Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. Ocular Wellness & Nutrition Society (OWNS) is affiliated with Healthcare and its members receive discounts on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Care Sciences and Services) / CiteScore - Q2 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.5 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.5 (2023)
Latest Articles
The Mixed Role of Sleep and Time of Day in Working Memory Performance of Older Adults with Mild Cognitive Impairment
Healthcare 2024, 12(16), 1622; https://doi.org/10.3390/healthcare12161622 (registering DOI) - 14 Aug 2024
Abstract
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The importance of night sleep for maintaining good physical and cognitive health is well documented as well as its negative changes during aging. Since Mild Cognitive Impairment (MCI) patients bear additional disturbances in their sleep, this study aimed at examining whether there are
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The importance of night sleep for maintaining good physical and cognitive health is well documented as well as its negative changes during aging. Since Mild Cognitive Impairment (MCI) patients bear additional disturbances in their sleep, this study aimed at examining whether there are potential mixed effects of sleep and afternoon time of day (ToD) on the storage, processing, and updating components of working memory (WM) capacity in older adults with MCI. In particular, the study compared patients’ performance in the three working memory components, in two-time conditions: “early in the morning and after night sleep”, and “in the afternoon and after many hours since night sleep”. The Working Memory Capacity & Updating Task from the R4Alz battery was administered twice to 50 older adults diagnosed with MCI. The repeated measures analysis showed statistically significant higher performance in the morning condition for the working memory updating component (p < 0.001). Based on the findings, it seems that the afternoon ToD condition negatively affects tasks with high cognitive demands such as the WM updating task in MCI patients. These findings could determine the optimal timing for cognitive rehabilitation programs for MCI patients and the necessary sleep duration when they are engaged in cognitively demanding daily activities.
Full article
Open AccessArticle
Postgraduate Year Two Medical Residents’ Awareness of Personal Development as a Physician during the Management of Inpatients: A Qualitative Study
by
Kazuki Tokumasu, Haruo Obara, Takanobu Hirosawa, Hiroko Ogawa and Fumio Otsuka
Healthcare 2024, 12(16), 1621; https://doi.org/10.3390/healthcare12161621 - 14 Aug 2024
Abstract
Clinical experiences, helping relationships, and reflection are key factors for personal development for physicians. However, few studies have shown which experiences are important for personal growth and how medical residents specifically use their experiences for personal growth. The aim of this study was
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Clinical experiences, helping relationships, and reflection are key factors for personal development for physicians. However, few studies have shown which experiences are important for personal growth and how medical residents specifically use their experiences for personal growth. The aim of this study was to identify from the medical residents’ perspective which clinical experiences contribute to their personal development. We employed a qualitative design, conducting semi-structured interviews with ten postgraduate year two medical residents at a Japanese teaching hospital. The interviews were transcribed in interview memos, anonymized, and subjected to reflective thematic analysis to generate themes relevant to personal and professional development. Successful clinical experiences with autonomy and responsibility in clinical management were shown to be essential points for personal development as a physician. Autonomy in this study was the attitude of making one’s own choices when managing patients. Responsibility was the obligation of the resident to take charge of a patient. Instructing junior trainees, appreciation received from patients, and approval granted by attending physicians reinforced their feelings of personal growth. The realization of what experiences and concepts influence medical residents’ personal growth and development will make their professional development more effective.
Full article
(This article belongs to the Special Issue Improving Primary Care through Healthcare Education)
Open AccessCase Report
Integrative Medicine Focusing on Ultrasound-Guided High-Dose Shinbaro 2 Pharmacopuncture for Acute Herniated Intervertebral Discs: A Case Report
by
Nam-Woo Lee, Jinho Lee, Jung-Min Yun, Siwon Kim and Won-Seok Chung
Healthcare 2024, 12(16), 1620; https://doi.org/10.3390/healthcare12161620 - 14 Aug 2024
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This study aimed to investigate the effects of ultrasound-guided high-dose Shinbaro 2 pharmacopuncture on the pain, dysfunction, and quality of life in patients with low back pain and radiating pain due to an acute herniated intervertebral disc (HIVD). A 39-year-old male patient with
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This study aimed to investigate the effects of ultrasound-guided high-dose Shinbaro 2 pharmacopuncture on the pain, dysfunction, and quality of life in patients with low back pain and radiating pain due to an acute herniated intervertebral disc (HIVD). A 39-year-old male patient with low back pain and radiating pain caused by an acute HIVD was treated with Korean and Western integrative medicine, with a focus on ultrasound-guided high-dose Shinbaro 2 pharmacopuncture at Kambin’s triangle. The treatment lasted 16 weeks, including a 12-day hospitalization. The low back pain and radiating pain were evaluated using the numeric rating scale (NRS). The lumbar function and quality of life were assessed using the Oswestry disability index (ODI) and the EuroQol five-dimension index (EQ5D). Satisfaction was gauged using the patient global impression of change (PGIC). After treatment, the NRS score decreased from 10 to 1, whereas the ODI and EQ5D scores improved from 84.44 to 28.89 and from 0.303 to 0.871, respectively. The PGIC was rated as 1, indicating considerable improvement. Notably, the changes observed during hospitalization were significant. This report suggests that ultrasound-guided high-dose Shinbaro 2 pharmacopuncture at Kambin’s triangle significantly improves the pain, dysfunction, and quality of life in patients with an acute HIVD, demonstrating its potential usefulness among Korean medicine practitioners.
