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Healthcare, Volume 8, Issue 1 (March 2020) – 68 articles

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Cover Story (view full-size image) In January 2020, a novel Coronavirus, defined as SARS-CoV-2, was identified as responsible for a [...] Read more.
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Open AccessArticle
Morphogenetic Variability as Potential Biomarker of Neurogenic Lesion Degree in Children with Spina Bifida
Healthcare 2020, 8(1), 68; https://doi.org/10.3390/healthcare8010068 - 24 Mar 2020
Viewed by 774
Abstract
Aims. In this study we analyzed the degree of genetic homozygosity among spina bifida patients with different degrees of neurogenic lesion (N = 82), as well as their clinical and neurological characteristics, compared to healthy control individuals (N = 100). Methods. [...] Read more.
Aims. In this study we analyzed the degree of genetic homozygosity among spina bifida patients with different degrees of neurogenic lesion (N = 82), as well as their clinical and neurological characteristics, compared to healthy control individuals (N = 100). Methods. According to clinical and electromyographic findings, we separately assessed the type of neurogenic lesion (paresis or paralysis). Regarding the degree of neurogenic lesion, patients were classified into three groups: mild, moderate and severe. We analyzed six muscles. For assessing the degree of individual genetic homozygosity, we tested the presence and distribution of 15 homozygous recessive characteristics (HRC). Results. The predominant type of neurogenic lesion was paresis. Every third evaluated muscle was affected in the group with mild neurogenic lesion, while more than half were affected in the group with severe neurogenic lesion. The average values of HRCs among different groups of patients and the control showed the population-genetic differences that exist among them (control x ¯ HRC/15 = 3.0 ± 0.2; mild x ¯ HRC/15 = 3.6 ± 0.2; moderate x ¯ HRC/15 = 4.8 ± 0.3; severe neurogenic lesion x ¯ HRC/15 = 5.0 ± 0.3). Conclusions. Spina bifida patients have a significant increase of recessive homozygosity and a decreased variability compared to the control group. As neurogenic lesions are more severe, more affected muscles are present, as well as the increase of individual recessive homozygosity. Full article
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Open AccessArticle
Differential Effects of Tai Chi Chuan (Motor-Cognitive Training) and Walking on Brain Networks: A Resting-State fMRI Study in Chinese Women Aged 60
Healthcare 2020, 8(1), 67; https://doi.org/10.3390/healthcare8010067 - 24 Mar 2020
Cited by 1 | Viewed by 843
Abstract
Background: This cross-sectional study aimed to investigate whether a long-term engagement in different types of physical exercise may influence resting-state brain networks differentially. In particular, we studied if there were differences in resting-state functional connectivity measures when comparing older women who are long-term [...] Read more.
Background: This cross-sectional study aimed to investigate whether a long-term engagement in different types of physical exercise may influence resting-state brain networks differentially. In particular, we studied if there were differences in resting-state functional connectivity measures when comparing older women who are long-term practitioners of tai chi chuan or walking. Method: We recruited 20 older women who regularly practiced tai chi chuan (TCC group), and 22 older women who walked regularly (walking group). Both the TCC group and the walking group underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan. The acquired rs-fMRI data of all participants were analyzed using independent component analysis. Age and years of education were added as co-variables. Results: There were significant differences in default network, sensory-motor network, and visual network of rs-fMRI between the TCC group and walking group (p < 0.05). Conclusions: The findings of the current study suggested that long-term practice of different types of physical exercises (TCC vs. walking) influenced brain functional networks and brain functional plasticity of elderly women differentially. Our findings encourage further research to investigate whether those differences in resting-state functional connectivity as a function of the type of physical exercise have implications for the prevention of neurological diseases. Full article
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Open AccessReview
“Nomen Omen”: Exploring Connected Healthcare through the Perspective of Name Omen
Healthcare 2020, 8(1), 66; https://doi.org/10.3390/healthcare8010066 - 23 Mar 2020
Viewed by 797
Abstract
Background: The evolution of names, from “medical informatics” to “connected health”, implies that the evolvement of technology in health care has been shifted from technology-oriented to healthcare-oriented implementation. Connected healthcare, a healthcare platform of remote monitoring and self-management through technological measures, is [...] Read more.
Background: The evolution of names, from “medical informatics” to “connected health”, implies that the evolvement of technology in health care has been shifted from technology-oriented to healthcare-oriented implementation. Connected healthcare, a healthcare platform of remote monitoring and self-management through technological measures, is suggested to contribute to the efficiency, cost-effectiveness, and satisfaction of healthcare recipient enhancement. However, limited understanding of related connected health (CH) terminology may constrain its implementation. Whether CH is a buzzword only or a practice that can contribute to an aging society is controversial. Objective: This study aims to distinguish CH-related terminology and to identify the trend of CH through reviewing its definition, initiation, development, and evolvement, in order to offer management insights and implications. The objective is to understand what is connected and who is cared about in the connected health model so that better applications can be addressed for the benefit of society. Method: This study reviews the evolution of names, from “medical informatics” in the 1970s to “connected health” after 2000, as well as relevant literature of CH, including e-health, telemedicine, telehealth, telecare, and m-health, to discover the trend of technology-related healthcare innovations. Results: The current status and issues facing accessibility, quality, and cost were presented. Its future trends will be explored through reviewing how changes in healthcare are managed, in addition to its operation and practice. Pre-conditions and requirements for implementing CH are identified to select a typical case to study. Findings suggest that areas with a complete business ecosystem—isolated locations, advanced information technology, aging in population, integrated health, and social care system—are prevalent for designing friendly CH environments. Conclusion: The evidence and tendency of technological convergence create a demand for innovation and partnering with start-up companies that offer a competitive advantage in innovation. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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Open AccessArticle
Health Disparities and Cardiovascular Disease
Healthcare 2020, 8(1), 65; https://doi.org/10.3390/healthcare8010065 - 22 Mar 2020
Viewed by 835
Abstract
The number one leading cause of death in 2017 for Americans was cardiovascular disease (CVD), and health disparities can exacerbate risks. This study evaluates the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 437,436) to estimate population risks for behavioral, socio-economic, [...] Read more.
