. Originality/value: The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Methods: Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Results: Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. Conclusions: This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD. [ABSTRACT FROM AUTHOR]

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture. [ABSTRACT FROM AUTHOR]

Online health consultations are becoming more popular as a result of technological improvements. Patients routinely look for information about medical disorders online, which could jeopardize the privacy of medical records and increase the workload of healthcare professionals. Nonetheless, academics continue to be extremely concerned about issues related to the quality characteristics that relate to the current architectural models, such as energy consumption, latency, resource utilization, scalability, and packet loss. This method, however, also results in a significant strain being placed on medical experts who must sort through vast amounts of medical records to extract certain information. This paper presents a novel ciphertext policy attribute-based encryption method coupled with fuzzy logic to overcome these issues. This solution uses a hybrid structure of IPFS and blockchain to store data and enables complex bidirectional access control. Before being added to IPFS, medical records are encrypted. To ensure data integrity, related IPFS hash indexes are then added to the blockchain. Utilizing attribute-based technology, users' data is encrypted to give them fine-grained bidirectional access control. A thorough security analysis proves the system's resilience, especially when faced with chosen plaintext assaults inside the random oracle model. Tests for this study were conducted using 10–50 attribute sets. This paper's technique solely makes use of a hash operation. All things considered; the study demonstrates that the proposed design is more efficient than earlier schemes. Thus, from the comparison study above, it can be concluded that the system presented in this work is more efficient. Results from simulations provide additional support for the suggested methodology by highlighting the improved computing efficiency of users as compared to baseline conventional systems. This study demonstrates how technological advancement and healthcare requirements can coexist harmoniously, paving the way for secure and effective online medical consultations that are powered by fuzzy logic. [ABSTRACT FROM AUTHOR]

Objective: Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods: Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results: Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate–high concordance overall (range, 77–96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion: While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence. What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers. [ABSTRACT FROM AUTHOR]

Background: Parenting-related leave policies have gained increasing endorsement across Organisation for Economic Co-operation and Development (OECD) countries in recent decades. Previous reviews have focused on the short-term impacts and found predominantly positive effects on children. Although there is a growing interest in the long-term impact during adolescence and young adulthood, a comprehensive assessment of this aspect is currently lacking. Methods: We systematically reviewed studies from three electronic databases (Scopus, Web of Science and PubMed), which used quasi-experimental design and examined policies legislating the introduction or expansion of parenting-related leave policies in North America or Europe. We looked at studies focused on well-being beyond the age of 12 and analyzed the findings across different domains of well-being: health, education and labour market outcomes. Results: The quasi-experimental evidence is rather limited. The introduction of leave policies or gender-specific quotas produces substantial benefits in the long run. Further, maternal socioeconomic and educational background appears to play a substantial moderating role between leave and adolescents' well-being. Adolescents with mothers who have higher levels of education have demonstrated a more pronounced advantage from the extended time spent together, thereby accentuating pre-existing disparities. Conclusions: Though the expansion of already long leaves might not generate significant outcomes, the introduction of leave policies or gender-specific quotas produces substantial long-term benefits. This evidence entails considerable policy implications for countries that lack a national leave policy or offer only short durations of paid leave, such as the USA. [ABSTRACT FROM AUTHOR]