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1.
Comput Intell Neurosci ; 2022: 2206573, 2022.
Article in English | MEDLINE | ID: mdl-35371215

ABSTRACT

In today's environment, electronics technology is growing rapidly because of the availability of the numerous and latest devices which can be deployed for monitoring and controlling the various healthcare systems. Due to the limitations of such devices, there is a dire need to optimize the utilization of the devices. In healthcare systems, Internet of things (IoT) based biosensors networking has minimal energy during transmission and collecting data. This paper proposes an optimized artificial intelligence system using IoT biosensors networking for healthcare problems for efficient data collection from the deployed sensor nodes. Here, an optimized tunicate swarm algorithm is used for optimizing the route for data collection and transmission among the patient and doctor. The fitness function of the optimized tunicate swarm algorithm used the distance, proximity, residual, and average energy of nodes parameters. The proposed method is attributed to the optimal CH chosen under TSA operation having a lower energy consumption. The performance of the proposed method is compared to the existing methods in terms of various metrics like stability period, lifetime, throughput, and clusters per round.


Subject(s)
Biosensing Techniques , Internet of Things , Algorithms , Artificial Intelligence , Delivery of Health Care/methods , Humans
3.
BMJ Open ; 12(3): e054561, 2022 03 09.
Article in English | MEDLINE | ID: mdl-35264349

ABSTRACT

OBJECTIVES: This scoping review aims to identify the level of willingness, the existing barriers, and motivators among older adults in using mobile applications to monitor and manage their health conditions. The secondary aim of this paper is to categorise these willingness, barriers and motivators using the Theoretical Domains Framework (TDF). DESIGN: Scoping review. DATA SOURCE: PubMed, Embase, CINAHL, Cochrane Library, Google Scholar and Science Direct (January 2009-December 2020). STUDY SELECTION: Studies that describe older adults' perspectives with regard to their willingness, barriers or motivators towards the use of mobile applications in monitoring and managing their health condition were included. DATA EXTRACTION: Titles and abstracts were initially screened by two reviewers. Articles agreed by both reviewers were proceeded to full-text screening. One reviewer extracted the data, which were verified by a second reviewer. Findings were further classified according to the 14 TDF domains by two researchers. RESULTS: Six studies were included in the final scoping review. Barriers to adopting mobile applications for health-related interventions among older adults were the most common topic identified in the included studies. Barriers included being unaware of the existence of mobile health applications, lack of technological skills, lack of perceived ability and time, absence of professional involvements, and violation of trust and privacy. With regard to willingness, older adults are willing to use mobile applications if the apps incorporated features from a trusted source and have valid credentials. Motivators included continuous improvements of mobile applications' design interface and personalised features tailored to older adults' needs. CONCLUSIONS: With the constant research for more diversified technology, the development of mobile applications to help older adults to manage and monitor health is seen as feasible, but barriers have to be addressed. The most prominent barriers linked to TDF domains were: (1) technological skills, (2) belief about consequences, and (3) memory, attention and decision process. Future interventions should use behaviour change techniques that target these three TDF domains in order to improve the ability to engage older adults with mobile technology.


Subject(s)
Mobile Applications , Telemedicine , Text Messaging , Aged , Delivery of Health Care/methods , Humans , Technology
4.
Math Biosci Eng ; 19(4): 3953-3971, 2022 02 11.
Article in English | MEDLINE | ID: mdl-35341282