Full article
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<p>Lumbar spine MRI conducted on 18 February 2023. (<b>A</b>) T2-weighted turbo-spin-echo sagittal view: the arrow indicates the area of the extruded L4/5 disc, and the L5 nerve roots are abutted against the extruded disc. (<b>B</b>) T2-weighted turbo-spin-echo axial view: the triangle indicates the area where the disc has extruded from the central to left foraminal zone.</p> Full article ">Figure 2
<p>Kambin’s triangle (yellow line) bordered by the exiting nerve root ((<b>A</b>) hypotenuse), thecal sac ((<b>B</b>) height), and superior border of the caudal vertebra ((<b>C</b>) width).</p> Full article ">Figure 3
<p>Ultrasound-guided Kambin’s triangle approach. (<b>A</b>) In the long-axis view, the facet joint was confirmed via the camel-hump sign. (<b>B</b>) In the short-axis view, the superior articular process of the L4–L5 facet joint, L5 transverse process, and L4 spinous process were observed in one plane. (<b>C</b>) The probe was moved cephalad, the transverse process disappeared, and only the superior articular process and facet joint were observed. (<b>D</b>) In the same plane as Figure (<b>C</b>), the path through which the needle entered Kambin’s triangle (marked with triangles) is shown.</p> Full article ">Figure 4
<p>Actual scan area and needle direction during the ultrasound-guided intervention. (<b>A</b>) The location of the ultrasound probe in the spine model. The square denotes the probe location and the arrow indicates the needle entry direction. (<b>B</b>) The position of the probe and the entry angle of the injection needle during the actual procedure.</p> Full article ">Figure 5
<p>Numeric rating scale scores for low back pain and radiculopathy. The asterisk indicates the date on which the ultrasound-guided procedure was performed.</p> Full article ">Figure 6
<p>Changes in the ODI and EQ5D scores on the admission date (2/17), discharge date (2/28), and end date of outpatient treatment (6/7). ODI, Oswestry disability index; EQ5D, EuroQol five-dimension index.</p> Full article ">
<p>Lumbar spine MRI conducted on 18 February 2023. (<b>A</b>) T2-weighted turbo-spin-echo sagittal view: the arrow indicates the area of the extruded L4/5 disc, and the L5 nerve roots are abutted against the extruded disc. (<b>B</b>) T2-weighted turbo-spin-echo axial view: the triangle indicates the area where the disc has extruded from the central to left foraminal zone.</p> Full article ">Figure 2
<p>Kambin’s triangle (yellow line) bordered by the exiting nerve root ((<b>A</b>) hypotenuse), thecal sac ((<b>B</b>) height), and superior border of the caudal vertebra ((<b>C</b>) width).</p> Full article ">Figure 3
<p>Ultrasound-guided Kambin’s triangle approach. (<b>A</b>) In the long-axis view, the facet joint was confirmed via the camel-hump sign. (<b>B</b>) In the short-axis view, the superior articular process of the L4–L5 facet joint, L5 transverse process, and L4 spinous process were observed in one plane. (<b>C</b>) The probe was moved cephalad, the transverse process disappeared, and only the superior articular process and facet joint were observed. (<b>D</b>) In the same plane as Figure (<b>C</b>), the path through which the needle entered Kambin’s triangle (marked with triangles) is shown.</p> Full article ">Figure 4
<p>Actual scan area and needle direction during the ultrasound-guided intervention. (<b>A</b>) The location of the ultrasound probe in the spine model. The square denotes the probe location and the arrow indicates the needle entry direction. (<b>B</b>) The position of the probe and the entry angle of the injection needle during the actual procedure.</p> Full article ">Figure 5
<p>Numeric rating scale scores for low back pain and radiculopathy. The asterisk indicates the date on which the ultrasound-guided procedure was performed.</p> Full article ">Figure 6
<p>Changes in the ODI and EQ5D scores on the admission date (2/17), discharge date (2/28), and end date of outpatient treatment (6/7). ODI, Oswestry disability index; EQ5D, EuroQol five-dimension index.</p> Full article ">
Open AccessArticle
Evolution of Fentanyl Prescription Patterns and Administration Routes in Primary Care in Salamanca, Spain: A Comprehensive Analysis from 2011 to 2022
by
Cristina Torres-Bueno, Mercedes Sanchez-Barba, Jose-Antonio Miron-Canelo and Veronica Gonzalez-Nunez
Healthcare 2024, 12(16), 1619; https://doi.org/10.3390/healthcare12161619 - 14 Aug 2024
Abstract
(1) Background: The escalating use of opioids contributes to social, health, and economic crises. In Spain, a notable surge in the medical prescription of opioids in recent years has been observed. The aim of this work was to assess the consumption rate of
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(1) Background: The escalating use of opioids contributes to social, health, and economic crises. In Spain, a notable surge in the medical prescription of opioids in recent years has been observed. The aim of this work was to assess the consumption rate of fentanyl, categorised by the different administration routes, in Primary Care in the province of Salamanca (Spain) spanning the years 2011 to 2022, and to compare it with the national trend and with data from the US. (2) Methods: Doses per inhabitant per day (DHD) were calculated, and interannual variations, as well as consumption rates, were subject to thorough analysis. (3) Results: The prevalence of fentanyl use in Salamanca has doubled from 1.21 DHD in 2011 to 2.56 DHD in 2022, with the transdermal system (TD) as the predominant administration route. This upward trajectory mirrors the national trend, yet the rise in fentanyl use is markedly lower than the reported data in the US. This finding may be attributed to an ageing population and potentially inappropriate fentanyl prescriptions, i.e., for the management of chronic non-cancer pain and other off-label prescriptions. (4) Conclusions: The use of fentanyl in Salamanca, particularly through transdermal systems, doubled from 2011 to 2022, aligning with the national trend. Preventive measures are imperative to prevent fentanyl misuse and moderate the observed escalation in consumption rates.
Full article
(This article belongs to the Section Pain Management)
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<p>Prevalence of fentanyl use in the Spanish province of Salamanca between 2011 and 2022. DHD data are shown for total fentanyl use as well as by route of administration (transdermal, buccal, nasal, and sublingual).</p> Full article ">Figure 2
<p>Distribution of fentanyl use by route of administration in the province of Salamanca between 2011 and 2022, expressed as percentage of total consumption. The majority of fentanyl prescriptions are for transdermal use, which also increases over the years to the detriment of the oral route.</p> Full article ">Figure 3
<p>Change in fentanyl use in the province of Salamanca between 2011 and 2022, expressed as percentage of variation in DHDs compared to 2011. Data are calculated for total fentanyl prescriptions, as well as for transdermal and oral formulations. There is a significant increase in the use of fentanyl, mainly due to the transdermal route, while the use of the oral formulation has remained constant.</p> Full article ">Figure 4
<p>Prevalence of fentanyl use in the Spanish province of Salamanca and in Spain between 2011 and 2022.</p> Full article ">Figure 5
<p>Comparison of the prevalence of fentanyl use in Salamanca and the US, expressed as a percentage (‰) of users in the total population. US data are from the National Survey on Drug Use and Health (NSDUH) of the Substance Abuse and Mental Health Services Administration (SAMHSA). There is an upward trend for total fentanyl use in both Salamanca and in the US.</p> Full article ">
<p>Prevalence of fentanyl use in the Spanish province of Salamanca between 2011 and 2022. DHD data are shown for total fentanyl use as well as by route of administration (transdermal, buccal, nasal, and sublingual).</p> Full article ">Figure 2
<p>Distribution of fentanyl use by route of administration in the province of Salamanca between 2011 and 2022, expressed as percentage of total consumption. The majority of fentanyl prescriptions are for transdermal use, which also increases over the years to the detriment of the oral route.</p> Full article ">Figure 3
<p>Change in fentanyl use in the province of Salamanca between 2011 and 2022, expressed as percentage of variation in DHDs compared to 2011. Data are calculated for total fentanyl prescriptions, as well as for transdermal and oral formulations. There is a significant increase in the use of fentanyl, mainly due to the transdermal route, while the use of the oral formulation has remained constant.</p> Full article ">Figure 4
<p>Prevalence of fentanyl use in the Spanish province of Salamanca and in Spain between 2011 and 2022.</p> Full article ">Figure 5
<p>Comparison of the prevalence of fentanyl use in Salamanca and the US, expressed as a percentage (‰) of users in the total population. US data are from the National Survey on Drug Use and Health (NSDUH) of the Substance Abuse and Mental Health Services Administration (SAMHSA). There is an upward trend for total fentanyl use in both Salamanca and in the US.</p> Full article ">
Open AccessArticle
Verification of Nasogastric Tube Positioning Using Ultrasound by an Intensive Care Nurse: A Pilot Study
by
María Robles-González, Oscar Arrogante, Juan Antonio Sánchez Giralt, Ismael Ortuño-Soriano and Ignacio Zaragoza-García
Healthcare 2024, 12(16), 1618; https://doi.org/10.3390/healthcare12161618 - 14 Aug 2024
Abstract
Placing a nasogastric tube (NGT) is a frequent nursing technique in intensive care units. The gold standard for its correct positioning is the chest X-ray due to its high sensitivity, but it represents a radiation source for critically ill patients. Our study aims
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Placing a nasogastric tube (NGT) is a frequent nursing technique in intensive care units. The gold standard for its correct positioning is the chest X-ray due to its high sensitivity, but it represents a radiation source for critically ill patients. Our study aims to analyze whether the ultrasound performed by an intensive care nurse is a valid method to verify the NGT’s correct positioning and to evaluate the degree of interobserver agreement between this nurse and an intensive care physician in the NGT visualization using ultrasound. Its correct positioning was verified by direct visualization of the tube in the stomach and indirect visualization by injecting fluid and air through the tube (“dynamic fogging” technique). A total of 23 critically ill patients participated in the study. A sensitivity of 35% was achieved using direct visualization, increasing up to 85% using indirect visualization. The degree of interobserver agreement was 0.88. Therefore, the indirect visualization of the NGT by an intensive care nurse using ultrasound could be a valid method to check its positioning. However, the low sensitivity obtained by direct visualization suggests the need for further training of intensive care nurses in ultrasonography. According to the excellent degree of agreement obtained, ultrasound could be performed by both professionals.
Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Student Engagement in Patient Safety and Healthcare Quality Improvement: A Brief Educational Approach
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Ileana Chavez-Maisterra, Ana Cecilia Corona-Pantoja, Luz Elena Madrigal-Gómez, Edgar Oswaldo Zamora-González and Luz Berenice López-Hernández
Healthcare 2024, 12(16), 1617; https://doi.org/10.3390/healthcare12161617 - 14 Aug 2024
Abstract
Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles.
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Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles. This study aimed to assess activities and tools implemented to improve PS and HQI education, as well as student engagement, in medical schools. We designed a two-week course for fourth-year medical students at the Autonomous University of Guadalajara, incorporating Fink’s taxonomy of significant learning to create engaging activities. The course featured daily synchronous and asynchronous learning, with reinforcement activities using tools, like augmented reality and artificial intelligence. A total of 394 students participated, with their performance in activities and final exam outcomes analyzed using non-parametric tests. Students who passed the final exam scored higher in activities focused on application and reasoning (p = 0.02 and p = 0.018, respectively). Activity 7B, involving problem-solving and decision-making, was perceived as the most impactful. Activity 8A, a case-based learning exercise on incident reporting, received the highest score for perception of exam preparation. This study demonstrates innovative teaching methods and technology to enhance student understanding of PS and HQI, contributing to improved care quality and patient safety. Further research on the long-term impact is needed.
Full article
(This article belongs to the Special Issue Improving Primary Care through Healthcare Education)
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<p>Fink’s significant learning categories as a framework for designing learning activities in teaching patient safety (PS) and healthcare quality improvement (HQI)<b>.</b> This figure was created by the authors based on L. Dee Fink’s work [<a href="#B25-healthcare-12-01617" class="html-bibr">25</a>].</p> Full article ">Figure 2
<p>Description of the seven types of reinforcement activities created and used in the course. Legend: FSL = Fink’s significant learning category.</p> Full article ">Figure 3
<p>Students’ final exam test scores comparison between men and women including the median, minimum, and maximum values of each group.</p> Full article ">Figure 4
<p>Results of the post-course questionnaire on satisfaction with the course activities.</p> Full article ">
<p>Fink’s significant learning categories as a framework for designing learning activities in teaching patient safety (PS) and healthcare quality improvement (HQI)<b>.</b> This figure was created by the authors based on L. Dee Fink’s work [<a href="#B25-healthcare-12-01617" class="html-bibr">25</a>].</p> Full article ">Figure 2
<p>Description of the seven types of reinforcement activities created and used in the course. Legend: FSL = Fink’s significant learning category.</p> Full article ">Figure 3
<p>Students’ final exam test scores comparison between men and women including the median, minimum, and maximum values of each group.</p> Full article ">Figure 4
<p>Results of the post-course questionnaire on satisfaction with the course activities.</p> Full article ">
Open AccessArticle
Eating Behaviors during Pregnancy: A Cross-Sectional Study
by
Jawaher Al Hamimi, Asma Al Shidhani, Maya Al Mamari, Ahmed Al Wahaibi and Salah T. Al Awaidy
Healthcare 2024, 12(16), 1616; https://doi.org/10.3390/healthcare12161616 - 13 Aug 2024
Abstract
Background: Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary
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Background: Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary care physicians. In this study, our aim is to identify key sociodemographic factors linked with eating disorders in Oman. Method: We used the Eating Disorder Examination Questionnaire to assess the potential for the presence of eating disorders. Chi-Square and Fisher’s Exact tests were used to analyze relationships between improper eating behavior and independent variables. Results: The study showed that 1.6% of participants had a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge eating at a prevalence of 18.8%. A pre-gestational low Body Mass Index (BMI) was associated with a higher prevalence of binge eating during pregnancy. Additionally, we found that pregnant women who were working were more prone to self-induced vomiting. High BMI before pregnancy was significantly associated with various inappropriate eating behaviors, such as restraint behavior (p = 0.000), shape concern (p = 0.000), weight concern (p = 0.040), eating (p = 0.045), laxative use (p = 0.020), and excessive exercise (p = 0.043). Conclusion: The study reveals a high prevalence of eating disorders in pregnancy. Less educated women exhibit higher laxative use, while working women show more instances of binge eating and self-induced vomiting. These findings emphasize the critical need to prioritize targeted interventions and support for vulnerable pregnant women.
Full article
(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)
Open AccessArticle
Occupational Injuries of Spanish Wildland Firefighters: A Descriptive Analysis
by
Fabio García-Heras, Juan Rodríguez-Medina, Arkaitz Castañeda, Patxi León-Guereño and Jorge Gutiérrez-Arroyo
Healthcare 2024, 12(16), 1615; https://doi.org/10.3390/healthcare12161615 - 13 Aug 2024
Abstract
The work of wildland firefighters, especially of the so-called ‘Brigadas de Refuerzo contra Incendios Forestales’, is characterised by high physical demands and extreme operating conditions. These professionals face long workdays (12 h), walking with heavy loads (~25 kg), being exposed to high temperatures
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The work of wildland firefighters, especially of the so-called ‘Brigadas de Refuerzo contra Incendios Forestales’, is characterised by high physical demands and extreme operating conditions. These professionals face long workdays (12 h), walking with heavy loads (~25 kg), being exposed to high temperatures (>30 °C), and handling specialised tools in high-risk environments. This study aimed to describe the prevalence of occupational injuries among members of the ‘Brigadas de Refuerzo contra Incendios Forestales’ and its relationship to variables such as age and work experience. A total of 217 wildland firefighters (18 female and 199 male) correctly answered a questionnaire developed on an ad hoc basis to meet the study’s objectives. A high prevalence of occupational injuries was observed among them (~76%). Age and work experience were shown to be significantly associated with injuries. Individuals over 35 years of age with more than 10 years’ experience had a higher probability of injury (OR = 2.14, CI = 1.12–4.06 and OR = 2.46, CI = 1.30–4.67, respectively). Injuries occurred mainly during physical training (~46%), followed by preventive work (~33%) and forest fires (~20%). The most common injuries were tendonitis and muscle pain (~44% and ~21% respectively), followed by sprains (~21%). The results underline the need for physical activity programmes adapted to help wildland firefighters, especially older and more experienced individuals. The identification of risk factors such as age and work experience can contribute to the prevention and management of occupational injuries among this group of highly specialised forestry workers. Specific preventative measures during training are required to mitigate the risk of injury among these crews, who play a crucial role in protecting the environment and public safety.
