Search results for: antiracist healthcare delivery

Authors: Sabine Pau, Sophia Volz, Emanuel Bauer, Amelie De Gregorio, Frank Reister, Wolfgang Janni, Florian Ebner

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Purpose: The umbilical cord pH is a well evaluated contributor for prediction of neonatal outcome. This study correlates nenonatal umbilical cord pH with the weekday of delivery, the time of birth as well as the staff hand over times (midwifes and doctors). Material and Methods: This retrospective study included all deliveries of a 20 year period (1994-2014) at our primary obstetric center. All deliveries with a newborn cord pH under 7,20 were included in this analysis (6929 of 48974 deliveries (14,4%)). Further subgroups were formed according to the pH (< 7,05; 7,05 – 7,09; 7,10 – 7,14; 7,15 – 7,19). The data were then separated in day- and night time (8am-8pm/8pm-8am) for a first analysis. Finally, handover times were defined at 6 am – 6.30 am, 2 pm -2.30 pm, 10 pm- 10.30 pm (midwives) and for the doctors 8-8.30 am, 4 – 4.30 pm (Monday- Thursday); 2 pm -2.30 pm (Friday) and 9 am – 9.30 am (weekend). Routinely a shift consists of at least three doctors as well as three midwives. Results: During the last 20 years, 6929 neonates were born with an umbilical cord ph < 7,20 ( < 7,05 : 7,1%; 7,05 – 7,09 : 10,9%; 7,10 – 7,14 : 30,2%; 7,15 – 7,19:51,8%). There was no significant difference between either night/day delivery (p = 0.408), delivery on different weekdays (p = 0.253), delivery between Monday to Thursday, Friday and the weekend (p = 0.496 ) or delivery during the handover times of the doctors as well as the midwives (p = 0.221). Even the standard deviation showed no differences between the groups. Conclusion: Despite an increased workload over the last 20 years, the standard of care remains high even during the handover times and night shifts. This applies for midwives and doctors. As the neonatal outcome depends on various factors, further studies are necessary to take more factors influencing the fetal outcome into consideration. In order to maintain this high standard of care, an adaption of work-load and changing conditions is necessary.

Keywords: delivery, fetal umbilical cord pH, day time, hand over times

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Authors: Felix E. Gbenoba, Opeyemi Dahunsi

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Self-instructional materials are at the heart of instructional delivery in Open and Distance Learning (ODL). The success of any ODL institution depends on the availability of instructional materials in quality and quantity. An ODL study material is expected to fully play the teacher plays in the face-to-face learning environment. In Nigeria, efforts to deliver ODL learning materials have been peculiarly challenging. Although researchers are unrelenting in hewing out ways to make ODL delivery in Africa generally and Nigeria in particular, meet the learners’ needs and acceptable global practices, the prospects of integrating instructional media into distance learning courses are largely unexplored. In the present study, we critically examine the prospects of integration of instructional media into ODL courses for pedagogic and other benefits it portends for delivery via the distance learning mode. Although efforts to integrate media in ODL have been recorded before now, the reality has not matched the expectation so far in Nigeria. This does not mean that the existing instructional materials have not produced any significant positive results in improving the overall learning (and teaching) experience in its institutions; it implies that increased integration as suggested here will further improve the experience as well as bring up the new challenges. Obstacles and problems of instructional materials and media development that could have affected the open educational resource initiatives are well established. The first aspect of this paper recalls the revolutionary strides that ODL brought to delivery of education in Nigeria particularly. The other aspect is on what instructional media are, their role, prospects and challenges for ODL in Nigeria; these are examined vis a vis the challenges of development, production and distribution of print instructional materials as the major format of instructional delivery at Nigeria’s only single mode ODL institution, NOUN. In the third aspect, we justify the need and benefits of integrating instructional media into the courses and make recommendations.

Keywords: instructional delivery, instructional media, ODL, media integration, Nigeria, self-instructional materials

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Authors: Josephine Aikpitanyi, Friday Okonofua, Lorrettantoimo, Sandy Tubeuf

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Every day, 800 women die from conditions related to pregnancy and childbirth, resulting in an estimated 300,000 maternal deaths worldwide per year. Over 99 percent of all maternal deaths occur in developing countries, with more than half of them occurring in sub-Saharan Africa. Nigeria being the most populous nation in sub-Saharan Africa bears a significant burden of worsening maternal and child health outcomes with a maternal mortality rate of 917 per 100,000 live births and child mortality rate of 117 per 1,000 live births. While several studies have documented that financial barriers disproportionately discourage poor women from seeking needed maternal and child healthcare, other studies have indicated otherwise. Evidence shows that there are instances where health facilities with skilled healthcare providers exist, and yet maternal, and child health outcomes remain abysmally low, indicating the presence of non-cognitive and behavioural factors that may affect the utilization of healthcare services. This study investigated the influence of locus of control and self-esteem on utilization of maternal and child healthcare services in Nigeria. Specifically, it explored the differences in utilization of antenatal care, skilled birth care, postnatal care, and child vaccination by women having an internal and external locus of control and women having high and low self-esteem. We collected information on non-cognitive traits of 1411 randomly selected women, along with information on utilization of the various indicators of maternal and child healthcare. Estimating logistic regression models for various components of healthcare services utilization, we found that women’s internal locus of control was a significant predictor of utilization of antenatal care, skilled birth care, and completion of child vaccination. We also found that having high self-esteem was a significant predictor of utilization of antenatal care, postnatal care, and completion of child vaccination after adjusting for other control variables. By improving our understanding of non-cognitive traits as possible barriers to maternal and child healthcare utilization, our findings offer important insights for enhancing participant engagement in intervention programs that are initiated to improve maternal and child health outcomes in low-and-middle-income countries.