The number one leading cause of death in 2017 for Americans was cardiovascular disease (CVD), and health disparities can exacerbate risks. This study evaluates the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 437,436) to estimate population risks for behavioral, socio-economic, psychological, and biological factors. A general linear model with a quasi-binomial link function indicated higher risks for the following groups: smokers (odds ratio, OR = 0.688), individuals with higher body mass index scores (OR = 1.023), persons unable to work (OR = 2.683), individuals with depression (OR = 1.505), workers who missed more days due to mental issues (OR = 1.12), the elderly, males (OR = 1.954), those in race categories “indigenous Americans, Alaskan non-Hispanics”, “Black Hispanics,” or “other, non-Hispanic,” and individuals with lower income. Surprisingly, increased consumption of alcohol was not found to be a risk factor as in other studies. Additional study of alcohol risk factors is needed. Further, Black non-Hispanics were associated with lower rates of CVD/MI (myocardial infarction), a finding that is supported by recent evidence of more unhealthy behaviors in other races. The results of this study highlight 2018 CVD/MI disparities based on the BRFSS and suggest the need for additional policy interventions including education and providing increased access to health care for the disadvantaged. The principles of beneficence and justice require policy interventions such as these. Full article
Open AccessArticle
Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China
Healthcare 2020, 8(1), 64; https://doi.org/10.3390/healthcare8010064 - 21 Mar 2020
Cited by 2 | Viewed by 3406
Abstract
Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan [...] Read more.
Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan and use a message-centered approach to identify problems that it entailed. It was found that the delayed decision making of the local government officials and the limited information disclosure should be mainly responsible for the ineffective risk communication. The principles for effective risk communication concerning Wuhan’s outbreak management were also discussed. The whole communication process is suggested to integrate the accessibility and openness of risk information, the timing and frequency of communication, and the strategies dealing with uncertainties. Based on these principles and lessons from Wuhan’s case, this paper employed a simplified Government–Expert–Public risk communication model to illustrate a collaborative network for effective risk communication. Full article
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Open AccessArticle
Outpatient Waiting Time at Vietnam Health Facilities: Policy Implications for Medical Examination Procedure
Healthcare 2020, 8(1), 63; https://doi.org/10.3390/healthcare8010063 - 20 Mar 2020
Viewed by 778
Abstract
Our study aims to measure outpatient waiting times at Vietnam health facilities according to the socioeconomic characteristics. We employed the 2015 Vietnam District and Commune Health Facility Survey which was a cross-sectional study designed by the World Bank in collaboration with the Vietnam [...] Read more.
Our study aims to measure outpatient waiting times at Vietnam health facilities according to the socioeconomic characteristics. We employed the 2015 Vietnam District and Commune Health Facility Survey which was a cross-sectional study designed by the World Bank in collaboration with the Vietnam Health Strategy and Policy Institute. This survey was designed to be representative of six provinces (Dien Bien, Hanoi, Binh Dinh, Dak Lak, Dong Nai, and Dong Thap) drawn from six distinct geographical regions of Vietnam. Data from 4949 outpatients at district hospitals (DHs) and 1724 outpatients at commune health centers (CHCs) were extracted for final analysis. We recorded average outpatient waiting times of 32.58 min at DHs and of 11.58 min at CHCs. Four hundred and forty-five outpatients at DHs (9.0%) and 720 those at CHCs (42.8%) were examined immediately (waiting time = 0 min). Outpatient waiting times were various in six distinct geographical regions. With an investigation according to several socioeconomic characteristics, significant differences in outpatient waiting times were observed at both two levels of health facilities as measured by province, age, self-reported health status, patient’s wealth, ethnicity, and health insurance. Conclusions. Outpatient waiting times from arrival at health facility until receiving care were significantly distinct amongst two health facility levels, revealing longer at DHs compared to at CHCs. There was significantly higher proportion of outpatients examined immediately at CHCs compared to at DHs. Our study suggests that, vulnerable populations, with longer outpatient waiting time, should be dealt with in appropriate models towards each medical facility according to key socioeconomic factors to contribute to simplify the process of medical examination and treatment for outpatients. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessArticle
Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults
Healthcare 2020, 8(1), 62; https://doi.org/10.3390/healthcare8010062 - 18 Mar 2020
Viewed by 821
Abstract
The purpose of this study was to examine the psychometric properties of the Advance Directive Attitude Survey in Korean (K-ADAS), a measure of attitudes toward advance directives (ADs). A total of 118 low-income, community-dwelling older adults (mean age, 75.09 years) participated. An exploratory [...] Read more.