Full article
Open AccessReview
Employing the Aviation Model to Reduce Errors in Robotic Gynecological Surgery: A Narrative Review
by
Stefano Restaino, Federico Paparcura, Martina Arcieri, Giulia Pellecchia, Alice Poli, Valerio Gallotta, Salvatore Gueli Alletti, Stefano Cianci, Vito Andrea Capozzi, Giorgio Bogani, Alessandro Lucidi, Marko Klarić, Lorenza Driul, Vito Chiantera, Fabrizio Dal Moro, Giovanni Scambia and Giuseppe Vizzielli
Healthcare 2024, 12(16), 1614; https://doi.org/10.3390/healthcare12161614 - 13 Aug 2024
Abstract
The operating room is the environment where harm to the patient is most likely. Robotic surgery was listed as one of the top 10 health hazards as late as 2020. Taking inspiration from other fields of application, such as aeronautics, checklists have been
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The operating room is the environment where harm to the patient is most likely. Robotic surgery was listed as one of the top 10 health hazards as late as 2020. Taking inspiration from other fields of application, such as aeronautics, checklists have been increasingly implemented in medical practice over the years, becoming essential components of the operating theatre. In addition to checklists, simulation has taken on a fundamental importance in reducing errors. This paper aims to provide a narrative review to assess the importance of checklists and training in robotic surgery and how they improve the outcome. A comprehensive literature search from January 2000 to September 2023 was conducted. A total of 97 articles were included in the initial search. Eleven studies were deemed relevant and were considered eligible for full-text reading. Among these, ten studies focused on the analysis of training effectiveness. An article in our review assessed the benefits of introducing checklists in the operating room. Innovations created in aviation, such as checklists and simulation, have entered the medical field to prevent human error. Developing dedicated checklist and surgical teams, through theoretical and practical training, has become essential in modern medicine. Tools such as checklists, training, and simulation are among the best methods to reduce adverse medical events.
Full article
Open AccessProtocol
CALL TO ECLS—Acronym for Reporting Patients for Extracorporeal Cardiopulmonary Resuscitation Procedure from Prehospital Setting to Destination Centers
by
Tomasz Sanak, Mateusz Putowski, Marek Dąbrowski, Anna Kwinta, Katarzyna Zawisza, Andrzej Morajda and Mateusz Puślecki
Healthcare 2024, 12(16), 1613; https://doi.org/10.3390/healthcare12161613 - 13 Aug 2024
Abstract
The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its
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The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its content. Validation is crucial to ensure that the acronym is theoretically correct and includes the necessary information that must be conveyed by EMS during the qualification of a patient with out-of-hospital cardiac arrest for ECMO. A survey was conducted using the LimeSurvey platform through the Survey Research System of the Jagiellonian University Medical College over a 6-month period (from December 2022 to May 2023). Usefulness, importance, clarity, and unambiguity were rated on a 4-point Likert scale, from 1 (not useful, not important, unclear, ambiguous) to 4 (useful, important, clear, unambiguous). On the 4-point scale, the Content Validity Index (I-CVI) was calculated as the percentage of subject matter experts who rated the criterion as having a level of importance/clarity/validity/uniqueness of 3 or 4. The Scale-level Content Validity Index (S-CVI) based on the average method was computed as the average of I-CVI scores (S-CVI-AVE) for all considered criteria (protocol). The number of fully completed surveys by experts was 35, and partial completion was obtained in 63 cases. All criteria were deemed significant/useful, with I-CVI coefficients ranging from 0.87 to 0.97. Similarly, the importance of all criteria was confirmed, as all I-CVI coefficients were greater than 0.78 (ranging from 0.83 to 0.97). The average I-CVI score for the ten considered criteria in terms of usefulness/significance and importance exceeded 0.9, indicating high validity of the tool/protocol/acronym. Based on the survey results and analysis of responses provided by experts, a second version was created, incorporating additional explanations. In Criterion 10, an explanation was added—“Signs of life”—during conventional cardiopulmonary resuscitation (ROSC, motor response during CPR). It has been shown that the acronym CALL TO ECLS, according to experts, is accurate and contains the necessary content, and can serve as a system to facilitate communication between the pre-hospital environment and specialized units responsible for qualifying patients for the ECPR.
Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
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Open AccessArticle
Effects of Hormonal Replacement Therapy and Mindfulness-Based Stress Reduction on Climacteric Symptoms Following Risk-Reducing Salpingo-Oophorectomy
by
Amira Mohammed Ali, Saeed A. Al-Dossary, Carlos Laranjeira, Faten Amer, Souheil Hallit, Abdulmajeed A. Alkhamees, Aljawharah Fahad Aljubilah, Musheer A. Aljaberi, Ebtesam Abdullah Alzeiby, Hammad Ali Fadlalmola, Annamaria Pakai and Haitham Khatatbeh
Healthcare 2024, 12(16), 1612; https://doi.org/10.3390/healthcare12161612 - 13 Aug 2024
Abstract
Breast Cancer Associated Susceptibility Proteins Type 1/2 (BRCA1/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1/2 insufficiency increases the risk for breast/ovarian/uterine cancers. Risk-reducing salpingo-oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which
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Breast Cancer Associated Susceptibility Proteins Type 1/2 (BRCA1/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1/2 insufficiency increases the risk for breast/ovarian/uterine cancers. Risk-reducing salpingo-oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which is frequently conducted by the age of 40 to lower the occurrence of cancer in women with BRCA1/2 mutations. However, abrupt estrogen decline following RRSO causes ovarian failure, which implicates various cellular physiological processes, resulting in the increased release of free radicals and subsequent severe onset of menopausal symptoms. Comfort measures (e.g., hormonal replacement therapy (HRT) and mindfulness-based stress reduction (MBSR)) may improve chronological menopause-related quality of life, but their specific effects are not clear in women with gene mutations. Aiming to fill the gap, this study used path analysis to examine the effects of HRT and MBSR on menopausal symptoms among RRSO patients (N = 199, mean age = 50.5 ± 6.7 years). HRT directly alleviated the levels of urogenital symptoms (β = −0.195, p = 0.005), which mediated its indirect significant effects on the somatic–vegetative and psychological symptoms of menopause (β = −0.046, −0.067; both p values = 0.004, respectively), especially in BRCA2 carriers and in women who were currently physically active, premenopausal at the time of RRSO, had a high BMI, and had no history of breast cancer. It increased the severity of urogenital symptoms in women with a history of cancer. MBSR, on the other hand, was associated with indirect increases in the intensity of the somatic–vegetative and psychological symptoms of menopause (β = 0.108, 0.029; p = 0.003, 0.033, respectively). It exerted positive direct effects on different menopausal symptoms in multigroup analysis. The results suggest that young women undergoing recent RRSO may benefit from HRT at an individual level, while their need for extensive measures to optimize their psychological wellbeing is ongoing. The adverse effects of MBSR, which are captured in the present study, imply that MBSR may interfere with redox sensitivity associated with estradiol fluctuations in BRCA1/2 carriers. Investigations are needed to test this hypothesis and elaborate on the underlying mechanisms in these women.
