Tag: pubmed

J Med Internet Res. 2024 Oct 17;26:e56192. doi: 10.2196/56192.

ABSTRACT

BACKGROUND: Barcode information management systems (BIMS) have been implemented in operating rooms to improve the quality of medical care and administrative efficiency. Previous research has demonstrated that the Agile development model is extensively used in the development and management of information systems. However, the effect of information systems on staff acceptance has not been examined within the context of clinical medical information management systems.

OBJECTIVE: This study aimed to explore the effects and acceptance of implementing a BIMS in comparison to the original information system (OIS) among operating and supply room staff.

METHODS: This study was a comparative cohort design. A total of 80 staff members from the operating and supply rooms of a Northern Taiwan medical center were recruited. Data collection, conducted from January 2020 to August 2020 using a mobile-based structured questionnaire, included participant characteristics and the Information Management System Scale. SPSS (version 20.0, IBM Corp) for Windows (Microsoft Corporation) was used for data analysis. Descriptive statistics included mean, SD, frequency, and percentage. Differences between groups were analyzed using the Mann-Whitney U test and Kruskal-Wallis test, with a P value <.05 considered statistically significant.

RESULTS: The results indicated that the BIMS generally achieved higher scores in key elements of system success, system quality, information quality, perceived system use, perceived ease of use, perceived usefulness, and overall quality score; none of these differences were statistically significant (P>.05), with the system quality subscale being closest to significance (P=.06). Nurses showed significantly better perceived system use than technicians (1.58, SD 4.78 vs -1.19, SD 6.24; P=.02). Significant differences in perceived usefulness were found based on educational level (P=.04) and experience with OIS (P=.03), with junior college-educated nurses and those with over 6 years of OIS experience reporting the highest perceived usefulness.

CONCLUSIONS: The study demonstrates that using the Agile development model for BIMS is advantageous for clinical environments. The high acceptance among operating room staff underscores its practicality and broader adoption potential. It advocates for continued exploration of technology-driven solutions to enhance health care delivery and optimize clinical workflows.

PMID:39418645 | DOI:10.2196/56192

JMIR Form Res. 2024 Oct 15. doi: 10.2196/62742. Online ahead of print.

ABSTRACT

BACKGROUND: Telemedicine has revolutionized healthcare by significantly enhancing accessibility. However, the acceptability and uptake of tele-medicine is prone to various hindering factors. Studies have shown that both patients and healthcare providers appreciate the aspect of convenience. However, healthcare providers’ limited understanding of or inability to leverage the technology involved can be a barrier. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports findings from a usability study of HelixVM™, a telemedicine platform that uses an Artificial Intelligence (AI)-powered triage for healthcare delivery. We discuss aspects of asynchronous medicine, healthcare accessibility, saving time, productivity, data exchange, security, privacy, AI-powered triage and quality of care.

OBJECTIVE: To assess the usability and effectiveness of the HelixVM marketplace platform.

METHODS: We recruited 102 patients and 12 providers in a mixed-methods study design involving surveys, and in-depth structured interviews with a subset of the providers only. The survey questionnaires are a modified version of the telehealth utility questionnaire. We analyzed the patient’s data using descriptive statistics and factor analysis to identify latent demographic patterns. For the providers data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers for negative, neutral or positive. We also calculated percentages of different responses for the providers from the surveys and interviews, where applicable.

RESULTS: Patients: Overall, 86% of patients are satisfied with HelixVM and 89% will use the services again. More than 90% of patients agreed that HelixVM improves access to healthcare, saves time and that the platform is an acceptable way to receive healthcare. Chi-square tests demonstrate statistical significance for all the survey questions (p-value <.001). Results from factor analysis show a higher propensity of female gender in middle age groups whose encounter type is fast-track, self-report medium level of tech-savviness and residing in the South regions of US rate the platform more positively. Providers: Thematic analysis identified themes of asynchronous medicine in terms of accessibility and quality of care, time and productivity, integration within the workflow, data exchange and AI-triage. Certain challenges of incomplete data in patient chart and its impact on provider time are cited. Suggestions for improvements include options to ensure completeness of patient questionnaires and better screening to ensure that only asynchronous ‘qualified’ patients get through to the provider.

CONCLUSIONS: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription is favorable as compared to traditional telemedicine. Some concerns on data completeness, gaps and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledgebase of existing literature and provides for a detailed analysis into the real-world implementation of a telemedicine market-place platform.