Keywords: behavioural economics, health-seeking behaviour, locus of control and self-esteem, maternal and child healthcare, non-cognitive traits, and healthcare utilization

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Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

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Authors: Huawei Ma, Wencai Du, Shengbin Liang

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Smart Home Healthcare technologies for the elderly represent a transformative paradigm that leverages emerging technologies to provide the elderly’ health indicators and daily life monitoring, emergency calls, environmental monitoring, behavior perception, and other services to ensure the health and safety of the elderly who are aging in their own home. However, the excessive complexity in the main adopted framework has affected the acceptance and adoption of the elderly. Therefore, this paper proposes a lightweight synergy architecture of IoT data and service for elderly home smart health environment. It includes the modeling of IoT applications and their workflows, data interoperability, interaction, and storage paradigms to meet the growing needs of older people so that they can lead an active, fulfilling, and quality life.

Keywords: smart home healthcare, IoT, independent living, lightweight framework

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Authors: Raed Alsufyani, Hissam Tawfik, Victor Chang, Muthu Ramachandran

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This study investigates the factors that influence the decision by players in the healthcare sector to embrace Cloud Business Intelligence Technology with a focus on healthcare organizations in Saudi Arabia. To bring this matter into perspective, this study primarily considers the Technology-Organization-Environment (TOE) framework and the Human Organization-Technology (HOT) fit model. A survey was hypothetically designed based on literature review and was carried out online. Quantitative data obtained was processed from descriptive and one-way frequency statistics to inferential and regression analysis. Data were analysed to establish factors that influence the decision to adopt Cloud Business intelligence technology in the healthcare sector. The implication of the identified factors was measured, and all assumptions were tested. 66.70% of participants in healthcare organization backed the intention to adopt cloud business intelligence system. 99.4% of these participants considered security concerns and privacy risk have been the most significant factors in the adoption of cloud Business Intelligence (CBI) system. Through regression analysis hypothesis testing point that usefulness, service quality, relative advantage, IT infrastructure preparedness, organization structure; vendor support, perceived technical competence, government support, and top management support positively and significantly influence the adoption of (CBI) system. The paper presents quantitative phase that is a part of an on-going project. The project will be based on the consequences learned from this study.

Keywords: cloud computing, business intelligence, HOT-fit model, TOE, healthcare and innovation adoption

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Authors: Teo Hao Jing, Shane Ho Ken Wae, Lee Jin Yu, Burra Venkata Durga Kumar

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Current distributed healthcare systems face the challenge of interoperability of health data. Storing electronic health records (EHR) in local databases causes them to be fragmented. This problem is aggravated as patients visit multiple healthcare providers in their lifetime. Existing solutions are unable to solve this issue and have caused burdens to healthcare specialists and patients alike. Blockchain technology was found to be able to increase the interoperability of health data by implementing digital access rules, enabling uniformed patient identity, and providing data aggregation. Consortium blockchain was found to have high read throughputs, is more trustworthy, more secure against external disruptions and accommodates transactions without fees. Therefore, this paper proposes a blockchain-based model for data management applications. In this model, a consortium blockchain is implemented by using a delegated proof of stake (DPoS) as its consensus mechanism. This blockchain allows collaboration between users from different organizations such as hospitals and medical bureaus. Patients serve as the owner of their information, where users from other parties require authorization from the patient to view their information. Hospitals upload the hash value of patients’ generated data to the blockchain, whereas the encrypted information is stored in a distributed cloud storage.

Keywords: blockchain technology, data management applications, healthcare, interoperability, delegated proof of stake

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Authors: Samarpreet Singh, Gerald Giesbrecht

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Both c-section and antibiotic exposure are linked to gut microbiota imbalance in infants. Such disturbance is associated with the Hypothalamic-Pituitary-Adrenal (HPA) axis function. However, the literature only has contradicting evidence for the association between c-sections and the HPA axis. Therefore, this study aims to test if the mode of delivery and antibiotics exposure is associated with the HPA axis. Also, whether exposure to both interacts with the HPA-axis. It was hypothesized that associations and interactions would be observed. Secondary data analysis was used for this co-relational study. Data for the mode of delivery and antibiotics exposure variables were documented from hospital records or self-questionnaires. In addition, cortisol levels (Area under the curve with respect to increasing (AUCi) and Area under the curve with respect to ground (AUCg)) were based on saliva collected from three months old during the infant’s visit to the lab and after drawing blood. One-way and between-subject ANOVA analyses were run on data. No significant association between delivery mode and infant cortisol level was found, AUCi and AUCg, p > .05. Only the infant’s AUCg was found to be significantly higher if there were antibiotics exposure at delivery (p = .001) or their mothers were exposed during pregnancy (p < .05). Infants born by c-section and exposed to antibiotics at three months had higher AUCi than those born vaginally, p < .02. These results imply that antibiotic exposure before three months is associated with an infant’s stress response. The association might increase if antibiotic exposure occurs three months after a c-section birth. However, more robust and causal evidence in future studies is needed, given a variable group’s statistically weak sample size. Nevertheless, the results of this study still highlight the unintended consequences of antibiotic exposure during delivery and pregnancy.

