A two-echelon responsive health analytic model for triggering care plan revision in geriatric care management

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults’ needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the Internet of Medical Things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities.

Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovación en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG®, intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40–0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovación en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.

COVID-19 in Single Kidney Patient

The COVID-19 pandemic has affected all people in the world, especially those at risk of kidney disorders. Early kidney damage in patients born with unilateral renal agenesis (URA) or solitary kidney can happen. These patients are at risk of chronic kidney disease (CKD), high blood pressure, and developing proteinuria. Unilateral renal agenesis is a cause of CKD. Therefore, it is very interesting that observe a unilateral renal Patient that Suffers from COVID-19. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. A 43-year-old male patient with unilateral renal presented to our hospital for corona disease. The case was discussed between the nephrologists, Infectious disease specialists, and nursing head nurses for a care plan daily. The patient had unilateral renal disease, and COVID-19 could have a detrimental effect on the renal, but renal tests were normal, and the patient recovered without acute renal complications. The treatment of such patients is the need for teamwork contain nephrologists, critical care nurses, and specialists in infectious and tropical diseases. This was a new experience in Iran.

Integration of an ICU visualization dashboard (i-Dashboard) as a platform to facilitate multidisciplinary rounds: A cluster randomized trial (Preprint)

BACKGROUND Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). OBJECTIVE i-Dashboard is a custom-developed visualization dashboard that supports 1) key information retrieval and reorganization, 2) time-series data and 3) display on large touchscreens during MDRs. The present study aimed to evaluate the performance, including the efficiency of pre-rounding data gathering, communication accuracy and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. METHODS A cluster randomized trial was performed in two surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performances and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire survey. RESULTS Between April 26, 2021, and July 18, 2021, 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For pre-rounding data gathering, the median (interquartile range [IQR]) time was 10.4 (9.1-11.8) and 4.6 (3.5-5.8) minutes using the established EMR and i-Dashboard (P<.001), respectively. During MDRs, data misrepresentations were significantly less frequent with i-Dashboard (median [IQR]: 0 [0-0]) than with the established EMR (4 [3-5]; P<.001). Also, effective recommendations were significantly more frequent with i-Dashboard than with the established EMR (P<.001). The questionnaire results revealed that participants favored using i-Dashboard in association with the enhancement of care plan development and team participation during MDRs. CONCLUSIONS i-Dashboard increases the efficiency in data gathering. Displaying i-Dashboard on large touchscreens in MDRs may enhance communication accuracy, information exchange and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. CLINICALTRIAL ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698

Elderly victims of violence: family assessment through the Calgary model

ABSTRACT Objective: To understand the structure, development, and functionality of the family of the elderly victim of violence. Method: Descriptive research with a qualitative approach, based on the Calgary Family Assessment Model. Four elderly people who suffered violence and their family members were assessed at home, from October to November 2019. Data analysis was based on the genogram and ecomap, as proposed in the model. Results: It was found that the members of the four families had low schooling and financial difficulties. As for the social support network, the neighbors, the health unit and the Church stood out. The members of each family nucleus expressed feelings of fear, insecurity, anger, nervousness, sadness and impotence, resulting from the conflict between the couple. Final considerations: In the assessed families, weaknesses and potentialities in the structure, development and functioning are highlighted, which must be considered in the elaboration of the care plan.

A Review of Genome-Based Precision Medicine Efforts Within the Department of Defense

