Healthcare

16 pages, 293 KiB

Open AccessEditor’s ChoiceArticle

Essential Skills for Health Communication, Barriers, Facilitators and the Need for Training: Perceptions of Healthcare Professionals from Seven European Countries

by Dina Zota, Dimitrios V. Diamantis, Konstantinos Katsas, Pania Karnaki, Thomas Tsiampalis, Piotr Sakowski, Costas A. Christophi, Eleni Ioannidou, Sara Darias-Curvo, Victoria-Luise Batury, Hendrik Berth, Anja Zscheppang, Maike Linke, Sotiris Themistokleous, Afroditi Veloudaki and Athena Linos

Healthcare 2023, 11(14), 2058; https://doi.org/10.3390/healthcare11142058 - 18 Jul 2023

Cited by 8 | Viewed by 7019

Abstract

Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional’s perception regarding health communication training’s necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey [...] Read more.

Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional’s perception regarding health communication training’s necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey in the framework of the H-Com project were utilized. The study included 691 healthcare professionals (physicians, nurses, students and allied health professionals) from seven European countries. Only 57% of participants had participated in health communication training, while 88.1% of them indicated a willingness to be trained in health communication. Nurses were more likely (OR = 1.84; 95% CI 1.16, 2.91) to have received such training, compared to physicians. Most examined communication skills, barriers and facilitators of effective communication, and perceived outcomes of successful communication were considered crucial for most participants, although physicians overall seemed to be less concerned. Most agreed perceived outcomes were improved professional–patient relations, patient and professional satisfaction, physical and psychological health amelioration and patients’ trust. Nurses evaluated the importance of these communication skills and communication barriers, facilitators and outcomes higher than physicians. Physicians may underestimate the importance of communication skills more than nurses. Health communication should become an integral part of training for all health professionals. Full article

(This article belongs to the Special Issue Expanding Competency of Primary Health Care: Emotional and Bio-Social Meanings for General Practice Consultation)

13 pages, 293 KiB

Open AccessEditor’s ChoiceArticle

Infant-Directed Speech to 3-Month-Old Severe Preterm Infants: The Influence of Birth Weight and Maternal Depressive Symptoms

by Alessandra Provera, Erica Neri and Francesca Agostini

Healthcare 2023, 11(12), 1807; https://doi.org/10.3390/healthcare11121807 - 20 Jun 2023

Cited by 4 | Viewed by 2249

Abstract

Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have [...] Read more.

Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have investigated the features of maternal verbal input. Furthermore, no study has investigated the relationship between the effect of severity of prematurity according to birth weight and maternal input. This study aimed to explore the effects of the severity of preterm birth and postnatal depression on maternal input during early interactions. The study included 64 mother–infant dyads, classified into three groups: 17 extremely low birth weight (ELBW) preterm infants, 17 very low birth weight (VLBW) preterm infants, and 30 full-term (FT) infants. At 3 months postpartum (corrected age for preterm infants), the dyads participated in a 5-min free interaction session. Maternal input was analyzed using the CHILDES system in terms of lexical and syntactic complexity (i.e., word types, word tokens, mean length of the utterance) and functional features. Maternal postnatal depression (MPD) was assessed using the Edinburgh Postnatal Depression Scale. The results showed that in high-risk conditions (i.e., ELBW preterm birth and maternal postnatal depression), maternal input was characterized by a lower frequency of affect-salient speech and a higher proportion of information-salient speech, specifically as directives and questions, suggesting that mothers in these conditions may experience more difficulty in conveying affective content to their infants. Moreover, the more frequent use of questions may reflect an interactive style characterized by a higher level of intrusiveness. These findings provide preliminary evidence of the impacts of prematurity severity and maternal depression on maternal verbal input, highlighting the importance of assessing both factors in clinical practice. Understanding the mechanisms underlying the impacts of prematurity and depression on early interactions may inform the development of tailored interventions aimed at promoting positive parent–infant interactions and child development. Full article

(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

19 pages, 941 KiB

Open AccessEditor’s ChoiceReview

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

by Rahman Shiri, Risto Nikunlaakso and Jaana Laitinen

Healthcare 2023, 11(12), 1792; https://doi.org/10.3390/healthcare11121792 - 17 Jun 2023

Cited by 26 | Viewed by 12061

Abstract

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review [...] Read more.

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines. Full article

(This article belongs to the Section Chronic Care)

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14 pages, 485 KiB

Open AccessEditor’s ChoiceSystematic Review

Causes for Medical Errors in Obstetrics and Gynaecology

by Désirée Klemann, Maud Rijkx, Helen Mertens, Frits van Merode and Dorthe Klein

Healthcare 2023, 11(11), 1636; https://doi.org/10.3390/healthcare11111636 - 2 Jun 2023

Cited by 6 | Viewed by 4073

Abstract

Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of [...] Read more.

Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in gynaecology and obstetrics and how they could be prevented, we conducted this systematic review. Methods: This systematic review was performed in compliance with the Prisma 2020 guidelines. We searched several databases for relevant studies (Jan 2010–May 2023). Studies were included if they indicated the presence of any potential risk factor at the hospital level for medical errors or adverse events in gynaecology or obstetrics. Results: We included 26 articles in the quantitative analysis of this review. Most of these (n = 12) are cross-sectional studies; eight are case–control studies, and six are cohort studies. One of the most frequently reported contributing factors is delay in healthcare. In addition, the availability of products and trained staff, team training, and communication are often reported to contribute to near-misses/maternal deaths. Conclusions: All risk factors that were found in our review imply several categories of contributing factors regarding: (1) delay of care, (2) coordination and management of care, and (3) scarcity of supply, personnel, and knowledge. Full article

(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

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11 pages, 577 KiB

Open AccessEditor’s ChoiceArticle

Examining the Public Messaging on ‘Loneliness’ over Social Media: An Unsupervised Machine Learning Analysis of Twitter Posts over the Past Decade

by Qin Xiang Ng, Dawn Yi Xin Lee, Chun En Yau, Yu Liang Lim, Clara Xinyi Ng and Tau Ming Liew

Healthcare 2023, 11(10), 1485; https://doi.org/10.3390/healthcare11101485 - 19 May 2023

Cited by 7 | Viewed by 3034

Abstract

Loneliness is an issue of public health significance. Longitudinal studies indicate that feelings of loneliness are prevalent and were exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. With the advent of new media, more people are turning to social media platforms such as [...] Read more.

Loneliness is an issue of public health significance. Longitudinal studies indicate that feelings of loneliness are prevalent and were exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. With the advent of new media, more people are turning to social media platforms such as Twitter and Reddit as well as online forums, e.g., loneliness forums, to seek advice and solace regarding their health and well-being. The present study therefore aimed to investigate the public messaging on loneliness via an unsupervised machine learning analysis of posts made by organisations on Twitter. We specifically examined tweets put out by organisations (companies, agencies or common interest groups) as the public may view them as more credible information as opposed to individual opinions. A total of 68,345 unique tweets in English were posted by organisations on Twitter from 1 January 2012 to 1 September 2022. These tweets were extracted and analysed using unsupervised machine learning approaches. BERTopic, a topic modelling technique that leverages state-of-the-art natural language processing, was applied to generate interpretable topics around the public messaging of loneliness and highlight the key words in the topic descriptions. The topics and topic labels were then reviewed independently by all study investigators for thematic analysis. Four key themes were uncovered, namely, the experience of loneliness, people who experience loneliness, what exacerbates loneliness and what could alleviate loneliness. Notably, a significant proportion of the tweets centred on the impact of the COVID-19 pandemic on loneliness. While current online interactions are largely descriptive of the complex and multifaceted problem of loneliness, more targeted prosocial messaging appears to be lacking to combat the causes of loneliness brought up in public messaging. Full article

(This article belongs to the Special Issue Social Media for Health Information Management)

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13 pages, 1507 KiB

Open AccessEditor’s ChoiceReview

Imaging Methods to Quantify the Chest and Trunk Deformation in Adolescent Idiopathic Scoliosis: A Literature Review

by Ana San Román Gaitero, Andrej Shoykhet, Iraklis Spyrou, Martijn Stoorvogel, Lars Vermeer and Tom P. C. Schlösser

Healthcare 2023, 11(10), 1489; https://doi.org/10.3390/healthcare11101489 - 19 May 2023

Cited by 3 | Viewed by 4674

Abstract

Background context: Scoliosis is a three-dimensional deformity of the spine with the most prevalent type being adolescent idiopathic scoliosis (AIS). The rotational spinal deformation leads to displacement and deformation of the ribs, resulting in a deformity of the entire chest. Routine diagnostic [...] Read more.