Keywords: HPA-axis, antibiotics, c-section, gut-microbiota, development, stress

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Authors: Alex Kiselyov, Suehyun Cho, Darrell Harrington; Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Michael Shpigelmacher

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Despite the most aggressive surgical and adjuvant therapeutic strategies, treatment of both pediatric and adult brainstem tumors remains problematic. Novel strategies, including targeted biologics, immunotherapy, and specialized delivery systems such as convection-enhanced delivery (CED), have been proposed. While some of these novel treatments are entering phase I trials, the field is still in need of treatment(s) that exhibits dramatically enhanced potency with optimal therapeutic ratio. Bionaut Labs has developed a modular microrobotic platform for performing localized delivery of diverse therapeutics in vivo. Our biocompatible particles (Bionauts™) are externally propelled and visualized in real-time. Bionauts™ are specifically designed to enhance the effect of radiation therapy via anatomically precise delivery of a radiosensitizing agent, as exemplified by temozolomide (TMZ) and Avastin™ to the brainstem gliomas of diverse origin. The treatment protocol is designed to furnish a better therapeutic outcome due to the localized (vs systemic) delivery of the drug to the neoplastic lesion(s) for use as a synergistic combination of radiation and radiosensitizing agent. In addition, the procedure is minimally invasive and is expected to be appropriate for both adult and pediatric patients. Current progress, including platform optimization, selection of the lead radiosensitizer as well as in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of porcine and ovine models, will be discussed.

Keywords: Bionaut, brainstem, glioma, local delivery, micro-robot, radiosensitizer

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Authors: Jiahui Yang, John Quigley, Lesley Walls

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In this paper, the authors develop a stochastic model regarding the investment in supplier delivery performance development from a buyer’s perspective. The authors propose a multivariate model through a Multinomial-Dirichlet distribution within an Empirical Bayesian inference framework, representing both the epistemic and aleatory uncertainties in deliveries. A closed form solution is obtained and the lower and upper bound for both optimal investment level and expected profit under uncertainty are derived. The theoretical properties provide decision makers with useful insights regarding supplier delivery performance improvement problems where multiple delivery statuses are involved. The authors also extend the model from a single supplier investment into a supplier portfolio, using a Lagrangian method to obtain a theoretical expression for an optimal investment level and overall expected profit. The model enables a buyer to know how the marginal expected profit/investment level of each supplier changes with respect to the budget and which supplier should be invested in when additional budget is available. An application of this model is illustrated in a simulation study. Overall, the main contribution of this study is to provide an optimal investment decision making framework for supplier development, taking into account multiple delivery statuses as well as multiple projects.

Keywords: decision making, empirical bayesian, portfolio optimization, supplier development, supply chain management

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Authors: Itamir de Morais Barroca Filho, Cephas A. S. Barreto, Ramon Malaquias, Cezar Miranda Paula de Souza, Arthur Costa Gorgônio, João C. Xavier-Júnior, Mateus Firmino, Fellipe Matheus Costa Barbosa

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Information and Communication Technologies (ICT) in healthcare are crucial for efficiently delivering medical healthcare services to patients. These ICTs are also known as e-health and comprise technologies such as electronic record systems, telemedicine systems, and personalized devices for diagnosis. The focus of e-health is to improve the quality of health information, strengthen national health systems, and ensure accessible, high-quality health care for all. All the data gathered by these technologies make it possible to help clinical staff with automated decisions using machine learning. In this context, we collected patient data, such as heart rate, oxygen saturation (SpO2), blood pressure, respiration, and others. With this data, we were able to develop machine learning models for patients’ risk of death and estimate the length of stay in ICU beds. Thus, this paper presents the methodology for applying machine learning techniques to develop these models. As a result, although we implemented these models on an IoT healthcare platform, helping clinical staff in healthcare in an ICU, it is essential to create a robust clinical validation process and monitoring of the proposed models.

Keywords: ICT, e-health, machine learning, ICU, healthcare

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Authors: Nihar Bheda

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Protecting digital assets such as networks, systems, and data from advanced cyber threats is the aim of Digital Immunity Systems (DIS), which are a subset of cybersecurity. With features like continuous monitoring, coordinated reactions, and long-term adaptation, DIS seeks to mimic biological immunity. This minimizes downtime by automatically identifying and eliminating threats. Traditional security measures, such as firewalls and antivirus software, are insufficient for enterprises, such as healthcare providers, given the rapid evolution of cyber threats. The number of medical record breaches that have occurred in recent years is proof that attackers are finding healthcare data to be an increasingly valuable target. However, obstacles to enhancing security include outdated systems, financial limitations, and a lack of knowledge. DIS is an advancement in cyber defenses designed specifically for healthcare settings. Protection akin to an "immune system" is produced by core capabilities such as anomaly detection, access controls, and policy enforcement. Coordination of responses across IT infrastructure to contain attacks is made possible by automation and orchestration. Massive amounts of data are analyzed by AI and machine learning to find new threats. After an incident, self-healing enables services to resume quickly. The implementation of DIS is consistent with the healthcare industry's urgent requirement for resilient data security in light of evolving risks and strict guidelines. With resilient systems, it can help organizations lower business risk, minimize the effects of breaches, and preserve patient care continuity. DIS will be essential for protecting a variety of environments, including cloud computing and the Internet of medical devices, as healthcare providers quickly adopt new technologies. DIS lowers traditional security overhead for IT departments and offers automated protection, even though it requires an initial investment. In the near future, DIS may prove to be essential for small clinics, blood banks, imaging centers, large hospitals, and other healthcare organizations. Cyber resilience can become attainable for the whole healthcare ecosystem with customized DIS implementations.

