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Aims: A proof-of- concept pilot investigating the profile of person who engaged with remote testing for their annual diabetes review, and service user (SU) and primary care practice acceptability for completing annual diabetes review tests remotely (blood pressure, finger-stick blood test and urine test). Method(s): A mixed methods evaluation based on SU surveys sent to all 144 pilot participants, semi-structured SU and staff interviews, and demographic and clinical data extraction from primary care electronic patient record system. Result(s): Profile: The pathway was considered suitable for people who were working, digitally capable, younger, had household support to complete the tests, had non-complex diabetes, or a combination of these attributes. It was deemed less suitable for the very elderly, the less digitally capable, those with complex health needs or socially isolated. SU Acceptability: Interviewees and survey respondents overall deemed the remote tests acceptable for use. Convenience and reduced exposure to Covid-19 were motivating factors for participation. Preference for face-to- face care or concerns around using digital technologies were key reasons for decline. Staff Acceptability: The pathway was deemed acceptable and was successfully implemented at both practices. Support from a designated pathway co-ordinator and project manager were key factors linked to acceptability and success. The remote pathway was seen as an opportunity to reduce primary care pressures on in-person care. Conclusion(s): It is possible to successfully conduct annual diabetes reviews remotely. Although not appropriate nor desirable to everyone, remote testing provides a viable alternative to in-person testing for certain individuals.
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This rapid review provides an overview of recent literature on the nature of digital interventions for young people in terms of technologies used, substances and populations targeted, and theoretical or therapeutic models employed. A keyword search was conducted using MEDLINE and other databases for 2015-2021. Following a title/ and full-text screening of articles and consensus decision on study inclusion, data extraction proceeded using an extraction grid. Data synthesis relied on an adapted conceptual framework (Stockings et al., 2016) that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment). The review identified 43 articles describing 39 digital interventions. Most were early interventions (n = 28), followed by prevention (n = 6) and treatment (n = 5). Of the five technologies identified, web-based interventions (n = 14) were most common. Digital interventions have mainly focused on alcohol use (n = 20), reflecting limited concern for other substance use and co-occurring use. Yet the rise in substance use and related harms during the Covid-19 pandemic highlights a critical need for more innovative substance use interventions. Technologies with more immersive and interactive features, such as VR and game-based interventions, call for further exploration. Only one intervention was culturally tailored and purposefully designed for gender minority youth, and another was geared to young men. As well, most interventions used a personalized or normative feedback approach, while a harm reduction approach guided only one intervention. The incorporation of culturally tailored interventions and harm reduction approaches may promote uptake and stronger engagement with digital interventions amongst youth.
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Objectives: Develop a coding system to extract EHR data and establish research validity to lessen need for manual data extraction Methods: As part of a data collection project for COVID + patients requiring ICU care, we established data elements able to be extracted from the Epic electronic health record (EHR). Collaboration between Information Technology (IT), research and clinical personnel established where data elements were located within the EHR and what data could be extracted with minimal manual assistance and uploaded to a research database. Coding was developed using Structured Query Language (SQL) with best practices (includes indexes, execution plans, optimized range keys, avoiding large reads inside read-write transactions as instructed by the Epic consultant). Accuracy of extracted data was evaluated by manual validation of data against Epic records via random selection of patient data within the cohort. Result(s): From July-December 2022, coding was developed which extracted over 130 fields of data from 3093 COVID patients across 5 INOVA ICU sites (demographic, physiologic, lab, interventions, outcome). Prior efforts at data extraction of these elements from research personnel (ZS) who previously performed this task noted an average of 4 hours/patient to complete coded fields. Coded data was also noted to be more accurate when accessed by the same personnel to manually extracted fields. Assuming 4 hrs/pt, manual extraction would require 12,372 hours, which equates to over 6 full time human research personnel. Data coding required 446 hours. Coded data extraction can be almost immediate once fields requested are established, decreasing personnel costs and effort significantly. Conclusion(s): Reduction in need for manual data collection using automated coding extraction can reduce costs, personnel time and enhance research efforts. Sharing coding mapping to other EPIC sites or use of similar methods may improve timeliness of ongoing data extraction and will be useful to develop earlywarning and patient-centered care algorithms to improve care.
