Search results for: healthcare disparities

Authors: Temesgen Geremew Tefery

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Nanomaterials, due to their unique properties, have revolutionized the field of biosensing. Their functionalization, or modification with specific molecules, is crucial for enhancing their biocompatibility, selectivity, and sensitivity. This review explores recent advancements in nanomaterial functionalization for biosensing applications. We discuss various strategies, including covalent and non-covalent modifications, and their impact on biosensor performance. The use of biomolecules like antibodies, enzymes, and nucleic acids for targeted detection is highlighted. Furthermore, the integration of nanomaterials with different sensing modalities, such as electrochemical, optical, and mechanical, is examined. The future outlook for nanomaterial-based biosensing is promising, with potential applications in healthcare, environmental monitoring, and food safety. However, challenges related to biocompatibility, scalability, and cost-effectiveness need to be addressed. Continued research and development in this area will likely lead to even more sophisticated and versatile biosensing technologies.

Keywords: biosensing, nanomaterials, biotechnology, nanotechnology

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Authors: Adi Levy

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Military and security personnel defections during nonviolent resistance (NVR) campaigns are recognized as an effective way of undermining the regime’s power, but they also may generate moral dilemmas that contradict the moral standing of NVR tactics. NVR campaigns have been primarily praised for their adherence to moral and legal norms, yet some of NVR tactics raise serious ethical concerns. This paper focuses on NVR tactics that seek to promote defections and disobedience within military and security personnel to sustain their campaign. Academic literature regarding NVR tactics indicates that compared to violent forms of resistance, defections are more likely to occur when security forces confront nonviolent activists. Indeed, defections play a strategically fundamental role in nonviolent campaigns, particularly against authoritarian regimes, as it enables activists to undermine the regime’s central pillars of support. This study examines the events of the Arab Spring and discusses the ethical problems that arise in nonviolent activists’ promotion of defections and disobedience. The cases of Syria and Egypt suggest that the strategic promotion of defections and disobedience was significantly effective in sustaining the campaign. Yet, while such defections enhance nonviolent activists’ resilience, how they are promoted can be morally contentious and the consequences can be dire. Defections are encouraged by social, moral and emotional appeals that use the power disparities between unarmed civilians and powerful regimes to affect soldiers and security personnel’s process of decision-making. In what is commonly referred to as dilemma action, nonviolent activists deliberately entangle security forces in a moral dilemma that compels them to follow a moral code to protect unarmed civilians. In this way, activists sustain their struggle and even gain protection. Nonviolent activists are likely to be completely defeated when confronted with armed forces. Therefore they rely on the military and security personnel’s moral conscious of convincing them to refrain from using force against them. While this is effective, it also leaves soldiers and security forces exposed to the implications and punishments that might follow their disobedience or defection. As long as they remain nonviolent, activists enjoy civilian immunity despite using morally contentious tactics. But the severe implications brought upon defectors. As a result, demand a deep examination of this tactic’s moral permissibility and a discussion that assesses culpability for the moral implications of its application.

Keywords: culpability, defections, nonviolence, permissibility

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Authors: Arpit Patil, Atharav Bhagwat, Rajas Bhope, Pramod Bide

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This research integrates IoT and ML to predict heart failure risks, utilizing the Framingham dataset. IoT devices gather real-time physiological data, focusing on heart rate dynamics, while ML, specifically Random Forest, predicts heart failure. Rigorous feature selection enhances accuracy, achieving over 90% prediction rate. This amalgamation marks a transformative step in proactive healthcare, highlighting early detection's critical role in cardiovascular risk mitigation. Challenges persist, necessitating continual refinement for improved predictive capabilities.

Keywords: cardiovascular diseases, internet of things, machine learning, cardiac risk assessment, heart failure prediction, early detection, cardio data analysis

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Authors: A. A. AlRasheed, A. Atkins, R. Campion

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This paper focuses on using knowledge management and visualisation concepts to improve the patients and hospitals employee’s workflow. Hospitals workflow is a complex and complicated process and poor patient flow can put both patients and a hospital’s reputation at risk, and can threaten the facility’s financial sustainability. Healthcare leaders are under increased pressure to reduce costs while maintaining or increasing patient care standards. In this paper, a framework is proposed to help improving patient experience, staff satisfaction, and operational efficiency across hospitals by using knowledge management based visualisation concepts. This framework is using real-time visibility to track and monitor location and status of patients, staff, rooms, and medical equipment.

Keywords: knowledge management, improvements, visualisation, workflow

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Authors: Jo Parsons, Cath Grimley, Debra Bick, Sarah Hillman, Louise Clarke, Helen Atherton