The purpose of this study was to examine the psychometric properties of the Advance Directive Attitude Survey in Korean (K-ADAS), a measure of attitudes toward advance directives (ADs). A total of 118 low-income, community-dwelling older adults (mean age, 75.09 years) participated. An exploratory factor analysis (EFA) was conducted to determine the factor structure of the K-ADAS. Validity was further assessed by known associations of the K-ADAS with perceived susceptibility and severity using part of the Advance Care Planning surveys. Its reliability was examined by calculating alpha coefficients. EFA determined a three-factor structure model with good model fit. Validity was further supported with significant correlations between the K-ADAS and susceptibility and severity. Reliability was supported by adequate level of Cronbach’s alpha. The K-ADAS was a valid and reliable measure for assessment of AD attitudes with a sound model fit. Thus, the K-ADAS can be used to assess AD attitudes among community-dwelling elders. Full article
(This article belongs to the Special Issue Health Care and Services for Elderly Population)
Open AccessReview
Current Development Status of Forest Therapy in China
Healthcare 2020, 8(1), 61; https://doi.org/10.3390/healthcare8010061 - 17 Mar 2020
Viewed by 822
Abstract
As a result of rapid urbanization and urban sprawl, natural ecosystems are shrinking or are fragmented, affecting people’s health and quality of life. Modern people prefer to live in large cities rather than rural areas because of greater convenience and more comfortable living [...] Read more.
As a result of rapid urbanization and urban sprawl, natural ecosystems are shrinking or are fragmented, affecting people’s health and quality of life. Modern people prefer to live in large cities rather than rural areas because of greater convenience and more comfortable living conditions. As a consequence, people are suffering from many psycho-physiological health problems and have a longing for natural environments to escape the concrete jungle. Forest therapy has emerged as a preventive and alternative therapy to cope with stress and enhance people’s health and wellbeing as a result of spending time in a green and healthy environment. Here, we review the activities related to forest therapy in China and discuss the commonalities and differences between the forest therapy types. Furthermore, we summarize the current achievements of forest therapy in basic research and the development of the forest therapy industry. We also describe the challenges that forest therapy has been facing. Finally, we provide suggestions for further development in research and industry. Full article
(This article belongs to the Section Health Policy)
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Open AccessArticle
Participant Experiences of an Infant Obesity Prevention Program Delivered via Telephone Calls or Text Messages
Healthcare 2020, 8(1), 60; https://doi.org/10.3390/healthcare8010060 - 16 Mar 2020
Viewed by 1043
Abstract
A 3-arm randomised controlled trial implemented in 2017, recruited participants from four Local Health Districts (LHDs) in New South Wales (NSW) to test an early obesity prevention program delivered via telephone calls (telephone) or text messages (SMS). This sub-study explored participants’ experience and [...] Read more.
A 3-arm randomised controlled trial implemented in 2017, recruited participants from four Local Health Districts (LHDs) in New South Wales (NSW) to test an early obesity prevention program delivered via telephone calls (telephone) or text messages (SMS). This sub-study explored participants’ experience and satisfaction with the program. A multimethod design was used. Quantitative satisfaction questions were completed by participants when their child was six-months old. A purposive sample of participants with varying satisfaction levels was invited for in-depth qualitative interviews. Data were analysed using Excel (quantitative) and inductive thematic analysis (qualitative). Of the 1155 participants recruited: 947 (293 telephone; 338 SMS; 316 control) completed the six-month survey; 34 (14 telephone; 13 SMS; 7 control) were interviewed. Participants’ overall program satisfaction was 100% (telephone) and 85% (SMS). Participants’ qualitative responses demonstrated appreciation of: personalised stage-based information; opportunity to communicate with health professionals (telephone); linked Healthy Beginnings booklets and SMS mostly as nudges (SMS). There is a clear need for stage-based information, and supplemented modes of delivery i.e., text messages along with telephone calls; with text messages solely seen as nudges or reminders. However, individual preferences vary according to information needs at any given time, time constraints on new mothers and hence, multiple modes of information provision are recommended in order to reach a wider population and for better engagement. Choice and flexibility in mode of delivery has the potential to provide equitable access to information, empowering women with infants to practice recommended health behaviours for infant obesity prevention. Full article
(This article belongs to the Section Nutrition and Public Health)
Open AccessArticle
Monitoring of Nesting Songbirds Detects Established Population of Blacklegged Ticks and Associated Lyme Disease Endemic Area in Canada
Healthcare 2020, 8(1), 59; https://doi.org/10.3390/healthcare8010059 - 13 Mar 2020
Viewed by 1396
Abstract
This study provides a novel method of documenting established populations of bird-feeding ticks. Single populations of the blacklegged tick, Ixodes scapularis, and the rabbit tick, Haemaphysalis leporispalustris, were revealed in southwestern Québec, Canada. Blacklegged tick nymphs and, similarly, larval and nymphal [...] Read more.