Background context: Scoliosis is a three-dimensional deformity of the spine with the most prevalent type being adolescent idiopathic scoliosis (AIS). The rotational spinal deformation leads to displacement and deformation of the ribs, resulting in a deformity of the entire chest. Routine diagnostic imaging is performed in order to define its etiology, measure curve severity and progression during growth, and for treatment planning. To date, all treatment recommendations are based on spinal parameters, while the esthetic concerns and cardiopulmonary symptoms of patients are mostly related to the trunk deformation. For this reason, there is a need for diagnostic imaging of the patho-anatomical changes of the chest and trunk in AIS. Aim: The aim of this review is to provide an overview, as complete as possible, of imaging modalities, methods and image processing techniques for assessment of chest and trunk deformation in AIS. Methods: Here, we present a narrative literature review of (1) image acquisition techniques used in clinical practice, (2) a description of various relevant methods to measure the deformity of the thorax in patients with AIS, and (3) different image processing techniques useful for quantifying 3D chest wall deformity. Results: Various ionizing and non-ionizing imaging modalities are available, but radiography is most widely used for AIS follow-up. A disadvantage is that these images are only acquired in 2D and are not effective for acquiring detailed information on complex 3D chest deformities. While CT is the gold standard 3D imaging technique for assessment of in vivo morphology of osseous structures, it is rarely obtained for surgical planning because of concerns about radiation exposure and increased risk of cancer during later life. Therefore, different modalities with less or without radiation, such as biplanar radiography and MRI are usually preferred. Recently, there have been advances in the field of image processing for measurements of the chest: Anatomical segmentations have become fully automatic and deep learning has been shown to be able to automatically perform measurements and even outperform experts in terms of accuracy. Conclusions: Recent advancements in imaging modalities and image processing techniques make complex 3D evaluation of chest deformation possible. Before introduction into daily clinical practice, however, there is a need for studies correlating image-based chest deformation parameters to patient-reported outcomes, and for technological advancements to make the workflow cost-effective. Full article

(This article belongs to the Special Issue Paediatric Spinal Deformity)

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12 pages, 806 KiB

Open AccessEditor’s ChoiceCommunication

Severe Gastrointestinal Toxicity Following the Use of Gilteritinib: A Case Series and Analysis of Postmarketing Surveillance Data

by Lucia Gozzo, Antonella Nardo, Serena Brancati, Antongiulio Judica, Andrea Duminuco, Cinzia Maugeri, Marina Parisi, Laura Longo, Daniela Cristina Vitale, Rosy Ruscica, Giovanni Luca Romano, Elisa Mauro, Paolo Fabio Fiumara, Giuseppe Alberto Maria Palumbo, Francesco Di Raimondo, Calogero Vetro and Filippo Drago

Healthcare 2023, 11(10), 1479; https://doi.org/10.3390/healthcare11101479 - 18 May 2023

Cited by 6 | Viewed by 1999

Abstract

Gilteritinib has been approved as monotherapy in adults with acute myeloid leukemia (AML) FLT3 mutated with relapsed or refractory disease, in light of its advantages in terms of survival and the favorable safety profile. Hepatobiliary disorders and musculoskeletal and connective tissue disorders represent [...] Read more.

Gilteritinib has been approved as monotherapy in adults with acute myeloid leukemia (AML) FLT3 mutated with relapsed or refractory disease, in light of its advantages in terms of survival and the favorable safety profile. Hepatobiliary disorders and musculoskeletal and connective tissue disorders represent the most frequent adverse reactions associated with gilteritinib, whereas the most frequent serious adverse reaction is acute kidney injury. In the summary of product characteristics, gastrointestinal (GI) events are indicated as very common, in particular diarrhea, nausea and stypsis. Furthermore, serious GI disorders have been observed with gilteritinib in clinical trials, including GI hemorrhage, GI perforation and GI obstruction. However, the association with the FLT3 inhibitor has not been confirmed. Nevertheless, serious GI AEs have been recognized as an important potential risk to be monitored in postmarketing surveillance. We present three cases of serious self-limiting GI events observed in patients on gilteritinib treatment for AML, and an analysis of relevant available postmarketing surveillance data. Full article

(This article belongs to the Special Issue Pharmacovigilance and Appropriate Drug Use)

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20 pages, 1854 KiB

Open AccessEditor’s ChoiceArticle

ALTAI Tool for Assessing AI-Based Technologies: Lessons Learned and Recommendations from SHAPES Pilots

by Jyri Rajamäki, Fotios Gioulekas, Pedro Alfonso Lebre Rocha, Xavier del Toro Garcia, Paulinus Ofem and Jaakko Tyni

Healthcare 2023, 11(10), 1454; https://doi.org/10.3390/healthcare11101454 - 17 May 2023

Cited by 5 | Viewed by 2218

Abstract

Across European countries, the SHAPES Project is piloting AI-based technologies that could improve healthcare delivery for older people over 60 years old. This article aims to present a study developed inside the SHAPES Project to find a theoretical framework focused on AI-assisted technology [...] Read more.