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The problem: Vaccinations are routinely offered to pregnant women in the UK for influenza (flu), pertussis (whooping cough), and COVID-19, yet the uptake of these vaccinations in pregnancy remains low. Pregnant women are at increased risk of hospitalisation, morbidity, and mortality from these preventable illnesses, which can also expose their unborn babies to an increased risk of serious complications, including in utero death. This research aims to explore how pregnant women feel about vaccinations offered during pregnancy (flu, whooping cough, and COVID-19), particularly following the COVID-19 pandemic. It also aims to examine factors influencing women’s decisions about vaccinations during pregnancy and how they feel about their health and vulnerabilities to illness arising from the COVID-19 pandemic. The approach: This is a qualitative study involving semi-structured interviews with pregnant women and midwives in the UK. Interviews with pregnant women explored their views since the COVID-19 pandemic about vaccinations offered during pregnancy and whether the pandemic has influenced perceptions of vulnerability to illness in pregnant women. Interviews with midwives explored vaccination discussions they routinely have with pregnant women and identified some of the barriers to vaccination that pregnant women discuss with them. Pregnant women were recruited via participating hospitals and community groups. Midwives were recruited via participating hospitals and midwife-specific social media groups. All interviews were conducted remotely (using telephone or Microsoft Teams) and analysed using thematic analysis. Findings: 43 pregnant women and 16 midwives were recruited and interviewed. The findings presented will focus on data from pregnant women. Pregnant women reported a wide range of views and vaccination behaviour, and identified several factors influencing their decision whether to accept vaccinations or not. These included internal factors (comprised of beliefs about susceptibility to illness, perceptions of immunity, fear, and feelings of responsibility), other influences (including visibility of illness and external influences such as healthcare professional recommendations), vaccination-related factors (comprised of beliefs about effectiveness and safety of vaccinations, availability and accessibility of vaccinations and preferences for alternative forms of protection to vaccination) and COVID-19 specific factors (including COVID-19 vaccinations and COVID-19 specific influences). Implications: Findings identified some of the factors that affect pregnant women’s decisions when deciding to have a vaccination or not and how these decisions have been influenced by COVID-19. Findings highlight areas where healthcare professional advice needs to focus, such as the provision of information about the increased vulnerability to illnesses during pregnancy and consideration of opportunistic vaccination at hospital appointments to maximise uptake of vaccinations during pregnancy. Findings of this study will inform the development of an intervention to increase vaccination uptake amongst pregnant women.

Keywords: vaccination, pregnancy, qualitative, interviews, COVID-19

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Authors: Kelsi Hagerty, Ami Rosen, Aaliyah Heyward, Nadia Ali, Emily Brown, Erin Demo, Yue Guan, Modele Ogunniyi, Brianna McDaniels, Alanna Morris, Kunal Bhatt

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Hereditary transthyretin amyloidosis (hATTR) is a progressive, multi-systemic, and life-threatening disease caused by a disruption in the TTR protein that delivers thyroxine and retinol to the liver. This disruption causes the protein to misfold into amyloid fibrils, leading to the accumulation of the amyloid fibrils in the heart, nerves, and GI tract. Over 130 variants in the TTR gene are known to cause hATTR. The Val122Ile variant is the most common in the United States and is seen almost exclusively in people of African descent. TTR variants are inherited in an autosomal dominant fashion and have incomplete penetrance and variable expressivity. Individuals with hATTR may exhibit symptoms from as early as 30 years to as late as 80 years of age. hATTR is characterized by a wide range of clinical symptoms such as cardiomyopathy, neuropathy, carpal tunnel syndrome, and GI complications. Without treatment, hATTR leads to progressive disease and can ultimately lead to heart failure. hATTR disproportionately affects individuals of African descent; the estimated prevalence of hATTR among Black individuals in the US is 3.4%. Unfortunately, hATTR is often underdiagnosed and misdiagnosed because many symptoms of the disease overlap with other cardiac conditions. Due to the progressive nature of the disease, multi-systemic manifestations that can lead to a shortened lifespan, and the availability of free genetic testing and promising FDA-approved therapies that enhance treatability, early identification of individuals with a pathogenic hATTR variant is important, as this can significantly impact medical management for patients and their relatives. Furthermore, recent literature suggests that TTR genetic testing should be performed in all patients with suspicion of TTR-related cardiomyopathy, regardless of age, and that follow-up with genetic counseling services is recommended. Relatives of patients with hATTR benefit from genetic testing because testing can identify carriers early and allow relatives to receive regular screening and management. Despite the striking prevalence of hATTR among Black individuals, hATTR remains underdiagnosed in this patient population, and germline genetic testing for hATTR in Black individuals seems to be underrepresented, though the reasons for this have not yet been brought to light. Historically, Black patients experience a number of barriers to seeking healthcare that has been hypothesized to perpetuate the underdiagnosis of hATTR, such as lack of access and mistrust of healthcare professionals. Prior research has described a myriad of factors that shape an individual’s decision about whether to pursue presymptomatic genetic testing for a familial pathogenic variant, such as family closeness and communication, family dynamics, and a desire to inform other family members about potential health risks. This study explores these factors through 10 in-depth interviews with patients with hATTR about what factors may be contributing to the underdiagnosis of hATTR in the Black population. Participants were selected from the Emory University Amyloidosis clinic based on having a molecular diagnosis of hATTR. Interviews were recorded and transcribed verbatim, then coded using MAXQDA software. Thematic analysis was completed to draw commonalities between participants. Upon preliminary analysis, several themes have emerged. Barriers identified include i) Misdiagnosis and a prolonged diagnostic odyssey, ii) Family communication and dynamics surrounding health issues, iii) Perceptions of healthcare and one’s own health risks, and iv) The need for more intimate provider-patient relationships and communication. Overall, this study gleaned valuable insight from members of the Black community about possible factors contributing to the underdiagnosis of hATTR, as well as potential solutions to go about resolving this issue.