ABSTRACT Introduction Providing patient-specific clinical care is an expanding focus for medical professionals and researchers, more commonly referred to as personalized or precision medicine. The goal of using a patient-centric approach is to provide safer care while also increasing the probability of therapeutic success through careful consideration of the influence of certain extrinsic and intrinsic human factors in developing the patient care plan. Of increasing influence on patient care is the phenotype and genotype information gathered from employing various next-generation sequencing methods. Guided by and partnered with our civilian colleagues, clinical components within the DoD are embracing and advancing genomic medicine in many facets—from the bench to the bedside—and in many therapeutic areas, from Psychiatry to Oncology. In this PubMed-based review, we describe published clinical research and interventions within the DoD using genome-informed data and emphasize precision medicine efforts in earlier stages of development with the potential to revolutionize the approach to therapeutics. Materials and Methods The new PubMed database was searched for articles published between 2015 and 2020 with the following key search terms: precision medicine, genomic, pharmacogenetic, pharmacogenomic, US military, and Department of Defense. Results Eighty-one articles were retrieved in our initial search. After screening the abstracts for studies that only involved direct testing of (or clinical interaction with) active duty, Reserve, National Guard, or civilian personnel working within the DoD and excluding any epidemiological or microbial isolation studies, seven were included in this review. Conclusion There are several programs and studies within the DoD, which investigate or use gene-based biomarkers or gene variants to deliver more precise clinical assessment and treatment. These genome-based precision medicine efforts aim to optimize the clinical care of DoD beneficiaries, particularly service members in the operational environment.

GAMBARAN TINGKAT KEMANDIRIAN LANSIA DALAM PEMENUHAN ACTIVITY OF DAILY LIVING (ADL) DI ROJINHOME THINSAGUNO IE ITOMAN OKINAWA JEPANG

Abstrak Activity of daily living (ADL) adalah aktivitas pokok bagi perawatan diri. Activity of daily living meliputi antara lain: ke toilet, makan, berpakaian (berdandan), mandi, dan berpindah tempat. Pengkajian ADL penting untuk mengetahui tingkat ketergantungan lansia dalam rangka menetapkan level bantuan bagi lansia tersebut dan untuk menyusun rencana perawatan jangka panjang. Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat kemandirian lansia dalam pemenuhan ADL yang tinggal di rojinhome Thinsaguno Ie Itoman Okinawa Jepang. Jenis penelitian ini adalah deskriptif observasional. Sampel dalam penelitian ini adalah seluruh lansia di rojinhome Thinsaguno Ie Itoman Okinawa Jepang sejumlah 34 responden. Penentuan sampel menggunakan teknik total sampling. Alat ukur yang digunakan adalah lembar checklist Barthel Index. Penelitian ini menggunakan analisis data univariat yang ditampilkan dalam distribusi frekuensi. Hasil penelitian menunjukan rata-rata umur yaitu 83,23 tahun dan paling dominan pada rentang umur old (75-90 tahun) yaitu 70,6%. Jenis kelamin sebagian besar perempuan yaitu 64,7%, tingkat kemandirian sedang dalam ADL yaitu 38,2%. Tingkat kemandirian lansia berdasarkan umur paling dominan pada rentang umur old (75-90 tahun) dengan tingkat kemandirian sedang (29,4%). Tingkat kemandirian lansia berdasarkan jenis kelamin paling dominan pada jenis kelamin perempuan dengan ketergantungan sedang (23,5%). Kata kunci: lansia, activity of daily living, tingkat kemandiria Abstract Activity of daily living (ADL) is a staple activity for self-care. Activity of daily living includes, among others: toileting, eating, dressing, showering, and moving places. ADL assessment is important to determine the level of dependence of the elderly in order to determine the level of assistance for the elderly and to develop a long-term care plan. The purpose of this study was to describe the level of independence of the elderly in fulfilling the ADL at rojinhome of Thinsaguno Ie Itoman Okinawa, Japan. The type of this research is descriptive observational with cross sectional approach. The sample in this research were all 34 elderly people at rojinhome Thinsaguno Ie Itoman Okinawa Japan. Determination of the sample using total sampling technique. The measuring instrument used is the Barthel Index checklist sheet. This study uses univariate data analysis which is displayed in the frequency distribution. The results showed that the average age was 83.23 years and the most dominant in the old age range (75-90 years) was 70.6%. The gender of most of the women was 64.7%, the level of independence was moderate in ADL, namely 38.2%. The level of elderly independence based on age is the most dominant in the old age range (75-90 years) with a moderate level of independence (29.4%). The level of independence of the elderly based on sex was the most dominant in the female sex with moderate dependence (23.5%). Keywords: elderly, activity of daily living, level of independence