Across European countries, the SHAPES Project is piloting AI-based technologies that could improve healthcare delivery for older people over 60 years old. This article aims to present a study developed inside the SHAPES Project to find a theoretical framework focused on AI-assisted technology in healthcare for older people living in the home, to assess the SHAPES AI-based technologies using the ALTAI tool, and to derive ethical recommendations regarding AI-based technologies for ageing and healthcare. The study has highlighted concerns and reservations about AI-based technologies, namely dealing with living at home, mobility, accessibility, data exchange procedures in cross-board cases, interoperability, and security. A list of recommendations is built not only for the healthcare sector, but also for other pilot studies. Full article

(This article belongs to the Section Artificial Intelligence in Medicine)

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12 pages, 1117 KiB

Open AccessEditor’s ChoiceArticle

The Effects of Neurodevelopmental Treatment-Based Trunk Control Exercise on Gross Motor Function and Trunk Control in Children with Developmental Disabilities

by Miho Park, Jeongseon Kim, Changseon Yu and Hyoungwon Lim

Healthcare 2023, 11(10), 1446; https://doi.org/10.3390/healthcare11101446 - 16 May 2023

Cited by 4 | Viewed by 6162

Abstract

Background: Good trunk control is essential for higher developmental stages as the trunk is activated first when movement occurs, providing stability for the head and extremities. Purpose: To determine if neurodevelopmental treatment-based trunk control exercise (NDT-TCE) is effective in improving gross motor function [...] Read more.

Background: Good trunk control is essential for higher developmental stages as the trunk is activated first when movement occurs, providing stability for the head and extremities. Purpose: To determine if neurodevelopmental treatment-based trunk control exercise (NDT-TCE) is effective in improving gross motor function and trunk control in children with developmental disabilities (DD). Materials and Methods: Twenty children with developmental disabilities were randomly assigned to the NDT-TCE (12 children) and control (8 children) groups. Results: After the intervention; the NDT-TCE group showed improvement in GMFM (Gross Motor Function Measure; except for the GMFM-E dimension) and SATCo scores. The control group showed improvement in GMFM-A; B; C; and total scores; as well as static and active control of SATCo. The NDT-TCE group had a significant improvement in the GMFM B dimension and total score compared to the control group. The NDT-TCE group showed a significant improvement in static and active control of SATCo compared to the control group, but there was no significant difference in reactive control. Conclusions: The NDT-TCE intervention specifically improved GMFM-B and trunk control scores. Therefore, NDT-TCE can be applied as a trunk-focused intervention for children with DD who have difficulty controlling their trunk. Full article

(This article belongs to the Section Chronic Care)

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10 pages, 502 KiB

Open AccessEditor’s ChoiceArticle

by Cristian Martín-Vázquez, Rubén García-Fernández, Natalia Calvo-Ayuso, María Cristina Martínez-Fernández, Cristina Liébana-Presa and José David Urchaga-Litago

Healthcare 2023, 11(10), 1424; https://doi.org/10.3390/healthcare11101424 - 14 May 2023

Cited by 4 | Viewed by 2806

Abstract

Background: Achieving the optimal quality of life is currently a health challenge for the world’s population. Pregnancy is a stressful period of life that affects women’s quality of life. Aims: This study aimed to describe and analyse the health-related quality of life in [...] Read more.

Background: Achieving the optimal quality of life is currently a health challenge for the world’s population. Pregnancy is a stressful period of life that affects women’s quality of life. Aims: This study aimed to describe and analyse the health-related quality of life in pregnant women during their first trimester in a health area in the north of Spain. Methods: A cross-sectional descriptive study was carried out. A total of 359 women completed the 36-Item Short-Form Health Survey. Results: The sample consisted of 57.9% primiparous women, 30% had experienced a previous abortion, and 7.2% were foreign women. The mean age was 33.53 years. The sum of the physical and mental component values was below 50 points. Notably, 4.17% of women reported a worsening of their health in the last year, and 28.69% had an increased depression risk. Conclusion: Being a foreigner, prenatal abortion, previous caesarean section, previous children, or assisted reproduction techniques are the variables that have a negative association with some dimensions of quality of life in pregnant women. Full article

(This article belongs to the Section Women's Health Care)

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11 pages, 271 KiB

Open AccessEditor’s ChoiceArticle

Cervical Cancer Prevention Knowledge (Cckp-64) among Female Students in Novi Sad, Serbia during COVID-19 Pandemic

by Sanja D Tomić, Andrijana Ćorić, Slobodan Tomić, Ermina Mujičić, Jelena Malenković, Armin Šljivo and Goran Malenković

Healthcare 2023, 11(10), 1400; https://doi.org/10.3390/healthcare11101400 - 12 May 2023

Cited by 3 | Viewed by 2709

Abstract

Cervical cancer is a significant global health concern affecting young women, with over 500,000 new cases reported annually. This questionnaire-based study aimed to evaluate the knowledge of cervical cancer prevention among female students at the University of Novi Sad during the COVID-19 pandemic [...] Read more.