Keywords: cardiac amyloidosis, heart failure, TTR, genetic testing

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Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

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Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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Authors: Jurijs Salijevs, Katrina Bolocko

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The integration of artificial intelligence and neural networks has significantly changed full-body imaging and high-resolution 3D mapping systems, and this paper reviews research in these areas. With an emphasis on their use in the early identification of melanoma and other disorders, the goal is to give a wide perspective on the current status and potential future of these medical imaging technologies. Authors also examine methodologies such as machine learning and deep learning, seeking to identify efficient procedures that enhance diagnostic capabilities through the analysis of 3D body scans. This work aims to encourage further research and technological development to harness the full potential of AI in disease diagnosis.

Keywords: artificial intelligence, neural networks, 3D scan, body scan, 3D mapping system, healthcare

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Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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Healthcare in remote areas is one of the major concerns in Indonesia. Building hospitals in a nation of 18.000 islands with a larger-than-life bureaucracy and problems with corruption, a critical shortage of qualified medical professionals and well-heeled patients resigned to traveling abroad for health care is a hard feat to accomplish. To assuring that all populations have access to appropriate and cost-effective care, a new solution to tackle this problem is with the presence of RV Car Clinic. This car has a concept such as a walking hospital that provides health facilities inside it. All of the health professionals who work in RV Car Clinic will do the rotation for a year in order to the equitable distribution of health workers. We need to advocate the policy makers to help realize RV Car Clinic in remote areas. Health services can be disseminated by the present of RV Car Clinic. Summarily, the local communities can get cost effectively because RV Car Clinic will come to their place and serve the health services.

Keywords: health policy, health professional, remote areas, RV Car Clinic

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Authors: Merih Welay Welesilassie

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This research investigated the factors influencing digital inclusion for young students with disabilities in Ethiopian schools. In this context, socio-economic, infrastructural, and cultural challenges amplify educational disparities. In the era of digital technology's pivotal role in education, it is crucial to ensure equitable access for students with disabilities. Nevertheless, obstacles like inadequate infrastructure, insufficient teacher training, and economic constraints impede the incorporation of digital tools in educational environments, especially for marginalised groups. This study employed an explanatory sequential mixed-methods approach involving data collection through a survey administered to 300 students. Subsequently, in-depth interviews were conducted with 30 participants to provide comprehensive insights into their experiences. The quantitative analysis uncovered that students with disabilities have limited support for digital readiness, find digital technologies less accessible, and perceive digital tools as less easy to use. The study revealed that economic barriers, such as the high cost of devices and limited internet access, prevent students from fully utilising digital resources. Furthermore, infrastructural challenges, such as unreliable electricity and poor internet connectivity, exacerbate the issue. The qualitative data provided a more profound understanding by emphasising social and attitudinal obstacles, including a lack of empathy from both peers and educators, exclusion from participatory digital tasks, and enduring negative stereotypes regarding disabilities. The research highlights the importance of implementing interventions to enhance digital accessibility for students with disabilities. Essential suggestions encompass refining teacher training programs to effectively facilitate inclusive education, improving digital infrastructure, and offering financial assistance to procure digital tools. Furthermore, implementing policy reforms and public awareness campaigns is crucial to cultivate a cultural shift and nurture a more inclusive societal atmosphere. This study yields valuable perspectives on the digital inclusion scenario in Ethiopia, laying the groundwork for prospective research endeavours to narrow the digital gap for students with disabilities.

Keywords: digital inclussion, students with disabilities, ethiopian education, barries and access

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Authors: Naseem M. Twaissi

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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

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Authors: Zahra BehboodiI-Moghadam, Zohre Khalajinia, Ali Reza Nikbakht Nasrabadi, Minoo Mohraz

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The purpose of our study was to explore and describe the experiences of pregnant women with HIV in Iran. A qualitative exploratory study with conventional content analysis was used. Twelve pregnant women with HIV who referred to perinatal care at the Imam Khomeini Hospital Behavioral Diseases Consultation: Center in Tehran were recruited to participate in in-depth interviews. The average age of the participants was 32.5 years. Four main themes were extracted from the data: “fear and hope, “stigma and discrimination, “marital life stability” and “trust”. The findings reveal the pregnant women living with HIV are vulnerable and need professional support. Improving the knowledge of healthcare professionals especially midwifes on pregnancy complications for women with HIV is crucial in order to provide high-quality care to pregnant women with HIV-positive.