ABSTRACT

Artificial Intelligence (AI) driven adaptive techniques are viable to optimize the resources in the Internet of Things (IoT) enabled wearable healthcare devices. Due to the miniature size and ability of wireless data transfer, Body Sensor Networks (BSNs) have become the center of attention in current medical media technologies. For a long-term and reliable healthcare system, high energy efficiency, transmission reliability, and longer battery lifetime of wearable sensors devices are required. There is a dire need for empowering sensor-based wearable techniques in BSNs from every aspect i.e., data collection, healthcare monitoring, and diagnosis. The consideration of protocol layers, data routing, and energy optimization strategies improves the efficiency of healthcare delivery. Hence, this work presents some key contributions. Firstly, it proposes a novel avant-garde framework to simultaneously optimize the energy efficiency, battery lifetime, and reliability for smart and connected healthcare. Secondly, in this study, an Adaptive Transmission Data Rate (ATDR) mechanism is proposed, which works on the average constant energy consumption by varying the active time of the sensor node to optimize the energy over the dynamic wireless channel. Moreover, a Self-Adaptive Routing Algorithm (SARA) is developed to adopt a dynamic source routing mechanism with an energy-efficient and shortest possible path, unlike the conventional routing methods. Lastly, real-time datasets are adopted for intensive experimental setup for revealing pervasive and cost-effective healthcare through wearable devices. It is observed and analysed that proposed algorithms outperform in terms of high energy efficiency, better reliability, and longer battery lifetime of portable devices.


Subject(s)
Artificial Intelligence , Internet of Things , Algorithms , Delivery of Health Care/methods , Reproducibility of Results
5.
Sci Rep ; 12(1): 4207, 2022 03 10.
Article in English | MEDLINE | ID: mdl-35273304

ABSTRACT

The COVID-19 pandemic has had a substantial and lasting impact on care provision, particularly in the field of cancer care. National steering has helped monitor the health situation and adapt the provision and organisation of care. Based on data from the French administrative healthcare database (SNDS) on the entire French population (67 million people), screening, diagnostic and therapeutic activity was monitored and compared 2019 on a monthly basis. A noteworthy decline in all activities (with the exception of chemotherapy) was observed during the first lockdown in France. Over the months that followed, this activity returned to normal but did not make up for the shortfall from the first lockdown. Finally, during the lockdown in late 2020, cancer care activity was conserved. In brief, in 2020, the number of mammograms decreased by 10% (- 492,500 procedures), digestive endoscopies by 19% (- 648,500), and cancer-related excision by 6% (- 23,000 surgical procedures). Hospital radiotherapy activity was down 3.8% (- 4400 patients) and that in private practice was down 1.4% (- 1600 patients). Chemotherapy activity increased by 2.2% (7200 patients), however. To summarize, COVID-19 had a very substantial impact during the first lockdown. Safeguarding cancer care activity helped limit this impact over the months that followed, but the situation remains uncertain. Further studies on the medium- and long-term impact on individuals (survival, recurrence, after-effects) will be conducted.


Subject(s)
COVID-19 , Delivery of Health Care/statistics & numerical data , Neoplasms/diagnosis , Neoplasms/therapy , Oncology Service, Hospital/statistics & numerical data , Quarantine/statistics & numerical data , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Delivery of Health Care/methods , France/epidemiology , Humans
6.
Implement Sci ; 17(1): 19, 2022 02 22.
Article in English | MEDLINE | ID: mdl-35193611

ABSTRACT

BACKGROUND: Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. OBJECTIVES: (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. METHOD: Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. RESULTS: A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. CONCLUSION: The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation.


Subject(s)
Delivery of Health Care , Delivery of Health Care/methods , Humans , Qualitative Research
10.
Syst Rev ; 11(1): 32, 2022 02 19.
Article in English | MEDLINE | ID: mdl-35183253

ABSTRACT

BACKGROUND: The psychosocial rehabilitation of an individual with mental illness is an evidence-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising scope for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map studies on how psychosocial rehabilitation is conducted for people living in Africa with the most chronic form of mental illness, schizophrenia. METHODS: This study will adopt the Arksey and O'Malley scoping review framework to search and compile relevant studies. This process will involve three steps: title screening, to be performed solely by the principal investigator, followed by abstract and full-text screening, to be performed independently by two reviewers (the principal investigator and co-investigator). Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records, and data charting form will be used to extract basic data of included studies. The risk of bias in the articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT). Finally, the content analysis of the screened studies will be performed with NVivo. EXPECTED OUTCOME: This study has the likelihood of revealing a research gap in psychosocial rehabilitation approaches and methods. The review results will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the psychosocial rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Sahara Africa. The implementation process also encompasses disseminating the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.