Keywords: digital immunity system, cybersecurity, healthcare data, emerging technology

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Authors: Rinat Gabbay-Benziv, Merav Ben-Natan, Ariel Roguin, Benyamine Abbou, Anna Ofir, Adi Klein, Dikla Dahan-Shriki, Mordechai Hallak, Boris Kessel, Mickey Dudkiewicz

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Introduction: Over recent decades, technology has become integral to healthcare, with electronic health records and advanced medical equipment now standard. However, this reliance has made healthcare systems increasingly vulnerable to ransomware attacks. On October 13, 2021, Hillel Yaffe Medical Center experienced a severe ransomware attack that disrupted all IT systems, including electronic health records, laboratory services, and staff communications. The attack, carried out by the group DeepBlueMagic, utilized advanced encryption to lock the hospital's systems and demanded a ransom. This incident caused significant operational and patient care challenges, particularly impacting the obstetrics department. Objective: The objective is to describe the challenges facing the obstetric division following a cyberattack and discuss ways of preparing for and overcoming another one. Methods: A retrospective descriptive study was conducted in a mid-sized medical center. Division activities, including the number of deliveries, cesarean sections, emergency room visits, admissions, maternal-fetal medicine department occupancy, and ambulatory encounters, from 2 weeks before the attack to 8 weeks following it (a total of 11 weeks), were compared with the retrospective period in 2019 (pre-COVID-19). In addition, we present the challenges and adaptation measures taken at the division and hospital levels leading up to the resumption of full division activity. Results: On the day of the cyberattack, critical decisions were made. The media announced the event, calling on patients not to come to our hospital. Also, all elective activities other than cesarean deliveries were stopped. The number of deliveries, admissions, and both emergency room and ambulatory clinic visits decreased by 5%–10% overall for 11 weeks, reflecting the decrease in division activity. Nevertheless, in all stations, there were sufficient activities and adaptation measures to ensure patient safety, decision-making, and workflow of patients were accounted for. Conclusions: The risk of ransomware cyberattacks is growing. Healthcare systems at all levels should recognize this threat and have protocols for dealing with them once they occur.

Keywords: ransomware attack, healthcare cybersecurity, obstetrics challenges, IT system disruption

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Authors: Tianyi Wang, Hieyong Jeong, An Guo, Yuko Ohno

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Healthcare robot for assisting sit-to-stand (STS) performance had aroused numerous research interests. To author’s best knowledge, knowledge about how evaluating healthcare robot is still unknown. Robot should be labeled as fault if users feel demanding during STS when they are assisted by robot. In this research, we aim to propose a method to evaluate sit-to-stand assist robot through center of pressure (CoP), then classify different STS performance. Experiments were executed five times with ten healthy subjects under four conditions: two self-performed STSs with chair heights of 62 cm and 43 cm, and two robot-assisted STSs with chair heights of 43 cm and robot end-effect speed of 2 s and 5 s. CoP was measured using a Wii Balance Board (WBB). Bayesian classification was utilized to classify STS performance. The results showed that faults occurred when decreased the chair height and slowed robot assist speed. Proposed method for fault classification showed high probability of classifying fault classes form others. It was concluded that faults for STS assist robot could be detected by inspecting center of pressure and be classified through proposed classification algorithm.

Keywords: center of pressure, fault classification, healthcare robot, sit-to-stand movement

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Authors: Ringisai Abigail Mawondo-Dhliwayo, Kahilu Kajimo-Shakantu

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Due to financial challenges which governments in general face, it is becoming more difficult for many to continually use their limited resources to undertake infrastructural development. Governments increasingly now need other delivery approaches, in particular, the Public-Private Partnerships which make it possible for the public sector to achieve infrastructural development without incurring any/minimum cost. The literature reviewed outlined that benefits of PPPs include timely delivery of quality projects with cost limits. The methodology utilized for the empirical study comprised six interviews and sixty questionnaires which were undertaken and administered by construction consultants and government officials involved in PPPs projects. The results obtained showed that PPPs are not widely used in Zimbabwe although the need for their use exists. The study also found some challenges which prevent or derail the rate at which PPPs are utilized, of which the primary one was a political influence. It is concluded that despite limitations, PPPs remain the most effective and viable option for the delivery of government projects. The study recommends that policy and framework for the implementation of PPPs be developed. More useful information could have been obtained if final users of PPPs projects were included in the sample for data collection.

Keywords: construction projects, procurement, public private partnerships, public sector

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Authors: Yogita Patil-Sen

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Magnetic nanoparticles such as those made of iron oxide have been widely explored as biocatalysts, contrast agents, and drug delivery systems. However, some of the challenges associated with these particles are agglomeration and biocompatibility, which lead to concern of toxicity of the particles, especially for drug delivery applications. Coating the particles with biocompatible materials such as lipids and peptides have shown to improve the mentioned issues. Thus, these core-shell type nanoparticles are emerging as the new class of nanomaterials for targeted drug delivery applications. In this study, various types of core-shell magnetic nanoparticles are prepared and characterized using techniques, such as Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Vibrating Sample Magnetometer (VSM) and Thermogravimetric Analysis (TGA). The heating ability of nanoparticles is tested under oscillating magnetic field. The efficacy of the nanoparticles as drug carrier is also investigated. The loading of an anticancer drug, Doxorubicin at 18 °C is measured up to 48 hours using UV-visible spectrophotometer. The drug release profile is obtained under thermal incubation condition at 37 °C and compared with that under the influence of oscillating field. The results suggest that the core-shell nanoparticles exhibit superparamagnetic behaviour, although, coating reduces the magnetic properties of the particles. Both the uncoated and coated particles show good heating ability, again it is observed that coating decreases the heating behaviour of the particles. However, coated particles show higher drug loading efficiency than the uncoated particles and the drug release is much more controlled under the oscillating magnetic field. Thus, the results strongly indicate the suitability of the prepared core-shell type nanoparticles as drug delivery vehicles and their potential in magnetic hyperthermia applications and for hyperthermia cancer therapy.