Keywords: HIV, pregnancy, content analysis, experiences, Iran, qualitative research

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Authors: E. C. Swart, E. Kunneke

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Background: Disparities in food security exist between communities and households across the country, reflecting continuing social and economic inequalities. The purpose of this study was to investigate the presence of food insecurity amongst UWC students. Method: Cross-sectional study recruited 200 students via email and cellphone from an ICS generated list of randomly selected students aged 18-25. Data collection took place during the first two weeks of term 3. Individual appointments were made with consenting participants and conducted in English by trained BSc Dietetics students. Data was analysed using SPSS. The hunger scale used by Stats SA (October 2010) was used. Dietary intake was assessed using a single 24hr recall. Results: Sixty-three percent of the students reported that they do experience some food insecurity whilst 14.5% reported to go hungry due to inadequate access to food. Coping mechanisms during periods of food insecurity include: Asking a friend, neighbour, family member (40%); Borrow (15%); Steal (none); Casual jobs (12%). Anthropometric status of students did not differ statistically significantly by food security status. A statistically significantly greater proportion of Xhosa speaking students reported inadequate money for food. Students residing in residences off campus appear to be least food secure in terms of money available and limiting food intake, whilst those residing at home are less food insecure. Similar proportions of students who receive bursaries or whose parents are paying reported going hungry whilst those who supports themselves never goes hungry. Mean nutrient intake during the previous 24 hours of students who reported inadequate resources to buy food, who eat less due to inadequate resources and who goes hungry only differed statistically significantly for Vitamin B (go hungry) and for fibre (money shortage). In general the nutrient intake is lower for those who reported to eat less and go hungry except for added sugar, vitamin A and folate (go hungry), and energy, fibre, iron, riboflavin and folate (eat less). For students who reported to have inadequate money to buy food, the mean nutrient intake was higher except for calcium and thiamin. The mean body mass index of this group of students was also higher even though the difference was not statistically significant. Conclusion: Hunger is present on campus however a single 24hr recall did not confirm statistically significant lower nutrient intakes for students who reported different levels of food insecurity.

Keywords: anthropometry, dietary intake, nutritional status, students

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Authors: K. Mellou, G. Anastopoulos, T. Zakinthinos, C. Botsi, A. Terzidis

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‘PHILOS – Emergency health response to refugee crisis’ is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP). The programme is funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. With the EU Member States accepting, the last period, accelerating migration flows, Greece inevitably occupies a prominent position in the migratory map due to this geographical location. The main objectives of the programme are a) reinforcement of the capacity of the public health system and enhancement of the epidemiological surveillance in order to cover refugees/migrant population, b) provision of on-site primary health care and psychological support services, and c) strengthening of national health care system task-force. The basic methods for achieving the aforementioned goals are: a) implementation of syndromic surveillance system at camps and enhancement of public health response with the use of mobile medical units (Sub-action A), b) enhancement of health care services inside the camps via increasing human resources and implementing standard operating procedures (Sub-action B), and c) reinforcement of the national health care system (primary healthcare units, hospitals, and emergency care spots) of affected regions with personnel (Sub-action C). As a result, 58 health professionals were recruited under sub-action 2 and 10 mobile unit teams (one or two at each health region) were formed. The main actions taken so far by the mobile units are the evaluation, of syndromic surveillance, of living conditions at camps and medical services. Also, vaccination coverage of children population was assessed, and more than 600 catch-up vaccinations were performed by the end of June 2017. Mobile units supported transportation of refugees/migrants from camps to medical services reducing the load of the National Center for Emergency Care (more than 350 transportations performed). The total number of health professionals (MD, nurses, etc.) placed at camps was 104. Common practices were implemented in the recording and collection of psychological and medical history forms at the camps. Protocols regarding maternity care, gender based violence and handling of violent incidents were produced and distributed at personnel working at camps. Finally, 290 health care professionals were placed at primary healthcare units, public hospitals and the National Center for Emergency Care at affected regions. The program has, also, supported training activities inside the camps and resulted to better coordination of offered services on site.

Keywords: migrants, refugees, public health, syndromic surveillance, national health care system, primary care, emergency health response

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Authors: Kwaku Damoah

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This study presents a comprehensive data-driven analysis to understand the evolution of adverse events (AEs) in pharmacovigilance. Utilizing data from the FDA Adverse Event Reporting System (FAERS), we employed three analytical methods: rank-based, frequency-based, and percentage change analyses. These methods assessed temporal trends and patterns in AE reporting, focusing on various drug-active ingredients and patient demographics. Our findings reveal significant trends in AE occurrences, with both increasing and decreasing patterns from 2000 to 2023. This research highlights the importance of continuous monitoring and advanced analysis in pharmacovigilance, offering valuable insights for healthcare professionals and policymakers to enhance drug safety.

Keywords: event analysis, FDA adverse event reporting system, pharmacovigilance, temporal trend analysis

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Authors: Raja Omman Zafar, Yves Rybarczyk, Johan Borg

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This article proposes a conceptual framework for the application of digital twin technology in home care. The main goal is to bridge the gap between advanced digital twin concepts and their practical implementation in home care. This study uses a literature review and thematic analysis approach to synthesize existing knowledge and proposes a structured framework suitable for homecare applications. The proposed framework integrates key components such as IoT sensors, data-driven models, cloud computing, and user interface design, highlighting the importance of personalized and predictive homecare solutions. This framework can significantly improve the efficiency, accuracy, and reliability of homecare services. It paves the way for the implementation of digital twins in home care, promoting real-time monitoring, early intervention, and better outcomes.