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Objective: The impact of social media on public health has been examined in various studies. However, none have explored user engagement based on the type of Facebook posts related to renal disease. Therefore, the present study sought to determine which type of nephrology-related posts have greater user engagement. Setting(s): Facebook pages. Method(s): The posts on a specific Facebook page curated by a team of nephrologists in Malaysia were examined in this cross-sectional study. The type of post, likes, comments, shares of a post and reach of a post were used for data analysis. Analysis of variance was used to quantify the relative contribution of each independent variable to the odds of the post being highly liked or shared. The Kruskal-Wallis test was used to compare links, photos, shared videos, status and videos for parameters such as reach, the number of times a specific piece of content has been displayed on a screen (impressions), and user engagement. Result(s): Shared videos and photos received the highest median reach of 5,862 and 5,880, respectively. People who 'liked' the page in 2019, 2020 and 2021 numbered 193, 4,196 and 2,835, respectively. Among the types of content on the Facebook page, photos and shared videos received the highest median lifetime reach of the post compared to links, status and videos in terms of 'people who liked the page'. Conclusion(s): The study findings suggest that posting a video or photo maximises the chance of engagement and meaningfully impacts public health outcomes.Copyright © The Author(s) 2023.
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Millions of people have been afflicted by the COVID-19 epidemic, which has resulted in hundreds of thousands of fatalities throughout the world. Extracting correct data on patients and facilities with and without COVID-19 with high confidence for medical specialists or the government is extremely difficult. As a result, utilizing blockchain technology, a reliable data extraction methodology for the COVID-19 database is constructed. In this accurate data extraction model development and validation study in blockchain technology for COVID analysis, here a novel Hybrid Deep Belief Lionized Optimization (HDBLO) approach is proposed. The weights of the deep model are optimized by the fitness of lion optimization. The implementation of this work is executed using MATLAB software. The simulation outcomes shows the effective performance of proposed model in blockchain technology in COVID paradigm in terms of Mean Absolute Error (MAE), Root Mean Square Error (RMSE), accuracy, F-measure, Processing time, precision and error. Consequently, the proposed approach is compared with the conventional strategies for significant validation. © 2023 Authors. All rights reserved.
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Introduction: Prone positions have been used extensively to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). During the COVID-19 pandemic there was widespread adoption of proning in patients with acute severe hypoxic respiratory failure. Few studies explore the use of prone positioning in mechanically ventilated COVID-19 patients. Method(s): This study was part of the REACT COVID observational study at University Hospital Southampton (UHS) [1]. Eligibility included admission to UHS with a positive COVID-19 RT-PCR between 03/2020 and 03/2022. Data was collected from all available electronic clinical data sources using semi-automated and manual data extraction. Result(s): 184 patients received invasive mechanical ventilation with documented evidence for 931 prone episodes. We performed detailed analysis for 763 prone episodes. The rest were excluded due to insufficient data. The median duration of each cycle was 16 h (IQR 15-17 h). 459 cycles were done within 7 days of intubation (early), 202 in 7-14 days (intermediate) and 102 after 14 days (late). The change in oxygenation defined as delta PaO2/ FiO2 ratio (DELTAPF) for early, intermediate, and late cycles were 2.4 +/- 5.2 kPa, 1.6 +/- 3.7 kPa and 1.4 +/- 4.0 kPa, (p = 0.03) respectively. The overall DELTAPF for all groups after a cycle was 2.1 +/- 4.7 kPa. There was an increase in PaCO2 following proning with an overall change of 0.30 +/- 1.0, however, this was not statistically significant (p = 0.30). Conclusion(s): Following proning, there was significant improvement in oxygenation. Cycles lasted for 16 h consistent with current ARDS guidelines [2]. Although the results suggest a diminishing response in those proned at later times, the DELTAPF ratio was still significant. Overall, this suggests a beneficial effect on oxygenation. However, findings cannot be translated into survival benefit. Further research including randomised controlled trials is recommended.