This study provides a novel method of documenting established populations of bird-feeding ticks. Single populations of the blacklegged tick, Ixodes scapularis, and the rabbit tick, Haemaphysalis leporispalustris, were revealed in southwestern Québec, Canada. Blacklegged tick nymphs and, similarly, larval and nymphal rabbit ticks were tested for the Lyme disease bacterium, Borrelia burgdorferi sensu lato (Bbsl), using PCR and the flagellin (flaB) gene, and 14 (42%) of 33 of blacklegged tick nymphs tested were positive. In contrast, larval and nymphal H. leporsipalustris ticks were negative for Bbsl. The occurrence of Bbsl in I. scapularis nymphs brings to light the presence of a Lyme disease endemic area at this songbird nesting locality. Because our findings denote that this area is a Lyme disease endemic area, and I. scapularis is a human-biting tick, local residents and outdoor workers must take preventive measures to avoid tick bites. Furthermore, local healthcare practitioners must include Lyme disease in their differential diagnosis. Full article
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Open AccessArticle
Association Between Back Muscle Strength and Proprioception or Mechanoreceptor Control Strategy in Postural Balance in Elderly Adults with Lumbar Spondylosis
Healthcare 2020, 8(1), 58; https://doi.org/10.3390/healthcare8010058 - 10 Mar 2020
Viewed by 1415
Abstract
This study aimed to investigate the relationship between back muscle strength and proprioception or mechanoreceptor control strategies used for postural balance in elderly adults with lumbar spondylosis. The displacement of the center of pressure (COP) excursion was determined in 24 elderly adults with [...] Read more.
This study aimed to investigate the relationship between back muscle strength and proprioception or mechanoreceptor control strategies used for postural balance in elderly adults with lumbar spondylosis. The displacement of the center of pressure (COP) excursion was determined in 24 elderly adults with lumbar spondylosis and 24 healthy young adults while the participants were standing upright on a balance board with their eyes closed. Vibratory stimulations of 30, 60, and 240 Hz were applied to the gastrocnemius (GS) and lumbar multifidus (LM) muscles to evaluate the effect of different proprioceptive signals on postural control. Back muscle strength was evaluated. Spearman’s rank correlation analysis was performed to determine the relationship between back muscle strength and significant COP excursion. Compared with young adults, elderly adults with lumbar spondylosis showed an increase in COP excursion displacement when a vibratory stimulation of 240 Hz was applied to the GS (P = 0.002) and LM muscles (P < 0.001). LM stimulation at 240 Hz was significantly associated with back muscle strength (P = 0.038). Postural control assessment with 240-Hz mechanoreceptor stimulation of the trunk could be a good indicator of postural instability due to over-dependence on mechanoreceptors and back muscle weakness in elderly adults with lumbar spondylosis. Full article
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Open AccessArticle
Tai Chi Training Evokes Significant Changes in Brain White Matter Network in Older Women
Healthcare 2020, 8(1), 57; https://doi.org/10.3390/healthcare8010057 - 09 Mar 2020
Cited by 2 | Viewed by 1037
Abstract
Background: Cognitive decline is age relevant and it can start as early as middle age. The decline becomes more obvious among older adults, which is highly associated with increased risk of developing dementia (e.g., Alzheimer’s disease). White matter damage was found to be [...] Read more.
Background: Cognitive decline is age relevant and it can start as early as middle age. The decline becomes more obvious among older adults, which is highly associated with increased risk of developing dementia (e.g., Alzheimer’s disease). White matter damage was found to be related to cognitive decline through aging. The purpose of the current study was to compare the effects of Tai Chi (TC) versus walking on the brain white matter network among Chinese elderly women. Methods: A cross-sectional study was conducted where 42 healthy elderly women were included. Tai Chi practitioners (20 females, average age: 62.9 ± 2.38 years, education level 9.05 ± 1.8 years) and the matched walking participants (22 females, average age: 63.27 ± 3.58 years, educational level: 8.86 ± 2.74 years) underwent resting-state functional magnetic resonance imaging (rsfMRI) scans. Diffusion tensor imaging (DTI) and graph theory were employed to study the data, construct the white matter matrix, and compare the brain network attributes between the two groups. Results: Results from graph-based analyses showed that the small-world attributes were higher for the TC group than for the walking group (p < 0.05, Cohen’s d = 1.534). Some effects were significant (p < 0.001) with very large effect sizes. Meanwhile, the aggregation coefficient and local efficiency attributes were also higher for the TC group than for the walking group (p > 0.05). However, no significant difference was found between the two groups in node attributes and edge analysis. Conclusion: Regular TC training is more conducive to optimize the brain functioning and networking of the elderly. The results of the current study help to identify the mechanisms underlying the cognitive protective effects of TC. Full article
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Open AccessArticle
Effects of Different Staircase Design Factors on Evacuation of Children from Kindergarten Buildings Analyzed via Agent-Based Simulation
Healthcare 2020, 8(1), 56; https://doi.org/10.3390/healthcare8010056 - 09 Mar 2020
Viewed by 821
Abstract
Staircase design is critical to the evacuation of children. Through an agent-based simulation, this study focused on the relationship between staircase design factors and evacuation efficiency in a multi-story kindergarten. A quantitative study was conducted on three critical architectural design factors: stair flight [...] Read more.