Keywords: digital twin, homecare, older adults, healthcare, IoT, artificial intelligence

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Authors: Pawan Hinge, Priya Gupta

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Due to cutting edge competitions between organizations and war for talent, the workforce as an asset is gaining significance. The employees are considered as the brand ambassadors of an organization, and their interactions with the clients and customers might impact directly or indirectly on the overall value of the organization. Especially, organizations in the healthcare industry the value of an organization in the perception of their employees can be one of the revenue generating and talent retention strategy. In such context, it is essential to understand that the brand awareness among employees can effect on employer brand image and brand value since the brand ambassadors are the interface between organization and customers and clients. In this exploratory study, we have adopted both quantitative and qualitative approaches for data analysis. Our study shows existing variation among nurses working in different business units of the same organization in terms of their customer interface or interactions and brand awareness.

Keywords: brand awareness, brand image, brand value, customer interface

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Authors: Asad Abbas, Muhammad Fezan Afzal, Muhammad Latif Anjum, Muhammad Azmat

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The Internet of Things (IoT) is used to link up real objects that use the internet to interact. IoT applications allow handling and operating the equipment in accordance with environmental needs, such as transportation and healthcare. IoT devices are linked together via a number of agents that act as a middleman for communications. The operation of a heat sensor differs indoors and outside because agent applications work with environmental variables. In this article, we suggest using Software Product Line (SPL) to model IoT agents and applications' features on an XML-based basis. The contextual diversity within the same domain of application can be handled, and the reusability of features is increased by XML-based feature modelling. For the purpose of managing contextual variability, we have embraced XML for modelling IoT applications, agents, and internet-connected devices.

Keywords: IoT agents, IoT applications, software product line, feature model, XML

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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A preliminary systematic review shows that health professionals experience a tension when communicating with the parents and family members of children with life-threatening and life-limiting conditions. On the one hand, they want to promote open and honest communication, while on the other, they are apprehensive about fostering an unrealistic sense of hope. Defining the boundaries between information that might offer reasonable hope versus that which results in false reassurance is challenging. Some healthcare providers worry that instilling a false sense of hope could motivate parents to seek continued aggressive treatment for their child, which in turn might cause the patient further unnecessary suffering. To date, there has been a lack of research in the Middle East regarding how healthcare providers do or should communicate bad news; in particular, the issue of hope in the field of paediatric palliative care has not been researched thoroughly. This study aims to explore, from the perspective of patients’ mothers, physicians, and nurses, the experience of communicating and receiving bad news in the care of children with palliative care needs. Data were collected using a collective qualitative case study approach across three paediatric units in a Jordanian hospital. Two data collection methods were employed: participant observation and semi-structured interviews. The overall number of cases was 15, with a total of 56 interviews with mothers (n=24), physicians (n=12), and nurses (n=20) completed, as well as 197 observational hours logged. The findings demonstrate that mothers wanted their doctors to provide them with hopeful information about the future progression of their child’s illness. Although some mothers asked their doctors to provide them with honest information regarding the condition of their child, they still considered a sense of hope to be essential for coping with caring for their child. According to mothers, hope was critical to treatment as it helped them to stay committed to the treatment and protected them to some extent from the extreme emotional suffering that would occur if they lost hope. The health professionals agreed with the mothers on the importance of hope, so long as it was congruent with the stage and severity of each patient’s disease. The findings of this study conclude that while parents typically insist on knowing all relevant information when their child is diagnosed with a severe illness, they considered hope to be an essential part of life, and they found it very difficult to handle suffering without any glimmer of it. This study finds that using negative terms has extremely adverse effects on the parents’ emotions. Hence, although the mothers asked the doctors to be as honest as they could, they still wanted the physicians to provide them with a positive message by communicating this information in a sensitive manner including hope.

Keywords: health professionals, children, communication, hope, information, mothers, palliative care

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Authors: L. Ramirez, E. Guillén, J. Sánchez

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Some of the main goals about telecare such as monitoring, treatment, telediagnostic are deployed with the integration of applications with specific appliances. In order to achieve a coherent model to integrate software, hardware, and healthcare systems, different telehealth models with Internet of Things (IoT), cloud computing, artificial intelligence, etc. have been implemented, and their advantages are still under analysis. In this paper, we propose an integrated model based on IoT architecture and cloud computing telehealth center. Analytics module is presented as a solution to control an ideal diagnostic about some diseases. Specific features are then compared with the recently deployed conventional models in telemedicine. The main advantage of this model is the availability of controlling the security and privacy about patient information and the optimization on processing and acquiring clinical parameters according to technical characteristics.

Keywords: analytics, telemedicine, internet of things, cloud computing

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Authors: Mandayachepa C. Nyando, Lauren Suchman, Innocencia Mtalimanja, Address Malata, Tamanda Jumbe, Martha Kamanga, Peter Waiswa