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Introduction/Aim: Self-management is considered important in people with pulmonary fibrosis (PF);however, components of self-management that are relevant to PF are not well defined. This study aimed to identify the common self-management components used in PF. Method(s): A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The protocol was registered with Open Science Framework database (doi: https://doi.org/10.17605/OSF.IO/EUZ6S). A systematic search was conducted on August 16, 2022, using five electronic databases (Medline, Embase, PsychInfo, CINAHL and the Cochrane central register of controlled trials). Search results were screened and studies were included if they (i) described any educational, behavioural and support components that aimed at facilitating self-management;(ii) involved adults with PF;and (iii) employed quantitative, qualitative or mixed methods. Two researchers performed record screening and data extraction independently followed by discussions of discrepancies. Result(s): Of the 27081 records screened, 87 studies were included (39% observational studies, 26% randomised controlled trials). The most common self-management components were patient education (78%), information or support for managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Majority of the included studies (71%) were rehabilitation programs with evidence of self-management training such as home exercise program and breathing training. Other studies included palliative care programs consisting of components such as patient education and care goal setting (12%), support programs for managing medication (4%), home-based self-monitoring training (4%), disease management programs (4%), mindfulness-focused stress reduction program (1%), telemedicine service delivered during the COVID-19 outbreak that included strategies to prevent infections and self-monitoring of clinical parameters (1%) and PF-specific educational and support website (1%). Over half of the interventions were provided by a multidisciplinary team. Conclusion(s): This review identified the common components used to promote self-management in PF. These findings help to guide the development of optimal interventions to support self-management in PF.
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Introduction: Covid pandemic and post pandemic era has brought in many challenges. Employees and family members across locations were at risk. Monitoring the public health parameters, comparing the trend, analysing the reports to provide insights to leadership team was enormous job with challenge of manual tracking & reconciliation of data from often inconsistent dataset from the respective government maintained and approved websites. Objective(s): To develop and use one active, dynamic dashboard with public health parameters and trend analysis. This should facilitate business leaders, global health team and key stakeholders on decision making process. Other objective is to reduce manual efforts of OHP. Intervention(s): Innovation & Engineering team was involved. Options considered were Power BI, Tableau, Spotfire etc. MS Office Power BI was chosen. Introducing digital transformation in the process to automate the data extraction on one hand through API feed at predefined frequencies and subsequently a reconciliation dashboard ensured live data feed for each specific location of interest. Few important parameters (reopening triggers and risk-mitigationmeasures) monitored include trends at various locations, vaccine status, 14 days trajectory of covid situation, positivity rate, R factor, fatality rate, number of beds available etc. Result(s): Situation monitoring with summary of input- insights on one dashboard was highly impactful and useful to take decisions for Leadership team. Conclusion(s): Digital Visualization product is used to connect to all the necessary websites (India/State specific as well as WHO and others) and pull in live relevant data for a simple summary dashboard which was used extensively by the leadership team to keep track of evolving situations and making decisions as appropriate. Utilization of technology makes life easier by saving time, efforts, brought down the data gathering and reconciliation effort to zero. Health manager could focus on.
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Alcohol use disorder (AUD) is highly prevalent in Australia.(1) However, best practice management of AUD in the community post discharge from hospital is not well articulated in the literature. In particular, given the harmful effects excessive alcohol consumption has on nutritional status there is a need to identify what approaches are being utilised in managing this vulnerable group.(2) Hence the aim of this scoping review was to identify the current approaches and outcomes with respect to nutritional care as identified by the Nutrition Care Process Model (NCPM) for patients discharged from hospital post alcohol withdrawal. This scoping review was registered with OpenScience Framework (words: PubMed, CINAHL, Web of Science and Scopus. Articles included were published between January 1995 and April 2022 Eligible articles were screened independently by pairs of reviewers, and consensus was reached across pairs to provide inter-rater and inter-consensus reliability. Screening and data extraction was conducted using Covidence by reviewers HM, ATM, CM, SG Fourteen articles were eligible for inclusion. Approaches to nutritional care was identified based on the intervention utilised and in comparison to the NCPM.(3) Key findings were screening for nutrition related problems and anthropometry measures were the most evaluated (n = 10), whereas practices of referral providing continuum of care were highlighted in only a minority of studies (n = 3). Education interventions included Motivational Interviewing and cognitive behavioural therapy sessions (4) (n = 7). Few studies (n = 4) which combined harm-reduction counselling with nutritional approaches and education interventions showed significant improvement (p < 0.05) in outcome measures of nutritional care. This was measured through the improvement in nutritional status (positive eating habits, decrease in nutrition-related impact symptoms, and WHO Quality of Life (QoL) health and physical domains) Limitations include varying aims of analysis and a paucity of information in this area. There is a need for further studies to be completed in this area to understand the nature of this complex issue and recommend effective strategies to improve health outcomes for individuals and populations.