Keywords: core-shell, hyperthermia, magnetic nanoparticles, targeted drug delivery

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Authors: Qing Wu, Xuchun Ye, Kirsten Corazzini

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Objective: It is increasingly recognized that patients’ rational and meaningful engagement in healthcare could make important contributions to their health care and safety management. However, recent evidence indicated that patients' actual roles in healthcare didn’t match their desired roles, and many patients reported a less active role than desired, which suggested that patient engagement in healthcare may be influenced by various factors. This study aimed to analyze influencing factors on patient engagement and explore the influence mechanism, which will be expected to contribute to the strategy development of patient engagement in healthcare. Methods: On the basis of analyzing the literature and theory study, the research framework was developed. According to the research framework, a cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale, Facilitation of Patient Involvement Scale and Wake Forest Physician Trust Scale, and other influencing factor related scales. A convenience sample of 580 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province, and Zhejiang Province. Results: The results of the cross-sectional survey indicated that the mean score for the patient engagement behavior was (4.146 ± 0.496), and the mean score for the willingness was (4.387 ± 0.459). The level of patient engagement behavior was inferior to their willingness to be involved in healthcare (t = 14.928, P ＜ 0.01). The influencing mechanism model of patient engagement in healthcare was constructed by the path analysis. The path analysis revealed that patient attitude toward engagement, patients’ perception of facilitation of patient engagement and health literacy played direct prediction on the patients’ willingness of engagement, and standard estimated values of path coefficient were 0.341, 0.199, 0.291, respectively. Patients’ trust in physician and the willingness of engagement played direct prediction on the patient engagement, and standard estimated values of path coefficient were 0.211, 0.641, respectively. Patient attitude toward engagement, patients’ perception of facilitation and health literacy played indirect prediction on patient engagement, and standard estimated values of path coefficient were 0.219, 0.128, 0.187, respectively. Conclusions: Patients engagement behavior did not match their willingness to be involved in healthcare. The influencing mechanism model of patient engagement in healthcare was constructed. Patient attitude toward engagement, patients’ perception of facilitation of engagement and health literacy posed indirect positive influence on patient engagement through the patients’ willingness of engagement. Patients’ trust in physician and the willingness of engagement had direct positive influence on the patient engagement. Patient attitude toward engagement, patients’ perception of physician facilitation of engagement and health literacy were the factors influencing the patients’ willingness of engagement. The results of this study provided valuable evidence on guiding the development of strategies for promoting patient rational and meaningful engagement in healthcare.

Keywords: healthcare, patient engagement, influencing factor, the mechanism

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Authors: Ashish Jain, Shivam Tayal

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There has been great interest in the field of Iontophoresis since few years due to its great applications in the field of controlled transdermal drug delivery system. It is an technique which is used to enhance the transdermal permeation of ionized high molecular weight molecules across the skin membrane especially Peptides & Proteins by the application of direct current of 1-4 mA for 20-40 minutes whereas chemical must be placed on electrodes with same charge. Iontophoresis enhanced the delivery of drug into the skin via pores like hair follicles, sweat gland ducts etc. rather than through stratum corneum. It has wide applications in the field of experimental, Therapeutic, Diagnostic, Dentistry etc. Medical science is using it to treat Hyperhidrosis (Excessive sweating) in hands and feet and to treat other ailments like hypertension, Migraine etc. Nowadays commercial transdermal iontophoretic patches are available in the market to treat different ailments. Researchers are keen to research in this field due to its vast applications and advantages.

Keywords: iontophoresis, novel drug delivery, transdermal, permeation enhancer

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Authors: Flavia Laffleur

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Summary: Biomaterials have gained immense interest in the pharmaceutical research in the last decades. Hyaluronic acid a carbohydrate and mucopolysaccharide was chemically modified in order to achieve and establish a promising platform for buccal drug delivery. Aim: Novel biomaterial was tested for its potential for buccal drug delivery. Background: Polysaccharide hyaluronic acid (HA) was chemically modified with cysteine ethyl ether (CYS). By immobilization of the thiol-bearing ligand on the polymeric backbone the thiolated bioconjugate HA-CYS was obtained. Methodology: Mucoadhesive, permeation enhancing and stability potential as well as mechanical, physicochemical properties further mucoadhesive strength, swelling index and residence time were investigated. The developed thiolated bioconjugate displayed enhanced mucoadhesiveness on buccal mucosa as well as permeation behavior and polymer stability. The near neutral pH and negative cytotoxicity studies indicated their non-irritability and biocompatible nature with biological tissues. Further, the model drug sulforhodamine 101 was incorporated to determine its drug release profiles. Results: The synthesized thiomer showed no toxicity. The mucoadhesion of thiolated hyaluronic acid on buccal mucosa was significantly improved in comparison to unmodified one. The biomaterial showed 2.5-fold higher stability in polymer structure. The release of sulforhodamine in the presence of thiolated hyaluronic acid was 2.3-fold increased compared to hyaluronic acid. Conclusion: Thus, the promising results encourage further investigations and exploitation of this versatile polysaccharide. So far, hyaluronic acid was not evaluated for buccal drug delivery.