Subject(s)
Psychiatric Rehabilitation , Schizophrenia , Africa South of the Sahara , Delivery of Health Care/methods , Humans , Mass Screening , Review Literature as Topic
13.
BMC Health Serv Res ; 22(1): 234, 2022 Feb 19.
Article in English | MEDLINE | ID: mdl-35183164

ABSTRACT

BACKGROUND: Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers include pragmatic, rapid change. Using the CIFR lens, we aimed to explore how pragmatic and complex healthcare improvement and implementation science can be integrated. METHODS: Our research involved the investigation of a case study that was undertaking the implementation of an improvement intervention at a large public health service. Our research involved qualitative data collection methods of semi-structured interviews and non-participant observations of the implementation team delivering the intervention. Thematic analysis identified key themes from the qualitative data. We examined our themes through the lens of CFIR to gain in-depth understanding of how the CFIR components operated in a 'real-world' context. RESULTS: The key themes emerging from our research outlined that leadership, context and process are the key components that dominate and affect the implementation process. Leadership which cultivates connections with front line clinicians, fosters engagement and trust. Navigating context was facilitated by 'bottom-up' governance. Multi-disciplinary and cross-sector capability were key processes that supported pragmatic and agile responses in a changing complex environment. Process reflected the theoretically-informed, and iterative implementation approach. Mapping CFIR domains and constructs, with these themes demonstrated close alignment with the CFIR. The findings bring further depth to CFIR. Our research demonstrates that leadership which has a focus on patient need as a key motivator to engage clinicians, which applies and ensures iterative processes which leverage contextual factors can achieve successful, sustained implementation and healthcare improvement outcomes. CONCLUSIONS: Our longitudinal study highlights insights that strengthen alignment between implementation science and pragmatic frontline healthcare improvement. We identify opportunities to enhance the relevance of CFIR in the 'real-world' setting through the interconnected nature of our themes. Our study demonstrates actionable knowledge to enhance the integration of implementation science in healthcare improvement.


Subject(s)
Delivery of Health Care , Implementation Science , Delivery of Health Care/methods , Humans , Leadership , Longitudinal Studies , Qualitative Research
14.
CMAJ ; 194(6): E186-E194, 2022 02 14.
Article in English | MEDLINE | ID: mdl-35165130

ABSTRACT

BACKGROUND: The clinical teaching unit is a widespread clinical training model that requires reform to prepare physicians for practice in the 21st century. In this systematic review, we aimed to identify evidence-based practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery. METHODS: We searched several databases from 1993 until Apr. 5, 2021, to identify published studies in inpatient clinical teaching units that involved medical trainees and reported outcomes related to trainee education or health care delivery. We identified emergent themes using a narrative approach and determined confidence in review findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) methodology. RESULTS: We included 107 studies of internal medicine clinical teaching units, of which 93 (87%) were conducted in North America. Surveys (n = 31, 29%), trials (n = 17, 16%) and narrative studies (n = 15, 14%) were the most prevalent study designs. Practices identified as contributing to improved clinical education or health care delivery included purposeful rounding (high confidence), bedside rounding (moderate confidence), resource stewardship interventions (high confidence), interprofessional rounds (moderate confidence), geographic wards (moderate confidence), allocating more trainee time to patient care or educational activities (moderate confidence), "drip" continuous models of admission (moderate confidence), limiting duty hours (moderate confidence) and limiting clinical workload (moderate confidence). INTERPRETATION: In this review, we identified several evidence-based practices that may contribute to improved educational and health care outcomes in clinical teaching unit settings. These findings may offer guidance for policies, resource allocation and staffing of teaching hospitals.


Subject(s)
Delivery of Health Care/methods , Evidence-Based Practice/methods , Internal Medicine/education , Clinical Trials as Topic , Education, Medical/methods , Humans , North America , Qualitative Research , Surveys and Questionnaires
15.
Internet resource in Portuguese | LIS -Health Information Locator | ID: lis-48574

ABSTRACT

Além das vacinas, que servem como prevenção, o Ministério da Saúde tem concentrado esforços na assistência das pessoas que tiveram a Covid-19 e necessitam de tratamento para reabilitação devido a sequelas causadas pela doença.