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Background: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a new innovation in contraceptive methods that allow users to inject themselves with a hormonal contraceptive in their own homes. Self-injection (SI) of DMPA-SC has the potential to improve the accessibility of family planning to women who want it and who are capable of injecting themselves. Malawi started implementing this new innovation in 2018. SI was incorporated into the DMPA-SC delivery strategy from its outset. Methodology: This study involved two districts in Malawi where DMPA-SC SI was rolled out: Mulanje and Ntchisi. We used a qualitative cross-sectional study design where 60 in-depth interviews were conducted with women of reproductive age group stratified as 15-45 age band. These included women who were SI users, non-users, and any woman who was on any contraceptive methods. The women participants were tape-recorded, and data were transcribed and then analysed using Dedoose software, where themes were categorised into mother and child themes. Results: Women perceived DMPA SC SI as uniquely private, convenient, and less painful when self-injected. In terms of privacy, women in Mulanje and Ntchisi especially appreciated that self-injecting allowed them to use covertly from partners. Some men do not allow their spouses to use modern contraceptive methods; hence women prefer to use them covertly. “… but I first reach out to men because the strongest power is answered by men (MJ015).” In addition, women reported that SI offers privacy from family/community and less contact with healthcare providers. These aspects of privacy were especially valued in areas where there is a high degree of mistrust around family planning and among those who feel judged or antagonized purchasing contraception, such as young unmarried women. Women also valued the convenience SI provided in terms of their ability to save time by injecting themselves at home rather than visiting a healthcare provider and having more reliable access to contraception, particularly in the face of stockouts. SI allows for stocking up on doses to accommodate shifting work schedules in case of future stockouts or hard times, such as the period of COVID-19, where there was a limitation in the movement of the people. Conclusion: Our findings suggest that SI may meet the needs of many women in Malawi as long as the barriers are eliminated. The barriers women mentioned include fear of self-inject and proper storage of the DMPA SC SI, and these barriers can be eliminated by proper training. The findings also set the scene for policy revision and direction at a national level and integrate the approach with national family planning strategies in Malawi. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

Keywords: family planning, Malawi, Sayana press, self-injection

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Authors: Mwafak Shakoor

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The purpose of this study was to reduce patient waiting times, improve system throughput and improve resources utilization in radiology department. A discrete event simulation model was developed using Arena simulation software to investigate different alternatives to improve the overall system delivery based on adding resource scenarios due to the linkage between patient waiting times and resource availability. The study revealed that there is no addition investment need to procure additional scanner but hospital management deploy managerial tactics to enhance machine utilization and reduce the long waiting time in the department.

Keywords: discrete event simulation, radiology department, arena, waiting time, healthcare modeling, computed tomography

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Authors: Francis Gyapong, Denis Yar

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The use of cell phones has become an indispensable tool in the hospital's settings. Cell phones are used in hospitals without restrictions regardless of their unknown microbial load. However, the indiscriminate use of mobile devices, especially at health facilities, can act as a vehicle for transmitting pathogenic bacteria and other microorganisms. These potential pathogens become exogenous sources of infection for the patients and are also a potential health hazard for self and as well as family members. These are a growing problem in many health care institutions. Innovations in mobile communication have led to better patient care in diabetes, asthma, and increased in vaccine uptake via SMS. Notwithstanding, the use of cell phones can be a great potential source for nosocomial infections. Many studies reported heavy microbial contamination of cell phones among healthcare workers and communities. However, limited studies have been reported in our region on bacterial contamination on cell phones among healthcare workers. This study assessed microbial contamination of cell phones of health care workers (HCWs) at the Mampong Municipal Government Hospital (MMGH), Ghana. A cross-sectional design was used to characterize bacterial microflora on cell phones of HCWs at the MMGH. A total of thirty-five (35) swab samples of cell phones of HCWs at the Laboratory, Dental Unit, Children’s Ward, Theater and Male ward were randomly collected for laboratory examinations. A suspension of the swab samples was each streak on blood and MacConkey agar and incubated at 37℃ for 48 hours. Bacterial isolates were identified using appropriate laboratory and biochemical tests. Kirby-Bauer disc diffusion method was used to determine the antimicrobial sensitivity tests of the isolates. Data analysis was performed using SPSS version 16. All mobile phones sampled were contaminated with one or more bacterial isolates. Cell phones from the Male ward, Dental Unit, Laboratory, Theatre and Children’s ward had at least three different bacterial isolates; 85.7%, 71.4%, 57.1% and 28.6% for both Theater and Children’s ward respectively. Bacterial contaminants identified were Staphylococcus epidermidis (37%), Staphylococcus aureus (26%), E. coli (20%), Bacillus spp. (11%) and Klebsiella spp. (6 %). Except for the Children ward, E. coli was isolated at all study sites and predominant (42.9%) at the Dental Unit while Klebsiella spp. (28.6%) was only isolated at the Children’s ward. Antibiotic sensitivity testing of Staphylococcus aureus indicated that they were highly sensitive to cephalexin (89%) tetracycline (80%), gentamycin (75%), lincomycin (70%), ciprofloxacin (67%) and highly resistant to ampicillin (75%). Some of these bacteria isolated are potential pathogens and their presence on cell phones of HCWs could be transmitted to patients and their families. Hence strict hand washing before and after every contact with patient and phone be enforced to reduce the risk of nosocomial infections.

Keywords: mobile phones, bacterial contamination, patients, MMGH

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Authors: Sina Dehghani, Zhikang Rong

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Historically, a variety of approaches have been taken to forecast commodity prices due to the significant implications of these values on the global economy. An accurate forecasting tool for a valuable commodity would significantly benefit investors and governmental agencies. Silver, in particular, has grown significantly as a commodity in recent years due to its use in healthcare and technology. This manuscript aims to utilize the Geometric Brownian Motion predictive model to forecast silver commodity prices over multiple 3-year periods. The results of the study indicate that the model has several limitations, particularly its inability to work effectively over longer periods of time, but still was extremely effective over shorter time frames. This study sets a baseline for silver commodity forecasting with GBM, and the model could be further strengthened with refinement.