Staircase design is critical to the evacuation of children. Through an agent-based simulation, this study focused on the relationship between staircase design factors and evacuation efficiency in a multi-story kindergarten. A quantitative study was conducted on three critical architectural design factors: stair flight width, positional relationship, and design pattern of the juncture between the staircase and the corridor. The findings were as follows. (1) When the stair flight width ranges from 0.7 to 1.0 m, an increase in this width can improve evacuation efficiency significantly; when the width ranges from 1.1 to 1.4 m, evacuation efficiency is improved continuously, but an increase in this width range has a diminishing effect on evacuation efficiency; when the width is greater than 1.7 m, a further increase has an adverse effect on evacuation efficiency, because such a staircase space allows overtaking behaviors. (2) Under the same stair flight width conditions, evacuation efficiency is higher when the staircase and corridor are perpendicular to each other than when they are parallel, because the natural steering angle of the children was preserved during their evacuation. (3) The cut corner and rounded corner designs between the staircase and corridor improved evacuation efficiency and alleviated the congestion at bottleneck positions; the evacuation efficiency continued to rise with an increase in the cutting angle. These findings are expected to provide a useful reference for the evacuation design of kindergarten buildings and for emergency evacuation management. Full article
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Open AccessArticle
Comparison of Root Surface Wear and Roughness Resulted from Different Ultrasonic Scalers and Polishing Devices Applied on Human Teeth: An In-Vitro Study
Healthcare 2020, 8(1), 55; https://doi.org/10.3390/healthcare8010055 - 07 Mar 2020
Viewed by 944
Abstract
The aim of the present study was to compare the root surface wear and roughness, resulted from the professional dental hygiene instruments, including ultrasonic dental scalers, rubber prophy cups, and nylon bristle brushes, on the extracted human mandibular incisor teeth. Teeth (n = [...] Read more.
The aim of the present study was to compare the root surface wear and roughness, resulted from the professional dental hygiene instruments, including ultrasonic dental scalers, rubber prophy cups, and nylon bristle brushes, on the extracted human mandibular incisor teeth. Teeth (n = 80) were randomly assigned into eight groups according to the applied scaler type (Ma = Magnetostrictive, Pi = Piezoelectric), degree of power (M = Medium, F = Full), and angulation (0° and 45°). In the second stage, the specimens (n = 40) were further divided into two groups according to the applied polishing device (nylon bristle brush or rubber prophy cup). Laser scanner and contact profilometer devices were used for the surface analysis. Both ultrasonic instruments tested in our study produced rougher surfaces when full power was used at a 0° angle (p < 0.01). The highest wear (0.82 ± 0.07 mm3) and roughness values (0.30 ± 0.01 µm) were detected in the PiF0 group. Polishing performed with a rubber prophy cup resulted in almost twice the wear as well as a smoother surface when compared to polishing performed with a nylon bristle brush (p < 0.001). Variations in the application parameters of ultrasonic scalers and the type of polishing instrument might lead to significantly different root-surface characteristics. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessProtocol
Cost-Effectiveness and Effects of a Home-Based Exercise Intervention for Female Caregivers of Relatives with Dementia: Study Protocol for a Randomized Controlled Trial
Healthcare 2020, 8(1), 54; https://doi.org/10.3390/healthcare8010054 - 06 Mar 2020
Viewed by 1040
Abstract
Previous research has proposed a range of support interventions to mitigate the adverse impact of caregiving on the daily life of caregivers of relatives with dementia. However, the effectiveness of these interventions shows a high variability. Informal caregivers usually lack the time and/or [...] Read more.
Previous research has proposed a range of support interventions to mitigate the adverse impact of caregiving on the daily life of caregivers of relatives with dementia. However, the effectiveness of these interventions shows a high variability. Informal caregivers usually lack the time and/or live too far from conventional facilities to do physical exercise, especially those who live in rural areas. Thus, home-based interventions may be more efficacious due to their greater convenience for this population. The present work proposes and describes a study protocol for a randomized control trial that will analyze the efficacy and cost-effectiveness of a home-based, structured individual physical exercise intervention to improve the health-related quality of life and the mental health of female informal caregivers of relatives with dementia. The nine-month-long intervention will comprise participation in two supervised physical exercise sessions per week at the caregiver’s home. The proposed study outcomes will be: (1) feasibility of and adherence to the home-based provision of the intervention; (2) improvement in physical fitness and quality of life; and (3) reduction in subjective burden, psychological symptomatology and depression. Analyses will also be performed to determine the cost-effectiveness after the intervention. In conclusion, this intervention might thus represent a tailored and feasible strategy to help caregivers cope with the physical and psychological stress resulting from caregiving-related responsibilities, and it could represent a novel cost-effective support home-based intervention for caregivers. Full article
(This article belongs to the Special Issue Health Care and Services for Elderly Population)
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Open AccessArticle
Learning from a Feasibility Trial of a Simple Intervention: Is Research a Barrier to Service Delivery, or is Service Delivery a Barrier to Research?
Healthcare 2020, 8(1), 53; https://doi.org/10.3390/healthcare8010053 - 03 Mar 2020
Viewed by 1000
Abstract
(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two [...] Read more.