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Objective To systematically evaluate the efficacy of low dose whole-lung irradiation in COVID-19 pneumonia based on the present evidence. Methods All literature related to the application of low dose whole-lung irradiation in COVID-19 pneumonia were retrieved from Pubmed, Embase, the Cochrane Library, Web of Science, Google scholar, Scoupus, CNKI, Wanfang database, VIP database until May 2022. Two researchers independently screened the literature. For the literature that met the inclusion criteria, both data extraction and literature quality evaluation were blinded. Revman 5.3 software was used for statistical analysis. Results A total of 5 controlled clinical trials involving 194 patients met the inclusion criteria. No statistically significant differences were detected in the low dose whole-lung irradiation group compared with the best supportive care group for clinical recovery rates, intubation rates, radiographic improvement rates and 28 d-overall survival. Conclusions In patients of COVID-19 pneumonia, low dose whole-lung irradiation conferred no significant benefit to clinical outcomes. Currently, the routine use of low dose whole-lung irradiation for the treatment of moderate to severe COVID-19 pneumonia is not recommended.Copyright © Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.
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Background: Inflammatory bowel diseases (IBDs) are chronic diseases that require routine hospital visits and long-term medical treatment for control of disease activity. Factors such as gender may impact the use and need for healthcare. This systematic review aimed to summarize what is known about sex differences in the risk of bowel surgery in patients with IBD Methods: Embase, Medline, CINAHL, and Web of Science abstracts (January 2012 to January 2022) were searched systematically for observational studies examining associations between sex and risk of bowel surgery. Screening and data extraction were performed independently by two reviewers using Covidence. Study data were analysed and reported in accordance with the PRISMA guidelines. Quality assessment of included studies was conducted using the Newcastle- Ottawa Scale for cohort studies. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for the risk of surgery In addition, meta-analysis was undertaken to assess the risk of surgery by IBD subtype. The between-study heterogeneity was assessed by calculating the tau-squared and the I-squared statistics Results: Of 9,902 screened articles, 36 studies were included in the review Most studies were retrospective by design (74.6%). In total, 21 of 36 studies found statistically significant sex-based differences in the risk of bowel surgery for IBD patients. A pooled estimate of HRs for the 13 studies eligible for meta-analysis showed a statistically significant increased risk of bowel surgery among male patients (HR: 1.43 [95% confidence interval (CI): 1.09;1.86]) compared to female patients. The between-study heterogeneity was high (I2=88.60 [60.60;96.33] and tau2=0.17 [0.03;0.58]) indicating that the pooled estimate should be interpreted with caution. These findings were consistent with the subgroup analysis for ulcerative colitis (HR: 1.78 [1.16;2.72]), but no statistically significant sex difference in the risk of surgery in Crohn's disease patients was found (HR: 1.26 [0.82;1.93]) Conclusion(s): Sex differences exist in the risk of bowel surgery in IBD patients, and further research is needed to address the underlying causes and consequences of these disparities. It is unclear whether differences are due to underlying biologic mechanisms or are associated with healthcare system related factors such as differential access to care. Surgical procedures or the lack or delay thereof, will have consequences for the further disease trajectory.