Keywords: buccal delivery, hyaluronic acid, mucoadhesion, thiomers

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Authors: Hend Albassam, Nouf Alrumaih

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Nowadays we are in the age of technologies and communication and there is no doubt that technologies such as the Internet can offer many advantages for many business fields, and the health field is no execution. In fact, using the Internet provide us with a new path to improve the quality of health care throughout the world. The e-healthcare offers many advantages such as: efficiency by reducing the cost and avoiding duplicate diagnostics, empowerment of patients by enabling them to access their medical records, enhancing the quality of healthcare and enabling information exchange and communication between healthcare organizations. There are many problems that result from using papers as a way of communication, for example, paper-based prescriptions. Usually, the doctor writes a prescription and gives it to the patient who in turn carries it to the pharmacy. After that, the pharmacist takes the prescription to fill it and give it to the patient. Sometimes the pharmacist might find difficulty in reading the doctor’s handwriting; the patient could change and counterfeit the prescription. These existing problems and many others heighten the need to improve the quality of the healthcare. This project is set out to develop a distributed e-healthcare system that offers some features of e-health and addresses some of the above-mentioned problems. The developed system provides an electronic health record (EHR) and enables communication between separate health care organizations such as the clinic, pharmacy and laboratory. To develop this system, the Service Oriented Architecture (SOA) is adopted as a design approach, which helps to design several independent modules that communicate by using web services. The layering design pattern is used in designing each module as it provides reusability that allows the business logic layer to be reused by different higher layers such as the web service or the website in our system. The experimental analysis has shown that the project has successfully achieved its aims toward solving the problems related to the paper-based healthcare systems and it enables different health organization to communicate effectively. It implements four independent modules including healthcare provider, pharmacy, laboratory and medication information provider. Each module provides different functionalities and is used by a different type of user. These modules interoperate with each other using a set of web services.

Keywords: e-health, services oriented architecture (SOA), web services, interoperability

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Authors: Samawi Zepure, Beck Christine, Gallagher Peg

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This community immersion employs the NLN Excellence Model which challenges nursing programs to create student-centered, interactive, and innovative experiences to prepare students for roles in providing high quality care, effective teaching, and leadership in the delivery of nursing services to individuals, families, and communities (NLN, 2006). Senior nursing students collaborate with ethnically and linguistically diverse participants at community-based sites and develop leadership roles of coordination of care linkage within the larger healthcare system, adherence, and self-care management. The immersion encourages students to develop competencies of the NLN Nursing Education Competencies Model (NLN, 2012), proposed to address fast changes in health care delivery, which include values of caring, diversity, and holism; and integrating concepts of context and environment, relationship, and teamwork. Students engage in critical thinking and leadership as they: 1) assess health/illness beliefs, values, attitudes, and practices, explore community resources, interview key informants, and collaborate with community participants to identify learning goals, 2) develop and implement appropriate holistic health promotion and disease prevention teaching interventions promoting continuity, sustainability, and innovation, 3) evaluate interventions through participant feedback and focus groups and, 4) reflect on the immersion experience and future professional role as advocate and citizen.

Keywords: quality of care, health of communities, students as leaders, health promotion

Procedia PDF Downloads 159

Authors: Abdessamad Dali-Ali, Houaria Beldjillali, Fouzia Agag, Asmaa Oukebdane, Ramzi Tidjani, Arslane Bettayeb, Khadidja Meddeber, Radia Dali-Yahia, Nori Midoun

Abstract:

Healthcare-associated infections are a real public health problem, especially in intensive care units. The aim of our study was to describe the epidemiological profile and to estimate the incidence of these infections at the intensive care unit of our teaching hospital. A prospective study was conducted, from June 2012 to December 2013. During this period, 305 patients having a duration of hospitalization equal or more than 48 hours were included in the study. In terms of the incidence of healthcare associated infections, nosocomial pneumonia occupied the first position with a cumulative incidence rate of 20.0%, followed by bacteremia (5.6%), central venous catheter infections (4%), and urinary tract infections (3%). In the case of isolated microorganisms, Gram-negative bacilli not enterobacteriaceae occupied the first place with 48.5%, followed by enterobacteria (32.1%). Acinetobacter baumannii was the most common germ (27.6%). Our study showed that the rate of health-care-associated infections was relatively high in the intensive care unit. A control program to reduce all infections is a priority for the Infection Control Associated Committee.

Keywords: epidemiological profile, healthcare associated infections, intensive care units, teaching hospital of Oran, Algeria

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Authors: Sanjay Kumar Behera, Kanhu Charan Patra

Abstract:

A GIS-based method has been applied for the determination of soil erosion and sediment yield in a small watershed in Ong River basin, Odisha, India. The method involves spatial disintegration of the catchment into homogenous grid cells to capture the catchment heterogeneity. The gross soil erosion in each cell was calculated using Universal Soil Loss Equation (USLE) by carefully determining its various parameters. The concept of sediment delivery ratio is used to route surface erosion from each of the discretized cells to the catchment outlet. The process of sediment delivery from grid cells to the catchment outlet is represented by the topographical characteristics of the cells. The effect of DEM resolution on sediment yield is analyzed using two different resolutions of DEM. The spatial discretization of the catchment and derivation of the physical parameters related to erosion in the cell are performed through GIS techniques.