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(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations—2nd Edition)
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Open AccessArticle
Long-Term Outcomes (10 Years) of Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Repair
by
Annalisa Vigna, Marta Barba and Matteo Frigerio
Healthcare 2024, 12(16), 1611; https://doi.org/10.3390/healthcare12161611 - 13 Aug 2024
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Vaginal vault prolapse is one of the main reasons for reoperation in patients with pelvic organ prolapse. Effective correction of the vaginal apex is essential for lasting repair for these women. Apical suspension of the sacrospinous ligament is probably one of the main
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Vaginal vault prolapse is one of the main reasons for reoperation in patients with pelvic organ prolapse. Effective correction of the vaginal apex is essential for lasting repair for these women. Apical suspension of the sacrospinous ligament is probably one of the main vaginal treatments still offered to patients today. We proposed an evaluation of the functional and anatomical results of long-term sacrospinous ligament fixation. Objective: The purpose of this study was to evaluate the 10-year results of sacrospinous ligament suspension as primary repair for apical prolapse and to evaluate long-term side effects. Materials and Methods: A retrospective study analyzed 10-year follow-up after prolapse repair using sacrospinous ligament suspension. A subjective recurrence was identified as the postoperative occurrence of swelling symptoms based on a particular item on the Italian Prolapse Quality of Life (P-QoL) questionnaire. An objective recurrence was defined as a postoperative decline to stage II or below in any compartment based on the POP-Q system or the requirement for additional surgery. The assessment of postoperative subjective satisfaction was conducted using the Patient Global Impression of Improvement (PGI-I) score. Results: In total, 40 patients underwent sacrospinous ligament fixation. Objective recurrence was remarkably high, as it was observed in 17 (56.7%) patients. Subjective recurrence was reported by ten (33.3%) women, and reintervention occurred in two (6.7%) of patients. From the point of view of quality of life, according to the PGI-I, twenty-three (76.7%) patients described some degree of improvement after surgery, four (13.3%) described their status as unmodified, and three (10%) reported some form of worsening after primary treatment. Conclusions: Transvaginal repair with sacrospinous fixation is a long-lasting option for prolapse repair, with improvement in every POP-q parameter. Some degree of anterior recurrence, recurrence of symptoms with swelling, or an overall worsening of quality of life after surgery is possible.
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Open AccessArticle
Family Members’ Explanatory Models of Cancer Anorexia–Cachexia
by
Susan McClement
Healthcare 2024, 12(16), 1610; https://doi.org/10.3390/healthcare12161610 - 13 Aug 2024
Abstract
The experience of bearing witness to the lack of appetite and involuntary weight loss that characterizes cancer anorexia–cachexia syndrome (CACS) is reported to be stressful for family members. Research identifies that family members engage in a wide range of behaviors in response to
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The experience of bearing witness to the lack of appetite and involuntary weight loss that characterizes cancer anorexia–cachexia syndrome (CACS) is reported to be stressful for family members. Research identifies that family members engage in a wide range of behaviors in response to a relative who shows minimal interest in eating and is literally ‘wasting away’ before their eyes. Some families, though concerned about the symptoms of CACS, do not dwell excessively on the patient’s nutritional intake while others continually harass the patient to eat and petition health care providers for aggressive nutritional interventions to eat in an attempt to stave off further physical deterioration. While studies have detailed how family members respond to a terminally ill relative with CACS, empirical work explicating the explanatory models of CACS that they hold is lacking. Explanatory models (EMs) reflect the beliefs and ideas that families have about why illness and symptoms occur, the extent to which they can be controlled, how they should be treated, and how interventions should be evaluated. To address this gap in the literature, a grounded theory study guided by Kleinman’s Explanatory Model questions was conducted with 25 family members of advanced cancer patients. The core category of ‘Wayfaring’ integrates the key categories of the model and maps onto Kleinman’s questions about CACS onset, etiology, natural course, physiological processes/anatomical structures involved, treatment, and the impacts of disease on patient and family. Findings suggest that a divergence between some biomedical constructions of CACS and explanatory models held by family members may fuel the family–health care provider conflict, thereby providing direction for communication with families about care of the patient with anorexia–cachexia.
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(This article belongs to the Special Issue Cachexia and Chronic Disease)
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Open AccessCorrection
Correction: Duevel et al. Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers. Healthcare 2024, 12, 1157
by
Juliane A. Duevel, Sebastian Gruhn, John Grosser, Svenja Elkenkamp and Wolfgang Greiner
Healthcare 2024, 12(16), 1609; https://doi.org/10.3390/healthcare12161609 - 13 Aug 2024
Abstract
Error in Figure [...]
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(This article belongs to the Special Issue Healthcare Management and Health Economics)
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<p>Cost-effectiveness planes for different willingness-to-pay (WTP) scenarios for case management after TIA (assuming intervention costs must be covered). Note: The red line in each figure panel displays the WTP threshold. Red dots indicate draws that exceed the respective WTP threshold, while turquoise dots indicate draws that meet or fall below the WTP threshold.</p> Full article ">
<p>Cost-effectiveness planes for different willingness-to-pay (WTP) scenarios for case management after TIA (assuming intervention costs must be covered). Note: The red line in each figure panel displays the WTP threshold. Red dots indicate draws that exceed the respective WTP threshold, while turquoise dots indicate draws that meet or fall below the WTP threshold.</p> Full article ">
Open AccessArticle
Effects of Community Assets on Major Health Conditions in England: A Data Analytic Approach
by
Aristides Moustakas, Linda J. M. Thomson, Rabya Mughal and Helen J. Chatterjee
Healthcare 2024, 12(16), 1608; https://doi.org/10.3390/healthcare12161608 - 12 Aug 2024
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Introduction: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. Methods: This paper quantified the effect of community assets
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Introduction: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. Methods: This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. Results: The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. Conclusions: The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.
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<p>(<b>a</b>) A spatial plot of a local healthcare unit (LTLA). Map plotted in Google maps using data from the Geoportal Statistics UK, available at: <a href="https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true" target="_blank">https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true</a> (accessed 20 February 2024). (<b>b</b>) Block diagram of the framework applied here. Initially data were mined from publicly available spatiotemporal data sets at the level of an LTLA. Data were standardised sequentially to facilitate comparisons across space, time, and unequal demographics. Clusters of community assets and health conditions were computed and visualised. Generalised linear models (GLMs) were fitted for each health condition as dependent variables and community assets as explanatory variables. Model selection was performed for each GLM eliminating the least informative community asset variables per health condition. The diversity of community assets as significant predictors per health condition was calculated. Hierarchical variance partitioning between each health condition and the significant explanatory community assets was computed indicating the unique variance explained by each community assets per health condition.</p> Full article ">Figure 1 Cont.