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Background: In the context of aphasia rehabilitation, there is a perceived need for interventions with a reduced linguistic demand targeting well-being. Mind-body and creative arts approaches are holistic and person-centred approaches, primarily relying on means other than verbal exchanges and promoting self-regulation strategies. Aim(s): This mixed-method systematic review aimed to evaluate the availability, feasibility and effectiveness of mind-body and creative arts therapies in promoting well-being for people with aphasia. Eight databases were searched using subject headings and keywords. Full-text screening, critical appraisal and data extraction were conducted independently by two reviewers. A segregated synthesis approach was used (i.e., Revised Effect Direction Plot technique and Thematic Synthesis approach). Findings are presented in a narrative and visual form. Main Contribution: Twenty-two studies were included (Mind-body: n = 11;Creative arts: n = 11). Heterogeneity of study design and quality, intervention type, procedures and dosage, outcomes, and level of offered communication support were identified. Improvements were noted across a wide range of well-being outcomes with more consistent positive results for anxiety and communication. One hundred and twenty-eight findings were extracted and synthesised in three broad themes: positive impact on self, empowering multifaceted experience, and relevance of needs-centred adjustments. Conclusion(s): Provisional findings about the benefits of mind-body and creative arts interventions on aspects of well-being for some individuals with aphasia were identified. However, findings are complex and need to be interpreted cautiously. Facilitators and barriers to these therapies are highlighted with related recommendations for practice. This review poses a demand for further research in the field, implementing rigorous methodology and aphasia-specific support to facilitate inclusion and engagement.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Introduction: Till date, no proven therapy exists for coronavirus disease (COVID-19), though different types of treatment modalities are being practiced around the world. Different studies regarding Convalescent Plasma (CP) therapy from COVID-19 recovered donors have shown favorable results with fewer adverse consequences. In this systematic review, we aimed to determine the safety and efficacy of CP as a therapy for COVID-19. Material(s) and Method(s): The English language databases of PubMed, Google Scholar, and Sci-enceDirect were searched up to 22 May 2020. Eligibility for inclusion, risk of bias assessment, and data extraction from the included studies were determined and a narrative synthesis was conducted. Result(s): A total of 12 studies were selected for review. The overall risks of bias were moderate to high. The results revealed significance in the initiation of CP therapy during the early stages of viremia from a safety and efficacy viewpoint. The patients also received concomitant drugs and other supportive therapies in most cases. Some cases of mortality were reported in 3 studies. Viral loads were documented to decrease and become negative in 8 studies within 3-26 days post-transfu-sion. The improvement in clinical symptoms following CP therapy was demonstrated in 9 studies. Most of the patients experienced very few adverse effects. Conclusion(s): The rational practice of CP therapy based on a risk-benefit judgment can prove to be an efficacious therapeutic option as a last resort until the approval of any therapeutic and/or prophy-lactic agent(s). The substantial randomized controlled trials (RCTs) are necessary to validate the effectiveness of such therapy.Copyright © 2021 Bentham Science Publishers.
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Background: COVID-19 pneumonia is newly recognized illness has spread rapidly around the world. It causes much morbidity and mortality. Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to severity of the disease, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Method(s): The improvement project carried over for four months in King Fahd Armed Forces hospital. Randomly selected 200 patients admitted to the hospital with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. The patient characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Result(s): 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5%. The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies and improvements in primary and secondary outcomes documented. Discussion(s): The length of stay in the study population in the project was 3 days as compared to 13 days in a major international study helping rapid turnover of beds and financial savings. The mortality was 2.5% compared to 7.3% in a major published study, reflecting the implications of aggressive management of diabetes by teamwork. The median values of FBS 130 mg/dl and RBS of 170mg/dl achieved by regular follow-up and support to the patient by running postdischarged clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion(s): COVID-19 patients with diabetes are more prone to have more severe disease, and tend to stay longer in hospital and have higher mortality compared to non-diabetics. An aggressive preemptive strategy with unified treatment protocols and readily available service of endocrinologist and effective control of diabetes and acute complications of diabetes significantly reduces the length of and mortality in COVID-19 patients with diabetes.
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Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities Material(s) and Method(s): After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Result(s): In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11-12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11-12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusion(s): In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2-3 days with morbidities.Copyright © 2023 Ravi Sunder Ragam, et al.
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The proceedings contain 388 papers. The topics discussed include: vitiligo diagnosis is associated with an increase in new-onset depression and anxiety: a population-based cohort study in the UK;effect modification of biologic survival by patient characteristics: a prospective cohort study from the British Association of Dermatologists Biologics And Immunomodulators Register;'a raised P3NP is a matter of time': replacing P3NP with FIB-4 for monitoring of methotrexate-related liver fibrosis;a randomized controlled trial assessing the effectiveness and safety of ciclosporin vs. methotrexate in the treatment of severe atopic eczema in children and young people: the treatment of severe atopic eczema trial (TREAT);carbonylated proteins as markers of oxidative stress and their association with filaggrin genotype in atopic eczema;skin tumors in England 2013-2019: in-depth reporting of a new consensus classification to improve prospective data extraction and clinical interpretation;a national review of porocarcinoma epidemiology in England 2013-2018;national Merkel cell carcinoma epidemiology and mortality-related risk factors in England 2004-2018;and hospitalization from COVID-19 is most frequently observed in patients with atopic dermatitis treated with systemic corticosteroids, and in particular when systemic corticosteroids are used in combination with another immunomodulatory treatment: lessons from the global SECURE-AD registry.