Keywords: DEM, GIS, sediment delivery ratio, sediment yield, soil erosion

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Authors: Mohd Zuhair, Ram Babu Roy

Abstract:

This paper presents an overview of the accessibility, design, and functioning of health insurance plans launched by state governments in India. In recent years, the governments of several states in India have come forward to provide health insurance coverage for the low-income group and rural population to reduce the out of pocket expenditure (OPE) on healthcare. Different health insurance schemes have different structures and offerings which differ in the different demographic factors. This study will portray a comparative analysis of the various health insurance schemes by analyzing different offerings and finance generation of the schemes. The comparative analysis will explain the lesson to be learned from these schemes and extend the existing knowledge of the health insurance in India. This would help in recognizing tension between various drivers and identifying issues pertaining to the sustainability of health insurance schemes in India.

Keywords: health insurance, out of pocket expenditure, universal healthcare, sustainability

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Authors: Abeer Amayri, Akif A. Bulgak

Abstract:

Due to today’s globalization as well as outsourcing practices of the companies, the Supply Chain (SC) performances have become more dependent on the efficient movement of material among places that are geographically dispersed, where there is more chance for disruptions. One such disruption is the quality and delivery uncertainties of outsourcing. These uncertainties could lead the products to be unsafe and, as is the case in a number of recent examples, companies may have to end up in recalling their products. As a result of these problems, there is a need to develop a methodology for selecting suppliers globally in view of risks associated with low quality and late delivery. Accordingly, we developed a two-stage stochastic model that captures the risks associated with uncertainty in quality and delivery as well as a solution procedure for the model. The stochastic model developed simultaneously optimizes supplier selection and purchase quantities under price discounts over a time horizon. In particular, our target is the study of global organizations with multiple sites and multiple overseas suppliers, where the pricing is offered in suppliers’ local currencies. Our proposed methodology is applied to a case study for a US automotive company having two assembly plants and four potential global suppliers to illustrate how the proposed model works in practice.

Keywords: global supply chains, quality, stochastic programming, supplier selection

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Authors: Yaw Opoku-Damoah, Run Zhang, Hang Thu Ta, Zhi Ping Xu

Abstract:

Gas therapy is still at an early stage of research and development. Even though most gasotransmitters have proven their therapeutic potential, their handling, delivery, and controlled release have been extremely challenging. This research work employs a versatile nanosystem that is capable of delivering a gasotransmitter in the form of a photo-responsive carbon monoxide-releasing molecule (CORM) for targeted cancer therapy. The therapeutic action was mediated by upconversion nanoparticles (UCNPs) designed to transfer bio-friendly low energy near-infrared (NIR) light to ultraviolet (UV) light capable of triggering carbon monoxide (CO) from a water-soluble amphiphilic manganese carbonyl complex CORM incorporated into a carefully designed lipid drug delivery system. Herein, gaseous CO that plays a role as a gasotransmitter with cytotoxic and homeostatic properties was investigated to instigate cellular apoptosis. After successfully synthesizing the drug delivery system, the ability of the system to encapsulate and mediate the sustained release of CO after light excitation was demonstrated. CO fluorescence probe (COFP) was successfully employed to determine the in vitro drug release profile upon NIR light irradiation. The uptake of nanoparticles enhanced by folates and its receptor interaction was also studied for cellular uptake purposes. The anticancer potential of the final lipid nanoparticle Lipid/UCNPs/CORM/FA (LUCF) was also determined by cell viability assay. Intracellular CO release and a subsequent therapeutic action involving ROS production, mitochondrial damage, and CO production was also evaluated. In all, this current project aims to use in vitro studies to determine the potency and efficiency of a NIR-mediated CORM prodrug delivery system.

Keywords: carbon monoxide-releasing molecule, upconversion nanoparticles, site-specific delivery, amphiphilic manganese carbonyl complex, prodrug delivery system.

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Authors: Suyeon Kwon, Ik Joong Kang, Wang Bingjie

Abstract:

Chitosan is a polymer that is usually produced from N-deacetylation of chitin. It is emerging as a promising biocompatible polymer that is harmless to humans. For the reason that many merits such as good adsorptive, biodegradability, many researches are being done on the chitosan for drug delivery system. Drug delivery system (DDS) has been developed for the control of drug. It makes the drug can be delivered effectively and safely into the targeted human body. The drug used in this work is hydrocortisone that is used in Rheumatism, skin diseases, allergy treatment. In this work, hydrocortisone was used to make allergic rhinitis medicine. Our study focuses on drug delivery through the nasal mucosa by using hydrocortisone impregnated chitosan nanoshells. This study has performed an investigation in order to establish the optimal conditions, changing concentration, quantity of hydrocortisone. DLS, SEM, TEM, FT-IR, UV spectrum were used to analyze the manufactured chitosan-hydrocortisone silver nanoshell and silver nanoshell, whose function as drug carriers. This study has performed an investigation on new drug carriers and delivery routes for hydrocortisone. Various methods of manufacturing chitosan-hydrocortisone nanoshells were attempted in order to establish the optimal condition. As a result, the average size of chitosan-hydrocortisone silver nanoshell is about 80 nm. So, chitosan-hydrocortisone silver nanoshell is suitable as drug carriers because optimal size of drug carrier in human body is less than 120 nm. UV spectrum of Chitosan-hydrocortisone silver nanoshell shows the characteristic peak of silver nanoshell at 420 nm. Likewise, the average size of chitosan-hydrocortisone silver nanoshell is about 100nm. It is also suitable for drug carrier in human body. Also, multi-layered silver shell over chitosan nanoshells induced the red-shift of absorption peak and increased the intensity of absorption peak. The resultant chitosan–silver nanocomposites (or nanoshells) exhibited the absorption peak around 430nm attributed to silvershell formation. i.e. the absorption peak was red-shifted by ca. 40 nm in reference to 390 nm of silver nanoshells.