PMID:39418632 | DOI:10.2196/62742

JCO Glob Oncol. 2024 Oct;10:e2400060. doi: 10.1200/GO.24.00060. Epub 2024 Oct 17.

ABSTRACT

PURPOSE: The incidence of GI cancers is increasing in sub-Saharan African countries. We described the oncological care pathway and assessed presentation, diagnosis, and treatment intervals and delays among patients with GI cancer who presented to the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria.

METHODS: We analyzed data from 545 patients with GI cancer in the African Research Group for Oncology (ARGO) database. We defined presentation interval as the interval between symptom onset and presentation to tertiary hospital, diagnostic interval as between presentation and diagnosis, and treatment interval as between diagnosis and initiation of treatment. We considered >3 months, >1 month, and >1 month to be presentation, diagnosis, and treatment delays, respectively. We compared lengths of intervals using Mann-Whitney U tests and logistic regression.

RESULTS: The most frequent cancer types were pancreatic (32%) and colorectal (28%). Most patients presented at stages III (38%) and IV (30%). The median presentation interval was 84 days (IQR, 56-191), and 49% presented after 3 months or longer. The median diagnosis and treatment intervals were 0 (IQR, 0-8) and 7 (IQR, 0-23) days, respectively. There was no relationship between age, sex, education, or distance to tertiary hospital and presentation delay, but patients with stage III to IV versus I to II had higher odds of presentation delay (odds ratio [OR], 1.68 [95% CI, 1.13 to 2.50]). Among patients with pancreatic cancer, older patients were less likely to have a diagnosis delay (OR, 0.50 [95% CI, 0.25 to 0.98]).

CONCLUSION: About half of patients with GI cancer in Ile-Ife, Nigeria, did not present to tertiary hospitals until more than 90 days after noticing symptoms. Efforts are warranted to improve public knowledge of GI cancer symptoms and to strengthen health systems for prompt diagnosis and referral to specialty care.

PMID:39418630 | DOI:10.1200/GO.24.00060

JCO Glob Oncol. 2024 Oct;10:e2400318. doi: 10.1200/GO-24-00318. Epub 2024 Oct 17.

ABSTRACT

PURPOSE: Paclitaxel is effective chemotherapy against various cancers but can cause hypersensitivity reaction (HSR). This study aimed to identify predictors associated with paclitaxel HSR and develop a clinical prediction model to guide clinical decisions.

METHODS: Data were collected from the medical records database of Rajavithi Hospital. Patients with cancer treated with paclitaxel from 2015 to 2022 were included, and a multivariable logistic regression analysis identified predictors associated with paclitaxel HSR. The scoring system was transformed and calibrated on the basis of diagnostic parameters. Discrimination and calibration performances were assessed. Internal validation was conducted using bootstrap resampling with 1,000 replications.

RESULTS: This study involved 3,708 patients with cancer, with an incidence of paclitaxel HSR of 10.11%. An 11-predictor-based Pac-HSR scoring system was developed, involving the following factors: younger age; poor Eastern Cooperative Oncology Group performance status; previous history of paclitaxel HSR; medication allergy history; chronic obstructive airway disease; lung and cervical cancers; high actual dose of paclitaxel; no diphenhydramine premedication; low hemoglobin level; high WBC count; and high absolute lymphocyte count. The C-statistics was 0.73 (95% CI, 0.70 to 0.76), indicating acceptable discrimination. The P value of the Hosmer-Lemeshow goodness-of-fit test was 0.751. The ratio of observed and expected values was 1.00, indicating good calibration. At a cutoff point of 8, specificity was 75.28% and sensitivity was 57.07%. Internal validation indicated good performance with minimal bias, and decision curve analysis demonstrated improved prediction with the use of this scoring system in clinical decision making.

CONCLUSION: This study developed the 11-predictor-based Pac-HSR scoring system for predicting paclitaxel HSR in patients with cancer. High-risk patients identified by this score should be prioritized for close monitoring and early treatment prophylaxis.

PMID:39418625 | DOI:10.1200/GO-24-00318

JCO Oncol Pract. 2024 Oct 17:OP2400354. doi: 10.1200/OP.24.00354. Online ahead of print.

ABSTRACT

PURPOSE: To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma.

METHODS: We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion.

RESULTS: We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02).

CONCLUSION: Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.

PMID:39418621 | DOI:10.1200/OP.24.00354

N Z Med J. 2024 Oct 18;137(1604):62-72. doi: 10.26635/6965.6552.