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Introduction: Access to safe, effective, quality, and affordable essential medicines (EM) for all is one of the World Health Organization's Sustainable Development Goals for health. However, access to EM for the treatment of non-communicable diseases (NCDs) is lacking in many low-income (LICs) and lower-middle income countries (LMICs). Chronic kidney disease (CKD) is often a downstream consequence of other NCDs, such as diabetes (DM) and cardiovascular disease (CVD), further exacerbating the economic burden on healthcare systems and societies. In nephrology, access to EM is especially important to reduce the risk of CKD progression because kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As members of the International Society of Nephrology (ISN) Emerging Leaders Program 2021 cohort, we conducted a scoping review to assess the breadth of evidence regarding EMs for management of CKD and related NCDs, with identification of barriers to EM access as one of our main aims. Method(s): We included English-language articles of any study design that addressed barriers to accessing essential medicines in populations with CKD (all stages, causes, and ages), CVD, hypertension, and/or DM. All ISN geographical regions and World Bank income categories were considered. We searched MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials to May 2021. Titles and abstracts were screened, and full texts were retrieved for potentially relevant publications. Each full-text article was assessed for inclusion. For included articles, data extraction was performed with a standardized form using Covidence software. Each step was performed by one reviewer and checked by a 2nd reviewer. Applying an ecological model, barriers were categorized as occurring at the national/health policy level, regional level, organization level, provider level, or patient level. Result(s): Ninety-six publications addressed barriers to access to essential medicines, including LICs (16 articles), LMICs (43 articles), upper-middle income countries (25 articles), high-income countries (10 articles), plus 21 articles which did not specify countries. Most publications assessed barriers at the health policy-level, which included high EM prices in the setting of current patent laws;lack of effective systems for public procurement of EM, resulting in large out-of-pocket household expenditure for medicines in LIC/LMIC;inefficient distribution systems with multiple price mark-ups;and lack of regulatory systems, giving rise to counterfeit medications. Regional-level barriers included lack of governance of supply chain logistics, lack of regional coordination, and poor transportation infrastructure, especially in rural settings. Organization-level barriers included medication stock-outs at facilities, and health care worker shortages. Provider-level barriers included irrational prescribing, lack of CKD identification, and poor communication with patients. Patient-level barriers included poverty, informational barriers/health literacy, and negative perception of generic medicines (Figure). [Formula presented] Conclusion(s): Barriers to accessing EM exist at several levels, particularly the health system-level, and affect LICs and LMICs disproportionately. This scoping review serves as an initial step towards designing implementation studies to address barriers to improve EM access. Conflict of interest Potential conflict of interest: MMMY has a consultancy agreement with George Clinical and served on a CKD advisory board sponsored by AstraZenecaCopyright © 2023
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At the beginning of the Corona pandemic, there was a surge in demand for medical masks, especially FFP2 masks, which could not be adequately met by existing mask manufacturers. This led to new manufacturers of FFP2 masks entering the market. However, in order for these new suppliers to be allowed to offer these products in conformity with the law, the masks must be tested by an independent body (notified body). This testing usually takes several months and is associated with a number of bureaucratic hurdles and expenses. This led to the fact that untested masks were sold and are still being sold. In order to subsequently identify untested masks, we propose a method that automatically checks a specific document from the testing, namely the type examination certificate. To enable automated evaluation, this paper presents a text-mining approach for verification. It consists of three steps: i) requirements identification of certificates, ii) data extraction and analysis and iii) evaluation of the results using a decision tree classifier. Finally, the algorithm is validated using a case study of several counterfeit FFP2 type examination certificates. The result shows that the text-mining approach is capable of distinguishing fake from real certificates. The ability to analyze certificates in an automated way will completely change the way market surveillance authorities and accredited verification bodies check documents. © 2022 IEEE.
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Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication;standardized protocols for evidence-based treatments;systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings. Copyright © The Author(s), 2023. Published by Cambridge University Press.