Subject(s)
COVID-19/complications , Delivery of Health Care/methods
16.
PLoS One ; 17(1): e0261604, 2022.
Article in English | MEDLINE | ID: mdl-35020735

ABSTRACT

BACKGROUND: Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. METHODS: The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. RESULTS: A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. CONCLUSIONS: Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.


Subject(s)
Delivery of Health Care/methods , Health Personnel/psychology , Adult , Aged , Female , Health Services Research , Humans , Latin America , Male , Middle Aged , Perception , Primary Health Care , Program Evaluation , Secondary Care , Surveys and Questionnaires , Young Adult
18.
JAMA Netw Open ; 5(1): e2142354, 2022 01 04.
Article in English | MEDLINE | ID: mdl-34985514

ABSTRACT

Importance: Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. Objective: To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. Design, Setting, and Participants: This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. Main Outcomes and Measures: Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). Results: On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. Conclusions and Relevance: In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.


Subject(s)
Amputation , COVID-19 , Delivery of Health Care/methods , Diabetes Mellitus , Diabetic Foot/surgery , Pandemics , Aged , COVID-19/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Emergency Service, Hospital , Female , Foot/pathology , Foot/surgery , Glycated Hemoglobin A , Hospitalization , Humans , Male , Middle Aged , Ontario/epidemiology , Physical Examination , SARS-CoV-2 , Vascular Surgical Procedures
19.
AIDS ; 36(6): 853-862, 2022 May 01.
Article in English | MEDLINE | ID: mdl-35025818

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the effectiveness of five intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC). DESIGN: A systematic review with meta-analysis. METHODS: We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e. re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness. RESULTS: Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) = 1.79;95% confidence interval (95% CI): 1.36-2.36, k = 14], retention in care (OR = 2.01; 95% CI: 1.64-2.64, k = 22), and viral suppression (OR = 2.50;95% CI: 1.87-3.34, k = 27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression. CONCLUSION: Several strategies are effective for improving HIV care outcomes among PWH who are OOC. More work is still needed for consistent definitions of OOC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.


Subject(s)
Acquired Immunodeficiency Syndrome , Delivery of Health Care , HIV Infections , Patient Navigation , Delivery of Health Care/methods , HIV Infections/epidemiology , HIV Infections/therapy , Humans
20.
BMJ Open ; 12(1): e058048, 2022 Jan 04.
Article in English | MEDLINE | ID: mdl-34983774

ABSTRACT

INTRODUCTION: The formation, modification and implementation of occupational health and safety policy for the Ghana healthcare industry hinge on data and reviews on occupational exposures. However, there is no synthesised review to speak to the issues of these occupational exposures. A scoping review on occupational exposures among the health workforce in Ghana will provide a broad overview of exposures, and can guide and assist in making decisions on occupational health issues relating to healthcare workers. METHODS AND ANALYSIS: Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. Primary research studies, government documents and other information on occupational exposures among healthcare workers published in the English language will be retrieved from databases including PubMed, CINAHL, Embase, MEDLINE, Scopus, PsycINFO and Google scholar. A systematic search strategy will be employed to identify articles from 1 January 2010 until 30 November 2021. Also, grey literature sources in Ghana including government and tertiary institutions websites will be searched. A reference list of key studies and other available non-electronic materials will also be screened to identify relevant studies for inclusion. The review will consider studies that address prevalence, knowledge and predisposing factors of occupational exposures along with the use of occupational hazards control/preventive measures. After removal of duplicates, and title and abstract screening, relevant articles will be subjected to full-text analysis. The screening processes will be conducted independently by two reviewers. Data will then be extracted and presented in tabular form with a narrative to aid easy comprehension. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. The findings will be disseminated through publications, conference presentations and stakeholder meetings.


Subject(s)
Occupational Health , Delivery of Health Care/methods , Ghana , Health Personnel , Health Workforce , Humans , Research Design , Review Literature as Topic
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