(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced. Full article
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Open AccessArticle
Reliability of the Linear Measurement (Contact) Method Compared with Stereophotogrammetry (Optical Scanning) for the Evaluation of Edema after Surgically Assisted Rapid Maxillary Expansion
Healthcare 2020, 8(1), 52; https://doi.org/10.3390/healthcare8010052 - 01 Mar 2020
Viewed by 870
Abstract
Many techniques have been developed to evaluate facial swelling after maxillofacial surgeries. Patients who undergo surgically assisted rapid maxillary expansion (SARME) develop facial edema more often than those who undergo minor oral surgeries. Reliable systems to assess soft tissue dimensions offer many advantages [...] Read more.
Many techniques have been developed to evaluate facial swelling after maxillofacial surgeries. Patients who undergo surgically assisted rapid maxillary expansion (SARME) develop facial edema more often than those who undergo minor oral surgeries. Reliable systems to assess soft tissue dimensions offer many advantages for documentation and treatment planning across surgical fields. (1) Background: The objective assessment of facial swelling is advantageous as it allows the evaluation of the effect of anti-inflammatory drugs. Therefore, this study aimed to compare the reliabilities of linear measurement method and optical scanning for the objective assessment of facial swelling after SARME. (2) Methods: Sixteen (12 women and 4 men) patients were enrolled. Linear measurements between guide points and facial scans were obtained for the left and right sides preoperatively and 1, 2, and 5 days after SARME. Preoperative values were subtracted from each post-operative value and the differences were compared between the two measurement methods. (3) Results: There were no statistically significant differences between the right and left sides at any time point in the measurements with either method. (4) Conclusions: Recently, stereophotogrammetry has been considered the first choice method for evaluating facial swelling. Furthermore, we found a strong correlation between volumetric analysis and linear measurement at all time points and for both sides. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
Open AccessFeature PaperEditorial
Outbreak of Novel Coronavirus (SARS-CoV-2): First Evidences From International Scientific Literature and Pending Questions
Healthcare 2020, 8(1), 51; https://doi.org/10.3390/healthcare8010051 - 27 Feb 2020
Cited by 4 | Viewed by 5453
Abstract
On 31 December, 2019, a cluster of 27 pneumonia cases of unknown etiology was reported by Chinese health authorities in Wuhan City (China) [...] Full article
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Open AccessArticle
Effectiveness of Swallowing Care on Safe Oral Intake Using Ultrasound-Based Observation of Residues in the Epiglottis Valley: A Pragmatic, Quasi-Experimental Study
Healthcare 2020, 8(1), 50; https://doi.org/10.3390/healthcare8010050 - 27 Feb 2020
Viewed by 1122
Abstract
The demand for methods to ensure safe oral consumption of food and liquids in order to prevent aspiration pneumonia has increased over the last decade. This study investigated the safety of swallowing care selected by adding ultrasound-based observation, evaluated its efficacy, and determined [...] Read more.
The demand for methods to ensure safe oral consumption of food and liquids in order to prevent aspiration pneumonia has increased over the last decade. This study investigated the safety of swallowing care selected by adding ultrasound-based observation, evaluated its efficacy, and determined effective content of selected swallowing care. The study employed a pragmatic quasi-experimental research design. Participants were 12 community-dwelling adult patients (age: 44–91 years) who had experienced choking within 1 month prior to the study. After the control phase, in which conventional swallowing care was provided, trained nurses provided ultrasound observation-based swallowing care for a minimum period of 2 weeks. Outcome measurements were compared across three points, namely T1—beginning of the control phase, T2 and T3—before and end of the intervention phase. The mean durations of intervention were 30.8 days in the control phase and 36.5 days in the intervention phase. Pneumonia and suffocation did not occur in the control phase or the intervention phase. The safe intake food level and the food intake level score significantly improved during the intervention phase (p = 0.032 and 0.017, respectively) by adding eating training based on the ultrasound observation. However, there was no significant improvement in the strength of the muscle related to swallowing by the selected basic training. Our results suggest that swallowing care selected based on the ultrasound observation, especially eating training, safely improved safe oral intake among community-dwelling adults with swallowing dysfunction. Full article
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Open AccessCommunication
N-of-1 Trials: Evidence-Based Clinical Care or Medical Research that Requires IRB Approval? A Practical Flowchart Based on an Ethical Framework
Healthcare 2020, 8(1), 49; https://doi.org/10.3390/healthcare8010049 - 27 Feb 2020
Viewed by 963
Abstract
N-of-1 trials can provide high-class evidence on drug treatment effectiveness at the individual patient level and have been given renewed interest over the past decade due to improvements of the initial single patient design. Despite these recent developments, there is still no consensus [...] Read more.
N-of-1 trials can provide high-class evidence on drug treatment effectiveness at the individual patient level and have been given renewed interest over the past decade due to improvements of the initial single patient design. Despite these recent developments, there is still no consensus under what circumstances N-of-1 trials should be considered as part of evidence-based clinical care and when they represent medical research with need for institutional review board (IRB) approval. This lack of consensus forms an obstacle for a more widespread implementation of N-of-1 trials. Based upon the existing literature, we as a group of researchers involved in N-of-1 trials and members of the IRB of a tertiary academic referral center, designed a practical flowchart based on an ethical framework to help make this distinction. The ethical framework together with a practical flowchart are presented in this communication. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessArticle
Predictive Factors of Deep Vein Thrombosis in Gynecologic Cancer Survivors with Lower Extremity Edema: A Single-Center and Retrospective Study
Healthcare 2020, 8(1), 48; https://doi.org/10.3390/healthcare8010048 - 27 Feb 2020
Viewed by 898
Abstract
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 [...] Read more.