Keywords: chitosan, drug delivery, hydrocortisone, rhinitis, nanoshell

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Authors: Kirstin Griffin

Abstract:

During a period of increased anxiety and stress, communication became the essential tool to help the public stay informed and feel prepared during the Covid-19 pandemic. However, certain groups of patients were not feeling as reassured. The news and media blasted the message that patients with diabetes were “high-risk" in regards to contracting the Covid-19 infection. Routine clinics were being cancelled, GP practices were closing their doors, and patients with type 1 diabetes were understandably scared. The influx of calls to diabetes specialists nurses from concerned patients highlighted the need for better and more specialised information. An Application specifically for patients with type 1 diabetes was created to deliver this information, and it proved to be the essential communication tool that was desperately needed. The Application for patients with type 1 diabetes aimed to deliver specialist information to patients in regards to their diagnosis, management, and ongoing follow-up commitments. The Application gives practical advice on multiple areas of diabetes management, including sick-day rules and diabetic emergencies, as well as up-to-date information on technology, including setting up Libre devices and downloading glucose meters to facilitate attending virtual clinics. Delivery of this information in an easy-to-understand and comprehensive way is intended to improve patient engagement with diabetes services and ultimately empower patients in the control of their own disease. The application also offers a messaging service to allow the diabetes team to send out alerts to patient groups on specific issues, such as changes to clinics, or respond to recent news updates regarding Covid-19. The App was launched in NHS Fife in June 2020 and has amassed 800 active users so far. There is growing engagement with the App since its launch, with over 1000 user interactions in the last month alone. Feedback shows that 100% of users like the App and have found it useful in the management of their diabetes. The App has proven to be an essential tool in communication with one of the most vulnerable groups during the Covid-19 pandemic, and its ongoing development will continue to increase patient engagement and improve glycaemic control for patients with type 1 diabetes. The future of chronic disease management should involve digital solutions such as apps to further empower patients in their healthcare.

Keywords: diabetes, endocrinology, digital healthcare, medical apps

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Authors: Umair Shafique, Hafiz Usman Zia, Fiaz Majeed, Samina Naz, Javeria Ahmed, Maleeha Zainab

Abstract:

The Internet of Things (IoT) has become a hot topic for the last couple of years. This innovative technology has shown promising progress in various areas, and the world has witnessed exponential growth in multiple application domains. Researchers are working to investigate its aptitudes to get the best from it by harnessing its true potential. But at the same time, IoT networks open up a new aspect of vulnerability and physical threats to data integrity, privacy, and confidentiality. It's is due to centralized control, data silos approach for handling information, and a lack of standardization in the IoT networks. As we know, blockchain is a new technology that involves creating secure distributed ledgers to store and communicate data. Some of the benefits include resiliency, integrity, anonymity, decentralization, and autonomous control. The potential for blockchain technology to provide the key to managing and controlling IoT has created a new wave of excitement around the idea of putting that data back into the hands of the end-users. In this manuscript, we have proposed a model that combines blockchain and IoT networks to address potential security and privacy issues in the healthcare domain. Then we try to describe various application areas, challenges, and future directions in the healthcare sector where blockchain platforms merge with IoT networks.

Keywords: IoT, blockchain, cryptocurrency, healthcare, consensus, data

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Authors: Krishna Dahiya, Esha Charaya

Abstract:

Induction of labour is a common obstetrical intervention. Around 1 in every 4 patient undergo induction of labour for different indications Purpose: To study the efficacy of the combination of Foley bulb and vaginal misoprostol in comparison to vaginal misoprostol alone for cervical ripening and induction of labour. Methods: A prospective randomised study was conducted on 150 patients with term singleton pregnancy admitted for induction of labour. Seventy-five patients were induced with both Foley bulb, and vaginal misoprostol and another 75 were given vaginal misoprostol alone for induction of labour. Both groups were then compared with respect to change in Bishop score, induction to the active phase of labour interval, induction delivery interval, duration of labour, maternal complications and neonatal outcomes. Data was analysed using statistical software SPSS version 11.5. Tests with P,.05 were considered significant. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (2.99 ± 1.72 and 2.17 ± 1.48 respectively with statistically significant difference (p=0.001 S, 95% C.I. -0.1978 to 0.8378). Mean induction to delivery interval was significantly lower in the combination group (11.76 ± 5.89 hours) than misoprostol group (14.54 ± 7.32 hours). Difference was of 2.78 hours (p=0.018,S, 95% CI -5.1042 to -0.4558). Induction to delivery interval was significantly lower in nulliparous women of combination group (13.64 ± 5.75 hours) than misoprostol group (18.4±7.09 hours), and the difference was of 4.76 hours (p=0.002, S, 95% CI 1.0465 to 14.7335). There was no difference between the groups in the mode of delivery, infant weight, Apgar score and intrapartum complications. Conclusion: From the present study it was concluded that addition of Foley catheter to vaginal misoprostol have the synergistic effect and results in early cervical ripening and delivery. These results suggest that the combination may be used to achieve timely and safe delivery in the presence of an unfavorable cervix. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications.

Keywords: Bishop score, Foley catheter, induction of labor, misoprostol

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