Cervical cancer is a significant global health concern affecting young women, with over 500,000 new cases reported annually. This questionnaire-based study aimed to evaluate the knowledge of cervical cancer prevention among female students at the University of Novi Sad during the COVID-19 pandemic using the Cervical Cancer Knowledge Prevention-64 (CCKP-64) tool. The study sample consisted of 402 predominantly 20–22-year-old female students from either social or technical science faculties in urban environments. Results revealed that out of the 402 female students involved in the study, most had a good general knowledge of primary prevention of cervical cancer, with a correct answer rate ranging from 29.9 to 80.6%. On the contrary, only 63.4% of female students have heard about the vaccine against cervical cancer; 52.0% know that the vaccine exists in Serbia; and 31.8% know where to get vaccinated. Only a small proportion of students (9.7%) have encountered cervical cancer among their relatives/friends and think that the disease could affect them in the future (25.4%). Older students (>26 years) generally (p < 0.05) had better knowledge regarding distressing symptoms of cervical cancer, cytological examination and secondary prevention; however, it was also noted that a significant percentage of this age group reported not having received vaccinations (53.0%, p = 0.001). This study underscores the need for increased awareness and education about the HPV vaccine and secondary prevention among young women in Serbia. Future research should investigate knowledge and attitudes toward cervical cancer prevention in diverse populations to develop effective interventions and strategies. These findings have implications for public health policies in Serbia to promote cervical cancer prevention among young women. Full article

(This article belongs to the Special Issue Diagnosis, Prevention, Treatment and Medical Care for Gynecologic and Perinatal Diseases)

13 pages, 478 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Significance of Post-Traumatic Growth and Mental Health for Coping in Multiple Sclerosis Caregivers

by Irene Gil-González, María Ángeles Pérez-San-Gregorio, Jesús Funuyet-Salas, Rupert Conrad and Agustín Martín-Rodríguez

Healthcare 2023, 11(10), 1390; https://doi.org/10.3390/healthcare11101390 - 11 May 2023

Cited by 2 | Viewed by 2141

Abstract

We investigated the influence of post-traumatic growth (PTG) and mental health (MH) on multiple sclerosis (MS) caregivers’ uses of coping strategies and identified biopsychosocial predictors of proactive or reactive coping. The Short Form Health Survey (SF-12), General Health Questionnaire (GHQ-28), Post-Traumatic Growth Inventory [...] Read more.

We investigated the influence of post-traumatic growth (PTG) and mental health (MH) on multiple sclerosis (MS) caregivers’ uses of coping strategies and identified biopsychosocial predictors of proactive or reactive coping. The Short Form Health Survey (SF-12), General Health Questionnaire (GHQ-28), Post-Traumatic Growth Inventory (PGI-21), Brief COPE Questionnaire (COPE-28), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate 209 caregivers. Higher PTG was related to greater use of emotional support, positive reframing, religion, active coping, instrumental support, planning, denial, self-distraction, self-blaming, and venting. Better MH was associated with greater use of acceptance, while behavioral disengagement and self-distraction were associated with poorer MH. The PTG dimensions relating to others and new possibilities, SF-12 dimensions of physical and emotional roles as well as partnership, not living with the patient, and significant others’ social support were predictors of proactive coping. Reactive coping was positively predicted by the PTG dimension relating to others, depression, vitality, other than partner relation, and physical role, and negatively predicted by mental health level and emotional role. In summary, higher MH was associated with proactive coping strategies, whereas post-traumatic growth was related to the use of a wide range of proactive coping as well as reactive coping strategies. Full article

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17 pages, 590 KiB

Open AccessEditor’s ChoiceSystematic Review

Spiritual Needs of Older Adults Living with Dementia: An Integrative Review

by Katherine Carroll Britt, Augustine C. O. Boateng, Hui Zhao, Francesca C. Ezeokonkwo, Chad Federwitz and Fayron Epps

Healthcare 2023, 11(9), 1319; https://doi.org/10.3390/healthcare11091319 - 4 May 2023

Cited by 8 | Viewed by 6351

Abstract

Older adults living with dementia experience progressive decline, prompting reliance on others for spiritual care and support. Despite a growing interest in studying persons living with dementia (PLwDs), empirical evidence on the spiritual needs of PLwDs has not been synthesized. Using the Whittemore [...] Read more.