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL. Full article
(This article belongs to the Section Women Health)
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Open AccessArticle
A Study on the Preference for the Defensive Attribute under Environmental Risk in China
Healthcare 2020, 8(1), 47; https://doi.org/10.3390/healthcare8010047 - 27 Feb 2020
Viewed by 859
Abstract
Little is known about the preference for defensive consumption goods and their defensive attributes under environmental risks in developing countries. The paper takes the water purifier as an example of defensive consumption goods against heavy metal pollution risk from drinking water. Using a [...] Read more.
Little is known about the preference for defensive consumption goods and their defensive attributes under environmental risks in developing countries. The paper takes the water purifier as an example of defensive consumption goods against heavy metal pollution risk from drinking water. Using a survey data in China, the discrete choice experiment method is employed to investigate rural farmers’ preferences for a water purifier. The scientific knowledge and risk perception effects are used to determine farmers’ preferences for the defensive attribute on a water purifier. Using a mixed logit model, rural farmers are found to prefer a water purifier with low price, free installation, a longer warranty period, and a heavy metal filter (i.e., the defensive attribute). Farmers’ neighborhood norm perception dominates the defensive preference while scientific knowledge do not work significantly. More specifically, the more the neighborhood norm perception is recognized, the more likely farmers are to improve their own preferences for the defensive attribute. Affected by the neighborhood norm perception, rural farmers’ preferences for the defensive attribute are found to be increased significantly as average income gaps narrow. The future defensive health policies should be devoted to improving environmental risk awareness and utilizing informal social networks in areas with high environmental risks. Full article
(This article belongs to the Section Environmental Factors and Global Health)
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Open AccessPerspective
On the Coronavirus (COVID-19) Outbreak and the Smart City Network: Universal Data Sharing Standards Coupled with Artificial Intelligence (AI) to Benefit Urban Health Monitoring and Management
Healthcare 2020, 8(1), 46; https://doi.org/10.3390/healthcare8010046 - 27 Feb 2020
Cited by 8 | Viewed by 6786
Abstract
As the Coronavirus (COVID-19) expands its impact from China, expanding its catchment into surrounding regions and other countries, increased national and international measures are being taken to contain the outbreak. The placing of entire cities in ‘lockdown’ directly affects urban economies on a [...] Read more.
As the Coronavirus (COVID-19) expands its impact from China, expanding its catchment into surrounding regions and other countries, increased national and international measures are being taken to contain the outbreak. The placing of entire cities in ‘lockdown’ directly affects urban economies on a multi-lateral level, including from social and economic standpoints. This is being emphasised as the outbreak gains ground in other countries, leading towards a global health emergency, and as global collaboration is sought in numerous quarters. However, while effective protocols in regard to the sharing of health data is emphasised, urban data, on the other hand, specifically relating to urban health and safe city concepts, is still viewed from a nationalist perspective as solely benefiting a nation’s economy and its economic and political influence. This perspective paper, written one month after detection and during the outbreak, surveys the virus outbreak from an urban standpoint and advances how smart city networks should work towards enhancing standardization protocols for increased data sharing in the event of outbreaks or disasters, leading to better global understanding and management of the same. Full article
Open AccessArticle
Cognitive Intervention with Musical Stimuli Using Digital Devices on Mild Cognitive Impairment: A Pilot Study
Healthcare 2020, 8(1), 45; https://doi.org/10.3390/healthcare8010045 - 25 Feb 2020
Viewed by 1011
Abstract
The effect of music therapy on cognitive function has been widely reported; however, its clinical implications remain controversial. Performing therapeutic musical activities in groups using individualized instruments can help overcome the issues of engagement and compliance. We aimed to evaluate the effect of [...] Read more.
The effect of music therapy on cognitive function has been widely reported; however, its clinical implications remain controversial. Performing therapeutic musical activities in groups using individualized instruments can help overcome the issues of engagement and compliance. We aimed to evaluate the effect of a cognitive intervention with musical stimuli using digital devices on mild cognitive impairment (MCI). In this prospective study, 24 patients with MCI (intervention group, 12; and control group, 12) were enrolled. We developed an electronic device with musical instruments and the Song-based Cognitive Stimulation Therapy protocol (SongCST). Patients in the intervention group underwent a 10-week cognitive intervention involving musical stimuli generated by our device. Effect of the intervention on cognitive function was evaluated by the Mini-Mental State Examination-Dementia Screening (MMSE-DS), Montreal Cognitive Assessment-Korean (MOCA-K), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). In the intervention group, MMSE-DS and MOCA-K scores improved significantly after the 10-week intervention. The changes in MOCA-K and CDR-SB scores were significantly different between the intervention and control groups. Our study showed that music therapy with digital devices has a positive effect on the executive function and overall disease severity in patients with MCI. Our study can facilitate individualization of music therapy using digital devices in groups. Full article
(This article belongs to the Special Issue Mobile Health Care with Smart Technology Applications)
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Open AccessArticle
Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation
Healthcare 2020, 8(1), 44; https://doi.org/10.3390/healthcare8010044 - 24 Feb 2020
Viewed by 2364
Abstract
Low back pain (LBP) is a pandemic and costly musculoskeletal condition in the United States (U.S.). Patients with LBP may endure surgery, injections, and expensive visits to emergency departments. Some suggest that using physical therapy (PT) or chiropractic in the earlier stage of [...] Read more.