Keywords: geometric Brownian motion, commodity, risk management, volatility, stochastic behavior, price forecasting

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Authors: Robert L. Fine, Zhiyong Yang, Christy Spivey, Bonnie Boardman, Maureen Courtney

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Importance: Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Reengineering ACP by using a web-based, consumer-driven process has recently been suggested. We report early experience with such a process. Objective: Begin to analyze the potential of the creation and use of ACP/ADs as generated by a consumer-friendly, digital process by 1) assessing the likelihood that consumers would create ACP/ADs without structured intervention by medical or legal professionals, and 2) analyzing the responses to determine if the plans can help doctors better understand a person’s goals, preferences, and priorities for their medical treatments and the naming of healthcare agents. Design: The authors chose 900 users of MyDirectives.com, a digital ACP/AD tool, solely based on their state of residence in order to achieve proportional representation of all 50 states by population size and then reviewed their responses, summarizing these through descriptive statistics including treatment preferences, demographics, and revision of preferences. Setting: General United States population. Participants: The 900 participants had an average age of 50.8 years (SD = 16.6); 84.3% of the men and 91% of the women were in self-reported good health when signing their ADs. Main measures: Preferences regarding the use of life-sustaining treatments, where to spend final days, consulting a supportive and palliative care team, attempted cardiopulmonary resuscitation (CPR), autopsy, and organ and tissue donation. Results: Nearly 85% of respondents prefer cessation of life-sustaining treatments during their final days whenever those may be, 76% prefer to spend their final days at home or in a hospice facility, and 94% wanted their future doctors to consult a supportive and palliative care team. 70% would accept attempted CPR in certain limited circumstances. Most respondents would want an autopsy under certain conditions, and 62% would like to donate their organs. Conclusions and relevance: Analysis of early experience with an all-digital web-based ACP/AD platform demonstrates that individuals from a wide range of ages and conditions can engage in an interrogatory process about values, goals, preferences, and priorities for their medical treatments by developing advance directives and easily make changes to the AD created. Online creation, storage, and retrieval of advance directives has the potential to remove barriers to ACP/AD and, thus, to further improve patient-centered end-of-life care.

Keywords: Advance Care Plan, Advance Decisions, Advance Directives, Consumer; Digital, End of Life Care, Goals, Living Wills, Prefences, Universal Advance Directive, Statements

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Authors: Natacha Julceus Fabien, Maryse Emmanuel Garcy

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Mental illness encompasses more than two hundred types of mental troubles, and more than half of the American population is at risk of being affected. If not effectively treated, mental illness can have dire consequences on health, the economy, and society. New York State, the second state after Florida with the most prominent Haitian/American, counted 180,710 inhabitants distributed in 60321 households in 2021, with almost half 46.4% being less than 35 years old. Studies show that while blacks are resilient, they are more likely to have severe mental diseases leading to disabilities compared to their white counterparts. Cultural competence in mental health services can narrow health disparities. Achieving this cultural competency in the health system involves good coordination in a robust health system where everyone is ready to contribute to its practical implementation. An effective way to address the issue is to have good baseline knowledge. However, there is not enough data that specifically informs on the accessibility to culturally competent mental health services for the Haitian American communities in New York. The purpose of this Community Needs Assessment is to assess the accessibility of minorities, particularly Haitian communities in New York, to culturally competent mental health services. This assessment will be conducted in the ten regions of New York State. Providers, clients, members of the community, and minority organizations will be recruited to collect quantitative and qualitative data. The quantitative part will be done in two surveys, one collecting primary data from the general population receiving the services and the other from health providers that provide health services. The questions and answers will be saved in Excel and analyzed on SPSS. For qualitative data, focus groups and in-depth guide interviews will be conducted and analyzed through Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis of how the population and critical informants understand and identify cultural competency components in the mental health system. This research will be presented at the HAFALI research forum and specific minority organizations in New York. It will be submitted to mental health conferences and specific journals for publication. It will be shared with the heads of the community health service and the heads of the New York State Office of Mental Health. This needs assessment will be used as a tool to improve access to culturally competent mental health services nationally and worldwide.

Keywords: mental health, minorities, New York, needs assessment

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Authors: Okunola Oluseye Ademola