<p>(<b>a</b>) A spatial plot of a local healthcare unit (LTLA). Map plotted in Google maps using data from the Geoportal Statistics UK, available at: <a href="https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true" target="_blank">https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true</a> (accessed 20 February 2024). (<b>b</b>) Block diagram of the framework applied here. Initially data were mined from publicly available spatiotemporal data sets at the level of an LTLA. Data were standardised sequentially to facilitate comparisons across space, time, and unequal demographics. Clusters of community assets and health conditions were computed and visualised. Generalised linear models (GLMs) were fitted for each health condition as dependent variables and community assets as explanatory variables. Model selection was performed for each GLM eliminating the least informative community asset variables per health condition. The diversity of community assets as significant predictors per health condition was calculated. Hierarchical variance partitioning between each health condition and the significant explanatory community assets was computed indicating the unique variance explained by each community assets per health condition.</p> Full article ">Figure 2
<p>(<b>a</b>) Dendrograms of the cluster analysis among health conditions. The cluster analysis deploys a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) to each other. Similarity is indicated by the Pearsons’ correlation values. (<b>b</b>) Dendrograms of the cluster analysis among the assets. The cluster analysis deployed a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) with each other. Similarity is indicated by the Pearsons’ correlation values.</p> Full article ">Figure 2 Cont.
<p>(<b>a</b>) Dendrograms of the cluster analysis among health conditions. The cluster analysis deploys a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) to each other. Similarity is indicated by the Pearsons’ correlation values. (<b>b</b>) Dendrograms of the cluster analysis among the assets. The cluster analysis deployed a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) with each other. Similarity is indicated by the Pearsons’ correlation values.</p> Full article ">Figure 3
<p>(<b>a</b>) Number of community assets included in the final model between a health condition (i.e., dependent variable) and the ten community asset explanatory variables investigated. The final model refers to the community assets included in the model after model selection eliminating the least informative ones. (<b>b</b>) Number of times that a community asset was included in the final model for a health condition.</p> Full article ">Figure 4
<p>(<b>a</b>) Pie chart of unique variance explained by each community asset per health condition. (<b>b</b>) Sum of total unique variance explained by each community asset across health conditions. (<b>c</b>) Sum of total unique variance explained per health condition.</p> Full article ">Figure 4 Cont.
<p>(<b>a</b>) Pie chart of unique variance explained by each community asset per health condition. (<b>b</b>) Sum of total unique variance explained by each community asset across health conditions. (<b>c</b>) Sum of total unique variance explained per health condition.</p> Full article ">
<p>(<b>a</b>) A spatial plot of a local healthcare unit (LTLA). Map plotted in Google maps using data from the Geoportal Statistics UK, available at: <a href="https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true" target="_blank">https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true</a> (accessed 20 February 2024). (<b>b</b>) Block diagram of the framework applied here. Initially data were mined from publicly available spatiotemporal data sets at the level of an LTLA. Data were standardised sequentially to facilitate comparisons across space, time, and unequal demographics. Clusters of community assets and health conditions were computed and visualised. Generalised linear models (GLMs) were fitted for each health condition as dependent variables and community assets as explanatory variables. Model selection was performed for each GLM eliminating the least informative community asset variables per health condition. The diversity of community assets as significant predictors per health condition was calculated. Hierarchical variance partitioning between each health condition and the significant explanatory community assets was computed indicating the unique variance explained by each community assets per health condition.</p> Full article ">Figure 1 Cont.
<p>(<b>a</b>) A spatial plot of a local healthcare unit (LTLA). Map plotted in Google maps using data from the Geoportal Statistics UK, available at: <a href="https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true" target="_blank">https://geoportal.statistics.gov.uk/datasets/196d1a072aaa4882a50be333679d4f63/explore?showTable=true</a> (accessed 20 February 2024). (<b>b</b>) Block diagram of the framework applied here. Initially data were mined from publicly available spatiotemporal data sets at the level of an LTLA. Data were standardised sequentially to facilitate comparisons across space, time, and unequal demographics. Clusters of community assets and health conditions were computed and visualised. Generalised linear models (GLMs) were fitted for each health condition as dependent variables and community assets as explanatory variables. Model selection was performed for each GLM eliminating the least informative community asset variables per health condition. The diversity of community assets as significant predictors per health condition was calculated. Hierarchical variance partitioning between each health condition and the significant explanatory community assets was computed indicating the unique variance explained by each community assets per health condition.</p> Full article ">Figure 2
<p>(<b>a</b>) Dendrograms of the cluster analysis among health conditions. The cluster analysis deploys a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) to each other. Similarity is indicated by the Pearsons’ correlation values. (<b>b</b>) Dendrograms of the cluster analysis among the assets. The cluster analysis deployed a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) with each other. Similarity is indicated by the Pearsons’ correlation values.</p> Full article ">Figure 2 Cont.
<p>(<b>a</b>) Dendrograms of the cluster analysis among health conditions. The cluster analysis deploys a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) to each other. Similarity is indicated by the Pearsons’ correlation values. (<b>b</b>) Dendrograms of the cluster analysis among the assets. The cluster analysis deployed a hierarchical procedure to form the clusters. Variables were grouped together that are correlated (i.e., similarity) with each other. Similarity is indicated by the Pearsons’ correlation values.</p> Full article ">Figure 3
<p>(<b>a</b>) Number of community assets included in the final model between a health condition (i.e., dependent variable) and the ten community asset explanatory variables investigated. The final model refers to the community assets included in the model after model selection eliminating the least informative ones. (<b>b</b>) Number of times that a community asset was included in the final model for a health condition.</p> Full article ">Figure 4
<p>(<b>a</b>) Pie chart of unique variance explained by each community asset per health condition. (<b>b</b>) Sum of total unique variance explained by each community asset across health conditions. (<b>c</b>) Sum of total unique variance explained per health condition.</p> Full article ">Figure 4 Cont.