Older adults living with dementia experience progressive decline, prompting reliance on others for spiritual care and support. Despite a growing interest in studying persons living with dementia (PLwDs), empirical evidence on the spiritual needs of PLwDs has not been synthesized. Using the Whittemore and Knafl method, this integrative review examined the literature from 2000 to 2022 on the spiritual care needs of PLwDs. We sought to identify characteristics of the spiritual needs of PLwDs and ways to address them. The ATLA Religion, CINAHL, PsycINFO, PubMed, and Socindex databases were used to search the literature, and 12 peer-reviewed articles met the inclusion criteria. Spiritual care needs varied across studies. Overall, findings support the importance of identifying PLwDs’ religious and spiritual backgrounds to inform person-centered care. Spiritual needs were identified as verbal and non-verbal expressions related to past meaning and religious and spiritual background and were not consistently addressed in care. Providers reported observing spiritual distress in the mild stage prompting the need for spiritual care. There is a great need for dementia-specific spiritual assessment tools and spiritual care interventions to support spiritual well-being in dementia care. Spiritual care involves facilitating religious rituals and providing spiritual group therapy and religious and spiritual activities. Full article

(This article belongs to the Special Issue Dementia and Care)

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21 pages, 1525 KiB

Open AccessEditor’s ChoiceArticle

Predicting Disability Using a Nomogram of the Tilburg Frailty Indicator (TFI)

by Robbert J. Gobbens, Livia M. Santiago, Izabella Uchmanowicz and Tjeerd van der Ploeg

Healthcare 2023, 11(8), 1150; https://doi.org/10.3390/healthcare11081150 - 17 Apr 2023

Cited by 4 | Viewed by 2466

Abstract

Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop [...] Read more.

Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible. Full article

(This article belongs to the Special Issue Frailty in Community-Dwelling Older People)

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11 pages, 1336 KiB

Open AccessEditor’s ChoiceArticle

Quality of Life and Family Support in Critically Ill Patients following ICU Discharge

by Konstantina Avgeri, Epaminondas Zakynthinos, Vasiliki Tsolaki, Markos Sgantzos, George Fotakopoulos and Demosthenes Makris

Healthcare 2023, 11(8), 1106; https://doi.org/10.3390/healthcare11081106 - 12 Apr 2023

Cited by 7 | Viewed by 3268

Abstract

Background: Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. Objectives: To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role [...] Read more.

Background: Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. Objectives: To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role of support by family members and friends. Methods: This prospective study was conducted in the University Hospital of Larissa Greece between 2020 and 2021. Patients hospitalized at the ICU for at least 48 h were included and assessed at hospital discharge, at 3 and at 12 months later. The research implements of the study were a dedicated questionnaire and the SF-36 health questionnaire for the appraisal of the QoL. Lung function changes were assessed by spirometry and physical performance by the 6-min walking test (6MWT). Results: One hundred and forty-three participants were included in the study. The mean (SD) of the physical and mental health SF-36 scores at hospital discharge, 3 and 12 months were 27.32 (19.59), 40.97 (26.34) and 50.78 (28.26) (p < 0.0001) and 42.93 (17.00), 55.19 (23.04) and 62.24 (23.66), (p < 0.0001), respectively. The forced expiratory volume in one second and 6MWT significantly improved over 12 months. Patients who were supported by two or more family members or patients who were visited by their friends >3 times/week presented better scores in the physical and mental SF36 domains at 12 months. Conclusion: This study shows that the quality of life of Greek patients who were discharged from the ICU can be positively affected both by the support they receive from their family environment and friends. Full article

(This article belongs to the Special Issue Nursing Care in the ICU)

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11 pages, 543 KiB

Open AccessEditor’s ChoiceReview

Pain in Ehlers–Danlos Syndrome: A Non-Diagnostic Disabling Symptom?

by Viviana Guerrieri, Alberto Polizzi, Laura Caliogna, Alice Maria Brancato, Alessandra Bassotti, Camilla Torriani, Eugenio Jannelli, Mario Mosconi, Federico Alberto Grassi and Gianluigi Pasta

Healthcare 2023, 11(7), 936; https://doi.org/10.3390/healthcare11070936 - 24 Mar 2023

Cited by 6 | Viewed by 5431

Abstract

Background: Ehlers–Danlos syndrome (EDS) is a phenotypically and genetically heterogeneous group of connective tissue disorders. Currently, diagnosis of EDS is based on a series of clinical and genetic tools. On the other hand, the hypermobile form has not yet been characterized from a [...] Read more.

Background: Ehlers–Danlos syndrome (EDS) is a phenotypically and genetically heterogeneous group of connective tissue disorders. Currently, diagnosis of EDS is based on a series of clinical and genetic tools. On the other hand, the hypermobile form has not yet been characterized from a genetic point of view: it is considered a part of a continuous spectrum of phenotypes, ranging from isolated non syndromic joint hypermobility, through to the recently defined hypermobility spectrum disorders (HSD). The aim of this study is to characterize the pain symptom that is not considered among the diagnostic criteria but is relevant to what concerns the quality of life of patients with EDS. (2) Methods: A review of the literature was performed on two medical electronic databases (PubMed and Embase) on 20 December 2022. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: published in the English language and published between 2000 and 2022. (3) Results: There were fifty eligible studies obtained at the end of the search and screen process. Pain is one of the most common symptoms found in Ehlers–Danlos (ED) patients. Different causes seem to be recognized in different phases of the syndrome. (4) Conclusions: Pain is a nonspecific symptom and cannot be considered among the diagnostic criteria, but it is a negative predictive factor in the quality of life of patients with EDS. Therefore, proper evaluation and treatment is mandatory. Full article