ABSTRACT

AIM: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor?

METHOD: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified.

RESULTS: Suicide was more likely to involve AAU among Māori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning.

CONCLUSION: Targeted public health interventions designed by and for specific demographic groups (particularly Māori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand.

PMID:39418606 | DOI:10.26635/6965.6552

N Z Med J. 2024 Oct 18;137(1604):35-41. doi: 10.26635/6965.6533.

ABSTRACT

AIMS: To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand.

METHODS: A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab.

RESULTS: A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections.

CONCLUSIONS: The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

PMID:39418603 | DOI:10.26635/6965.6533

N Z Med J. 2024 Oct 18;137(1604):13-21. doi: 10.26635/6965.6599.

ABSTRACT

AIM: To determine if high normal early pregnancy HbA1c (35-40mmol/mol), in the absence of diabetes, was associated with increased risk of adverse perinatal outcomes compared to normal HbA1c (<35mmol/mol).

METHOD: A retrospective chart review was carried out on all singleton births in the Wellington region from 1 July 2019 to 31 December 2019. Exclusion criteria were participants domiciled outside the Wellington region, HbA1c ≥50mmol/mol, pre-existing diabetes, gestational diabetes in current pregnancy, no HbA1c performed <20 weeks or the first HbA1c was taken at ≥20 weeks. Baseline characteristics, HbA1c and pregnancy outcomes were obtained. The primary outcome was birth weight and was analysed using multiple linear regression.

RESULTS: There were 1,067 participants in the normal HbA1c (nHbA1c) group and 186 in the high normal HbA1c (hnHbA1c) group. There was no difference in birth weight between hnHbA1c and nHbA1c. hnHbA1c had significantly lower odds of post-partum haemorrhage and composite maternal adverse outcomes compared to nHbA1c (OR 0.52, 95% CI 0.35-0.76) and (OR 0.64, 95% CI 0.46-0.89).

CONCLUSION: High normal HbA1c was not associated with increased risk of adverse perinatal outcomes in pregnant people who did not develop gestational diabetes.

PMID:39418601 | DOI:10.26635/6965.6599

Health Care Women Int. 2024 Oct 17:1-15. doi: 10.1080/07399332.2024.2413448. Online ahead of print.

ABSTRACT

The authors aimed to explore the association between anthropometric indicators and cognitive function and determine which aspects of anthropometric indicators are most closely related to cognitive function. A sum of 3269 older women were included in this study. Body mass index (BMI), waist circumference, hip circumference, calf circumference, and waist-to-hip ratio were obtained to reflect anthropometric indicators. Cognitive function was assessed using Mini-Mental State Examination (MMSE). Researchers revealed statistically significant differences in total MMSE scores among the low, medium, and high groups of BMI, waist circumference, hip circumference, and calf circumference. Researchers also observed that calf circumference, hip circumference, and waist circumference are significantly associated with the total MMSE score. Our findings highlighted that older women with greater BMI, waist circumference, hip circumference, and calf circumference have a better level of cognitive function. Calf circumference is the most closely anthropometric indicator related to cognitive function in Chinese older women.

PMID:39418595 | DOI:10.1080/07399332.2024.2413448

Environ Sci Technol. 2024 Oct 17. doi: 10.1021/acs.est.4c05327. Online ahead of print.

ABSTRACT

To assess the potential risks of contemporary levels of plastic pollution in freshwater ecosystems, a large-scale experiment was conducted over 10 weeks in a boreal lake at the IISD-Experimental Lakes Area (Ontario, Canada). Fragments of common polymers (polyethylene, polystyrene, and polyethylene terephthalate), each with distinct colors and buoyancies, were added as a single pulse to seven in-lake mesocosms in equal contributions in a range of environmentally relevant nominal concentrations (6-29,240 particles/L). Two additional mesocosms with no added microplastics were used as controls. Zooplankton ingested low levels of microplastics (mean of 0.06 particles/individual ± SD 0.07) and generally their total abundance and community composition were not negatively impacted. Temporary changes were however observed; total zooplankton abundance and abundance of calanoid copepods were temporarily stimulated by increasing nominal microplastic concentrations, and modest, short-term reductions in egg production of the cyclopoid copepod Tropocyclops extensus and abundance of copepod nauplii occurred. Collectively, these results suggest that microplastics could have complex impacts on zooplankton communities, stimulating some species while negatively impacting others.

PMID:39418533 | DOI:10.1021/acs.est.4c05327