<p>(<b>a</b>) Pie chart of unique variance explained by each community asset per health condition. (<b>b</b>) Sum of total unique variance explained by each community asset across health conditions. (<b>c</b>) Sum of total unique variance explained per health condition.</p> Full article ">
Open AccessArticle
Migration Challenges and Their Impact on the Primary Healthcare System—A Qualitative Research
by
Olga Partyka, Monika Pajewska, Aleksandra Czerw, Katarzyna Sygit, Oleh Lyubinets, Tomasz Banaś, Krzysztof Małecki, Elżbieta Grochans, Szymon Grochans, Anna Cybulska, Daria Schneider-Matyka, Elżbieta Cipora, Mateusz Kaczmarski, Krzysztof Sośnicki, Grażyna Dykowska, Zofia Sienkiewicz, Łukasz Strzępek, Ewa Bandurska, Weronika Ciećko, Jarosław Drobnik, Piotr Pobrotyn, Aleksandra Sierocka, Michał Marczak and Remigiusz Kozlowskiadd
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Healthcare 2024, 12(16), 1607; https://doi.org/10.3390/healthcare12161607 - 12 Aug 2024
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In 2020 it is estimated that 281 million people were international migrants. Migrants constitute a potentially vulnerable population in terms of facing discrimination, poor living and housing conditions, and insufficient access to healthcare services. Due to the armed conflict in Ukraine in 2022,
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In 2020 it is estimated that 281 million people were international migrants. Migrants constitute a potentially vulnerable population in terms of facing discrimination, poor living and housing conditions, and insufficient access to healthcare services. Due to the armed conflict in Ukraine in 2022, almost 10 million people crossed the Polish border within a year of the outbreak of the conflict. The objective of this paper is to present the use of primary healthcare services by people migrating from Ukraine to Poland and identify the barriers in access to healthcare by this group of persons. This study used a qualitative research technique in the form of an expert interview using individual in-depth interviews (IDI). The study group consisted of professionally active primary healthcare providers (doctors, nurses, and facility managers) in Poland. Research was carried out in the areas regarding the availability of healthcare, the potential threats and challenges, and possible system solutions. The results showed that the most common cause for doctor’s appointments among migrants are respiratory infections, including COVID-19. Many cases were related to back pain, mainly resulting from the physical work of the patients. Additionally, some barriers to access and the provision of healthcare services for patients from Ukraine were identified. The majority (75%) of respondents indicated language as a significant barrier when providing services. Based on the study results, we recommend creating a dedicated website and telephone hotline for this group of persons as well as the use of traditional media to distribute information about access to healthcare services. It is also essential to focus on assistance for older people, since they may experience more difficulties with language and navigating the healthcare system.
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Open AccessArticle
Healthcare Professionals’ Documentation in Supported Accommodation for People with Profound Intellectual Disabilities: An Educational Intervention Study
by
Kjellaug K. Myklebust, Julia Bogen Ramstad and Solveig Karin Bø Vatnar
Healthcare 2024, 12(16), 1606; https://doi.org/10.3390/healthcare12161606 - 12 Aug 2024
Abstract
Good-quality relationships in which individuals with profound intellectual disabilities (intelligence quotient, IQ < 20–25) are recognized by healthcare professionals (HPs) are essential for the quality of healthcare and promoting autonomy. This study examines the impact of an educational intervention on documentation of the
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Good-quality relationships in which individuals with profound intellectual disabilities (intelligence quotient, IQ < 20–25) are recognized by healthcare professionals (HPs) are essential for the quality of healthcare and promoting autonomy. This study examines the impact of an educational intervention on documentation of the interplay between HP and individuals receiving services in supported accommodation in Norway. An educational intervention study was designed to encourage HPs to document their approaches and interplay. The Scale for the Evaluation of Staff-Patient Interactions in Progress Notes (SESPI) was applied to measure documentation before and after the intervention. Journal notes written over a three-month period before the intervention and a three-month period after the intervention were measured. Prior to the intervention, only 23.1% of the journal notes described the resident’s experiences, increasing by 5.4% (p = 0.041) post-intervention. Practical solutions to individual experiences increased from 0.9% to 8.5% (p < 0.001). The educational intervention demonstrated a significant increase in the documentation of residents’ experiences and the interplay between HPs and residents. Future research should explore the generalizability of these findings. Incomplete documentation of HPs’ relational work conceals important aspects of the healthcare provided, potentially resulting in confining autonomy and participation for individuals with intellectual disabilities.
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(This article belongs to the Section Healthcare Quality and Patient Safety)
Open AccessArticle
Comparative Efficacy of Fractional CO2 Laser Combined with Topical Steroid Cream versus Solution for Post-Thyroidectomy Scar Treatment: A Prospective Study
by
Ching-Ya Huang, Yuan-Hao Yen, Cen-Hung Lin, Yueh-Ju Tsai, Ko-Chien Lin, Hui-Ping Lin and Ching-Hua Hsieh
Healthcare 2024, 12(16), 1605; https://doi.org/10.3390/healthcare12161605 - 12 Aug 2024
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Backgrounds: Post-thyroidectomy scarring is a common illness impacting patient quality of life. Fractional carbon dioxide (CO2) lasers and topical steroids delivered via laser-assisted drug delivery (LADD) have shown potential for scar treatment. However, ideal steroid formulations (cream vs. solution) when combined
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Backgrounds: Post-thyroidectomy scarring is a common illness impacting patient quality of life. Fractional carbon dioxide (CO2) lasers and topical steroids delivered via laser-assisted drug delivery (LADD) have shown potential for scar treatment. However, ideal steroid formulations (cream vs. solution) when combined with laser therapy remain unclear. Methods: This study included 12 patients receiving fractional CO2 laser on post-thyroidectomy scars. After laser treatment, one scar half received topically applied steroid cream, while the other half received steroid solution. The Patient and Observer Scar Assessment Scale (POSAS) was used to measure the scar conditions at the time prior to the first treatment and one year later by the patients themselves and by the surgeon who did the laser treatment. Scar appearance was photographically assessed at baseline and 6 months post-treatment by four blinded evaluators using scales. Results: This study discovered a modest improvement in the appearance of post-thyroidectomy scars when combining fractional CO2 laser treatment with either topical steroid cream or solution. Patients and treating physicians examined the POSAS scores one year after treatment found significant improvements in all aspects of the scar conditions, with high efficacy and satisfaction levels reported by patients. Conclusions: Fractional CO2 laser combined with topical steroid delivery, either cream or solution form, significantly enhanced post-thyroidectomy scar appearance with modest effect and high patient satisfaction. This approach may represent a promising scar management strategy along with current scar treatment for the post-thyroidectomy scar.