(This article belongs to the Special Issue Musculoskeletal Pain Care and Management in Rare Diseases)

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16 pages, 335 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Solitary Sexual Desire: Its Relation to Subjective Orgasm Experience and Sexual Arousal in the Masturbation Context within a Spanish Population

by Oscar Cervilla, Eva Jiménez-Antón, Ana Álvarez-Muelas, Pablo Mangas, Reina Granados and Juan Carlos Sierra

Healthcare 2023, 11(6), 805; https://doi.org/10.3390/healthcare11060805 - 9 Mar 2023

Cited by 8 | Viewed by 5007

Abstract

The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary [...] Read more.

The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary sexual desire to explain the subjective orgasm experience (Study 1) and sexual arousal (Study 2) in the context of solitary masturbation. Study 1, composed of 2406 heterosexual adults (M age = 39.72, SD = 11.81), assessed for solitary sexual desire, dyadic sexual desire, and the intensity of the subjective orgasm experience obtained through solitary masturbation, along with other associated parameters. Study 2, consisting of 41 heterosexual young people (M age = 22.49, SD = 3.17), evaluated the genital response (penile circumference/vaginal pulse amplitude) and subjective arousal to sexually explicit films related to solitary masturbation. In both men and women, solitary sexual desire accounted for a significant percentage of the subjective orgasm experience obtained through solitary masturbation. In addition, in women, the propensity for sexual arousal was explained by solitary sexual desire. It is concluded that solitary sexual desire -as opposed to dyadic- is important to explain sexual arousal and orgasm in the solitary masturbation context. These results highlight the importance of addressing sexual desire in the solitary context, given its implications with other dimensions of sexual functioning. Full article

(This article belongs to the Special Issue Advances in Sexual Health, Sexual Functioning, and Psychological Well-Being)

17 pages, 1883 KiB

Open AccessEditor’s ChoiceArticle

Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a Systematic Review and Meta-Analysis

by Zhumei Yu, Lili Wang, Yang Wang, Min Zhang, Yanqin Xu and Annuo Liu

Healthcare 2023, 11(5), 778; https://doi.org/10.3390/healthcare11050778 - 6 Mar 2023

Cited by 7 | Viewed by 2866

Abstract

Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification [...] Read more.

Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification of preterm infants that are at high-risk for developing BPD. Methods: The derivation cohort was derived from a systematic review and meta-analysis of risk factors for BPD. The statistically significant risk factors with their corresponding odds ratios were utilized to construct a logistic regression risk prediction model. By scoring the weights of each risk factor, a risk scoring tool was established and the risk stratification was divided. External verification was carried out by a validation cohort from China. Results: Approximately 83,034 preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g were screened in this meta-analysis, and the cumulative incidence of BPD was about 30.37%. The nine predictors of this model were Chorioamnionitis, Gestational age, Birth weight, Sex, Small for gestational age, 5 min Apgar score, Delivery room intubation, and Surfactant and Respiratory distress syndrome. Based on the weight of each risk factor, we translated it into a simple clinical scoring tool with a total score ranging from 0 to 64. External validation showed that the tool had good discrimination, the area under the curve was 0.907, and that the Hosmer–Lemeshow test showed a good fit (p = 0.3572). In addition, the results of the calibration curve and decision curve analysis suggested that the tool showed significant conformity and net benefit. When the optimal cut-off value was 25.5, the sensitivity and specificity were 0.897 and 0.873, respectively. The resulting risk scoring tool classified the population of preterm infants into low-risk, low-intermediate, high-intermediate, and high-risk groups. This BPD risk scoring tool is suitable for preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g. Conclusions: An effective risk prediction scoring tool based on a systematic review and meta-analysis was developed and validated. This simple tool may play an important role in establishing a screening strategy for BPD in preterm infants and potentially guide early intervention. Full article

(This article belongs to the Special Issue Maternal, Fetal and Neonatal Health)

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13 pages, 249 KiB

Open AccessEditor’s ChoiceArticle

Tokophobia: Case Reports and Narratives of Ten Japanese Women

by Mizuki Takegata, Yuriko Usui, Satoshi Sohda, Satoru Takeda, Jun Takeda, Tomomi Saito, Yasuyo Kasai, Hideki Watanabe, Megumi Haruna, Yukiko Ohashi and Toshinori Kitamura

Healthcare 2023, 11(5), 696; https://doi.org/10.3390/healthcare11050696 - 26 Feb 2023

Cited by 8 | Viewed by 3151

Abstract

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic [...] Read more.