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The study investigated various socio-cultural factors influencing adherence to antiretroviral drugs among people living with HIV in a University Teaching Hospital in South-western Nigeria. The objectives are to examine the perception of people living with HIV/AIDS (PLWHA) of antiretroviral therapy (ART) in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, investigate the influence of socio-cultural factors on adherence of PLWHA to treatment regimen in the study area and assess the prevalence of adherence to ART among PLWHA in the study area. It was a cross-sectional where both qualitative and quantitative research methods were adopted. The participants were HIV diagnosed patients attending clinic at the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife between the ages of 18 and 60 years. Also three healthcare delivery personnel working in the clinic were interviewed. Out of the 3007 patients receiving treatment, using Fischer’s formula of sampling technique, 336 patients living with HIV/AIDS were selected for the study. These participants had been on antiretroviral drugs for more than six months prior to the study and were selected using simple random sampling technique. Two focus group discussion sessions comprising of 10 male and 10 female living with HIV and currently on ART were conducted. These groups were purposively selected based on their being on ART for more than one year. Also in-depth interviews were conducted among three purposively selected healthcare givers (an experienced nurse, a doctor and a pharmacist) who are working in this clinic. All the participants were interviewed at the clinic on the various clinic days. Data were collected using a structured questionnaire, an interview guide and tape-recorder. The quantitative data were analysed using descriptive and inferential statistics. Content analysis was employed to analyse responses from IDI and FGD sessions. The findings from the study revealed a very positive perception to ART among PLWHA which was about 86.3% while the level of adherence to ART was 89.0% among the respondents. There was a very strong relationship between social and family supports and the degree of adherence to ART in the PLWHA. Nutrition, polygamy, difficulty in financing transportation fare to the clinic, unemployment, drug hawkers, religion, excuse duty from work and waking up very early were highlighted as socio-cultural barriers to adherence to ART. Fear of death, strong family support, religion belief, not seeking alternative treatment, absence of rituals and perceived improved health status were identified as very strong facilitators to adherence. The study concluded that to achieve a very optimal outcome in the management of HIV among PLWHA, various social and cultural contexts should be taken into consideration as this study was able to ascertain the influence of various socio-cultural factors militating and facilitating adherence to ART.

Keywords: ART, HIV, PLWHA, socio-cultural

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Authors: Bashir Abdu Muzakkari, Aisha Umar Sulaiman, Mohamed Afendee Muhamad, Sanah Abdullahi Muaz

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The field of the Internet of Things (IoT) is rapidly expanding and has the potential to completely change how we work, live, and interact with the world. The Internet of Things (IoT) is the term used to describe a network of networked physical objects, including machinery, vehicles, and buildings, which are equipped with electronics, software, sensors, and network connectivity. This review paper aims to provide a comprehensive overview of the current state of IoT, including its definition, key components, development history, and current applications. The paper will also discuss the challenges and opportunities presented by IoT, as well as its potential impact on various industries, such as healthcare, agriculture, and transportation. In addition, this paper will highlight the ethical and security concerns associated with IoT and the need for effective solutions to address these challenges. The paper concludes by highlighting the prospects of IoT and the directions for future research in this field.

Keywords: internet of things, IoT, sensors, network

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Authors: Lik Hang Gary Wong

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Background: Practice learning is crucial for preparing the healthcare profession to meet the real challenge upon graduation. Students are required to demonstrate their competence in managing interpersonal challenges, such as teamwork with other professionals and communicating well with the service users, during the placement. Such competence precedes clinical practice, and it may eventually affect students' actual performance in a clinical context. Unfortunately, there were limited studies investigating how such competence affects students' performance in practice learning. Objectives: The aim of this study is to investigate how self-rated interpersonal competence affects students' actual performance during clinical placement. Methods: 40 occupational therapy students from Hong Kong were recruited in this study. Prior to the clinical placement (level two or above), they completed an online survey that included the Interpersonal Communication Competence Scale (ICCS) measuring self-perceived competence in interpersonal communication. Near the end of their placement, the clinical educator rated students’ performance with the Student Practice Evaluation Form - Revised edition (SPEF-R). The SPEF-R measures the eight core competency domains required for an entry-level occupational therapist. This study adopted the cross-sectional observational design. Pearson correlation and multiple regression are conducted to examine the relationship between students' interpersonal communication competence and their actual performance in clinical placement. Results: The ICCS total scores were significantly correlated with all the SPEF-R domains, with correlation coefficient r ranging from 0.39 to 0.51. The strongest association was found with the co-worker communication domain (r = 0.51, p < 0.01), followed by the information gathering domain (r = 0.50, p < 0.01). Regarding the ICCS total scores as the independent variable and the rating in various SPEF-R domains as the dependent variables in the multiple regression analyses, the interpersonal competence measures were identified as a significant predictor of the co-worker communication (R² = 0.33, β = 0.014, SE = 0.006, p = 0.026), information gathering (R² = 0.27, β = 0.018, SE = 0.007, p = 0.011), and service provision (R² = 0.17, β = 0.017, SE = 0.007, p = 0.020). Moreover, some specific communication skills appeared to be especially important to clinical practice. For example, immediacy, which means whether the students were readily approachable on all social occasions, correlated with all the SPEF-R domains, with r-values ranging from 0.45 to 0.33. Other sub-skills, such as empathy, interaction management, and supportiveness, were also found to be significantly correlated to most of the SPEF-R domains. Meanwhile, the ICCS scores correlated differently with the co-worker communication domain (r = 0.51, p < 0.01) and the communication with the service user domain (r = 0.39, p < 0.05). It suggested that different communication skill sets would be required for different interpersonal contexts within the workplace. Conclusion: Students' self-perceived interpersonal communication competence could predict their actual performance during clinical placement. Moreover, some specific communication skills were more important to the co-worker communication but not to the daily interaction with the service users. There were implications on how to better prepare the students to meet the future challenge upon graduation.

Keywords: interpersonal competence, clinical education, healthcare professional education, occupational therapy, occupational therapy students

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