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<p>A visual comparison of four representative patients (<b>A</b>–<b>H</b>) undergoing treatment for post-thyroidectomy scars before and six months after their initial treatment. The “C” indicates sides treated with steroid cream clobetasol propionate in the concentration of 0.05%, while “T” stands for treatment with steroid solution of triamcinolone acetonide.</p> Full article ">Figure 2
<p>(<b>A</b>) The Patient and Observer Scar Assessment Scale (POSAS) measurement based on patient assessments of overall scar conditions before and one year after initial treatment. This measurement is based on a 0–10 scale, with 0 representing no change from normal skin and 10 indicating a large departure. Lower ratings indicated better results. (<b>B</b>) Patient-reported satisfaction, which included general comments on the treatment’s efficacy and satisfaction. These measurements were assessed on a scale of −10 to 10, with 10 indicating high satisfaction. * <span class="html-italic">p</span> < 0.05 indicates significant difference.</p> Full article ">Figure 3
<p>The outcome of the entire treatment. (<b>A</b>) The Patient and Observer Scar Assessment Scale (POSAS) measurement based on physician assessments of overall scar conditions before to and one year after initial treatment. This measurement is based on a 0–10 scale, with 0 representing no change from normal skin and 10 indicating a large departure. Lower ratings indicated better results. (<b>B</b>) Physician-reported overall scarring condition compared to surrounding normal skin on a 0–10 scale, with 0 representing no difference from normal skin and 10 indicating a severe divergence. Lower scores indicated a better scar condition. (<b>C</b>) Physician-reported overall scar improvement six months after initial treatment vs. pre-treatment condition, with scores ranging from 0 to 10 and 10 indicating the most improvement. The dots with different color represented given scores by different physician. Higher scores are preferable. * <span class="html-italic">p</span> < 0.05 indicates significant difference.</p> Full article ">Figure 4
<p>The outcomes were judged using photographs taken after 6 months of initiating treatment and compared to those taken before treatment to determine which side was better than the other. These physicians were blinded to the treatment regimens applied to both sides of the post-thyroidectomy scar. The dots with different color represented given scores by different physician.</p> Full article ">
<p>A visual comparison of four representative patients (<b>A</b>–<b>H</b>) undergoing treatment for post-thyroidectomy scars before and six months after their initial treatment. The “C” indicates sides treated with steroid cream clobetasol propionate in the concentration of 0.05%, while “T” stands for treatment with steroid solution of triamcinolone acetonide.</p> Full article ">Figure 2
<p>(<b>A</b>) The Patient and Observer Scar Assessment Scale (POSAS) measurement based on patient assessments of overall scar conditions before and one year after initial treatment. This measurement is based on a 0–10 scale, with 0 representing no change from normal skin and 10 indicating a large departure. Lower ratings indicated better results. (<b>B</b>) Patient-reported satisfaction, which included general comments on the treatment’s efficacy and satisfaction. These measurements were assessed on a scale of −10 to 10, with 10 indicating high satisfaction. * <span class="html-italic">p</span> < 0.05 indicates significant difference.</p> Full article ">Figure 3
<p>The outcome of the entire treatment. (<b>A</b>) The Patient and Observer Scar Assessment Scale (POSAS) measurement based on physician assessments of overall scar conditions before to and one year after initial treatment. This measurement is based on a 0–10 scale, with 0 representing no change from normal skin and 10 indicating a large departure. Lower ratings indicated better results. (<b>B</b>) Physician-reported overall scarring condition compared to surrounding normal skin on a 0–10 scale, with 0 representing no difference from normal skin and 10 indicating a severe divergence. Lower scores indicated a better scar condition. (<b>C</b>) Physician-reported overall scar improvement six months after initial treatment vs. pre-treatment condition, with scores ranging from 0 to 10 and 10 indicating the most improvement. The dots with different color represented given scores by different physician. Higher scores are preferable. * <span class="html-italic">p</span> < 0.05 indicates significant difference.</p> Full article ">Figure 4
<p>The outcomes were judged using photographs taken after 6 months of initiating treatment and compared to those taken before treatment to determine which side was better than the other. These physicians were blinded to the treatment regimens applied to both sides of the post-thyroidectomy scar. The dots with different color represented given scores by different physician.</p> Full article ">
Open AccessArticle
Spiritual Connectivity Intervention for Individuals with Depressive Symptoms: A Randomized Control Trial
by
Judy Leung and Kin-Kit Li
Healthcare 2024, 12(16), 1604; https://doi.org/10.3390/healthcare12161604 - 12 Aug 2024
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Depression is one of the most prevalent mental disorders worldwide. This study examined the effect of a spiritual connectivity intervention on individuals with depression in a randomized waitlist-controlled trial. Fifty-seven participants with mild or moderate depressive symptoms were randomly assigned to either the
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Depression is one of the most prevalent mental disorders worldwide. This study examined the effect of a spiritual connectivity intervention on individuals with depression in a randomized waitlist-controlled trial. Fifty-seven participants with mild or moderate depressive symptoms were randomly assigned to either the intervention group (n = 28) or the waitlist control group (n = 29). The intervention comprised eight weekly sessions focusing on divine connection, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. The outcome measures included depressive symptoms, anxiety, hope, meaning in life, self-esteem, and social support. Participants completed self-administered questionnaires at baseline (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Repeated-measures ANOVA and one-way ANCOVA were used to compare the within-group and between-group differences in the changes in outcome variables. Participants in the intervention group showed significant improvements in depression, anxiety, spiritual experience, hope, self-esteem, and perceived social support after the intervention. Effect size statistics showed small to large differences (Cohen’s d, 0.308 to −1.452). Moreover, 85.71% of participants in the intervention group also experienced clinically significant reductions in PHQ-9 scores from baseline to immediate post-intervention. This study highlights the effectiveness of a low-cost, accessible intervention suitable for community implementation by clergy and faith-based organizations.
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Open AccessSystematic Review
E-Health Interventions to Improve Health Outcomes in Patients with Systemic Lupus Erythematosus: A Systematic Review
by
Ana Canal-Pérez, Alba Navas-Otero, Araceli Ortiz-Rubio, Alejandro Heredia-Ciuró, Julia Raya-Benítez, Javier Martín-Núñez and Marie Carmen Valenza
Healthcare 2024, 12(16), 1603; https://doi.org/10.3390/healthcare12161603 - 12 Aug 2024
Abstract
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Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that involves damage to one or more organs and systems. E-Health technologies have been used to improve the quality of care and to minimize the cost of rehabilitation services. This study aimed to
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Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that involves damage to one or more organs and systems. E-Health technologies have been used to improve the quality of care and to minimize the cost of rehabilitation services. This study aimed to provide the most recent and convincing evidence on the rehabilitation effects of e-Health interventions compared to conventional treatments. Methods: A systematic review was conducted. Inclusion criteria were defined following PICO recommendations (i.e., populations, intervention, comparison and outcome measures). Methodological quality and risk-of-bias were assessed for each study. Results: Six studies met the inclusion criteria, providing data on 743 individuals with SLE. Results indicated that e-Health interventions improved health outcomes, such as disease management or emotional status. Methodological quality was moderate and low risk-of-bias was found in the majority of the studies included. Conclusions: For patients with SLE, e-Health interventions are a safe rehabilitation intervention to improve health outcomes. However, more high-quality studies with large samples are needed, with a focus on the long-term outcomes of e-Health interventions for patients with SLE.
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Figure 1
Figure 1
<p>PRISMA flow diagram of literature search and study selection.</p> Full article ">Figure 2
<p>Risk-of-bias of randomized controlled trials included in the systematic review using the RoB 2 [<a href="#B21-healthcare-12-01603" class="html-bibr">21</a>,<a href="#B22-healthcare-12-01603" class="html-bibr">22</a>,<a href="#B23-healthcare-12-01603" class="html-bibr">23</a>,<a href="#B24-healthcare-12-01603" class="html-bibr">24</a>,<a href="#B25-healthcare-12-01603" class="html-bibr">25</a>,<a href="#B26-healthcare-12-01603" class="html-bibr">26</a>].</p> Full article ">
<p>PRISMA flow diagram of literature search and study selection.</p> Full article ">Figure 2
<p>Risk-of-bias of randomized controlled trials included in the systematic review using the RoB 2 [<a href="#B21-healthcare-12-01603" class="html-bibr">21</a>,<a href="#B22-healthcare-12-01603" class="html-bibr">22</a>,<a href="#B23-healthcare-12-01603" class="html-bibr">23</a>,<a href="#B24-healthcare-12-01603" class="html-bibr">24</a>,<a href="#B25-healthcare-12-01603" class="html-bibr">25</a>,<a href="#B26-healthcare-12-01603" class="html-bibr">26</a>].</p> Full article ">
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