Low back pain (LBP) is a pandemic and costly musculoskeletal condition in the United States (U.S.). Patients with LBP may endure surgery, injections, and expensive visits to emergency departments. Some suggest that using physical therapy (PT) or chiropractic in the earlier stage of LBP reduces the utilization of expensive health services and lowers the treatment costs. Given that there are costs and benefits with each of these treatments, the remaining question is in a short period of time which of these treatments is optimal. The purpose of this study was to investigate the cost-effectiveness of chiropractic versus PT in the U.S. A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group. The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group. Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. Full article
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Open AccessReview
Heart Rate Assessment during Neonatal Resuscitation
Healthcare 2020, 8(1), 43; https://doi.org/10.3390/healthcare8010043 - 23 Feb 2020
Viewed by 1002
Abstract
Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal [...] Read more.
Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth. Full article
(This article belongs to the Special Issue Asphyxia and Resuscitation in Neonates)
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Open AccessArticle
Emotional Intelligence Components as Predictors of Engagement in Nursing Professionals by Sex
Healthcare 2020, 8(1), 42; https://doi.org/10.3390/healthcare8010042 - 22 Feb 2020
Viewed by 1095
Abstract
Engagement of nursing professionals is related to their psychological wellbeing, and therefore, emotional intelligence acts as a predictor. The purpose of this study was to analyze the explanatory value of the dimensions of emotional intelligence in engagement in both sexes, as well as [...] Read more.
Engagement of nursing professionals is related to their psychological wellbeing, and therefore, emotional intelligence acts as a predictor. The purpose of this study was to analyze the explanatory value of the dimensions of emotional intelligence in engagement in both sexes, as well as the conditional effect of interaction of sex as a moderating variable. The sample was comprised of 2126 nurses with a mean age of 31.66 years. The Utrecht Work Engagement Scale and the Brief Inventory of Emotional Intelligence for Senior Citizens (EQ-i-20M) were used for their evaluation. The results revealed the existence of significant differences in engagement depending on the sex of the nursing professionals. Furthermore, this study showed that the interpersonal component of emotional intelligence is the predictor of engagement of female professionals, while mood and the interpersonal dimensions have a higher predictive value of engagement in males. Finally, this study was able to emphasize the sex differences found along with the importance of the role emotional intelligence dimensions have in engagement levels, which must be taken into account when designing intervention programs to improve engagement and promote participation of nursing professionals in their workplace. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Reasons for Increased Caesarean Section Rate in Vietnam: A Qualitative Study among Vietnamese Mothers and Health Care Professionals
Healthcare 2020, 8(1), 41; https://doi.org/10.3390/healthcare8010041 - 21 Feb 2020
Viewed by 928
Abstract
The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%–15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical [...] Read more.
The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%–15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were ‘request for Caesarean section,’ ‘mental strain of obstetricians,’ and ‘decision-making process.’ To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important. Full article
(This article belongs to the Special Issue Maternal and Child Health: Advances in Translational Research)
Open AccessFeature PaperArticle
Glycemia after Betamethasone in Pregnant Women without Diabetes—Impact of Marginal Values in the 75-g OGTT
Healthcare 2020, 8(1), 40; https://doi.org/10.3390/healthcare8010040 - 17 Feb 2020
Viewed by 917
Abstract
Betamethasone (BM) administration in pregnancy has been shown to reduce the incidence and severity of neonatal respiratory distress syndrome. Its known diabetogenic impact, combined with placental insulin resistance, leads to a transient increase in glycemia. However, its effect on glucose homeostasis in pregnancy [...] Read more.
Betamethasone (BM) administration in pregnancy has been shown to reduce the incidence and severity of neonatal respiratory distress syndrome. Its known diabetogenic impact, combined with placental insulin resistance, leads to a transient increase in glycemia. However, its effect on glucose homeostasis in pregnancy has not been adequately investigated. We closely monitored and assessed the glycemic profile of 83 pregnant women, with normal glucose metabolism, who were given BM during their hospitalization due to threatened premature labor. A significant change in the glycemic profile in most patients was noted, lasting 1.34 ± 1.05 days. Sixty-six of eighty-three women were eventually treated with insulin to maintain glycemia within acceptable limits. The mean ± SD insulin dosage was 12.25 ± 11.28 units/day. The need for insulin therapy was associated with higher BM doses and the presence of marginal values in the 75-g oral glucose tolerance test (OGTT) at 60 min. Our study demonstrates, following BM administration, the need for increased awareness and individualized monitoring/treatment of pregnant women with normal—yet marginal—values in the 75-g OGTT. Full article
(This article belongs to the Section Women Health)
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Open AccessArticle
The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis
Healthcare 2020, 8(1), 39; https://doi.org/10.3390/healthcare8010039 - 13 Feb 2020
Viewed by 983
Abstract
Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to [...] Read more.
Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix—in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values. Full article
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