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic women and their psychological/demographic background. Furthermore, there is no available summary of the lived experience of Japanese women with tokophobia. This study aims to identify the intensity patterns of various types of fear among the participants and summarize the lived experience of having intense fear of childbirth. A qualitative descriptive study was conducted using a semi-structured interview. Pregnant women with an intense fear of childbirth participated in individual interviews facilitated by a psychiatrist and a midwife. Audio recordings of the interviews were transcribed and analyzed using a content analysis approach. The number of participants was ten. The types of feared objects varied individually and these were categorized as being related to either prospective or retrospective fear. The participants’ experiences were grouped into three categories: difficulty in daily life, preoccupied negative expectation towards childbirth, and psychological adaptation to the upcoming childbirth. The results imply that women with tokophobia continuously suffer from fear in their daily life; hence, a special approach is needed to detect and reduce their fear. Full article

(This article belongs to the Special Issue Perinatal Mental Health and Care)

14 pages, 2070 KiB

Open AccessEditor’s ChoiceArticle

Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series

by Samuele Ceruti, Andrea Glotta, Maira Biggiogero, Martino Marzano, Giovanni Bona, Marco Previsdomini, Andrea Saporito and Xavier Capdevila

Healthcare 2023, 11(5), 650; https://doi.org/10.3390/healthcare11050650 - 23 Feb 2023

Cited by 1 | Viewed by 2480

Abstract

Background: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term [...] Read more.

Background: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). Methods: A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. Results: A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = −5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. Conclusions: Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19. Full article

(This article belongs to the Section Critical Care)

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13 pages, 624 KiB

Open AccessEditor’s ChoiceArticle

by Tadesse Melaku Abegaz and Askal Ayalew Ali

Healthcare 2023, 11(4), 541; https://doi.org/10.3390/healthcare11040541 - 12 Feb 2023

Cited by 3 | Viewed by 3178

Abstract

This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). [...] Read more.

This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). Diabetes patients ≥18 years old who had a complete record of physical component score and mental component scores in round 2 and round 4 of the survey were included. The primary outcome was HRQOL of diabetes patients as measured by the Medical Outcome Study short-form (SF-12v2^TM). Multinomial logistic regression and negative binomial regression were conducted to determine associated factors of HRQOL and HCE, respectively. Overall, 5387 patients were included for analysis. Nearly 60% of patients had unchanged HRQOL after the follow-up, whereas almost 15% to 20% of patients showed improvement in HRQOL. The relative risk of declined mental HRQOL was 1.5 times higher relative to unchanged mental HRQOL in patients who were on sulfonylurea 1.55 [1.1–2.17, p = 0.01] than metformin users. The rate of HCE decreased by a factor of 0.79, [95% CI: 0.63–0.99] in patients with no history of hypertension. Patients on sulfonylurea 1.53 [1.20–1.95, <0.01], insulin 2.00 [1.55–2.70, <0.01], and TZD 1.78 [1.23–2.58, <0.01] had increased risk of HCE compared to patients who were on metformin. In general, antidiabetic medications modestly improved HRQOL in patients with diabetes during the follow-up period. Metformin had a lower rate of HCE as compared to other medications. The selection of anti-diabetes medications should focus on HRQOL in addition to controlling glucose level. Full article

(This article belongs to the Special Issue Pharmacy Practice and Administration 2.0)

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18 pages, 7003 KiB

Open AccessEditor’s ChoiceArticle

A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept

by José Miguel Ramírez-Sanz, José Luis Garrido-Labrador, Alicia Olivares-Gil, Álvaro García-Bustillo, Álvar Arnaiz-González, José-Francisco Díez-Pastor, Maha Jahouh, Josefa González-Santos, Jerónimo J. González-Bernal, Marta Allende-Río, Florita Valiñas-Sieiro, Jose M. Trejo-Gabriel-Galan and Esther Cubo

Healthcare 2023, 11(4), 507; https://doi.org/10.3390/healthcare11040507 - 9 Feb 2023

Cited by 3 | Viewed by 3112

Abstract

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed [...] Read more.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson’s disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs. Full article

(This article belongs to the Special Issue Analysis of Healthcare Big Data and Health Informatics)

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13 pages, 276 KiB

Open AccessEditor’s ChoiceArticle

Changes in Physical Activity and Depression among Korean Adolescents Due to COVID-19: Using Data from the 17th (2021) Korea Youth Risk Behavior Survey

by Yong-Sook Eo and Myo-Sung Kim

Healthcare 2023, 11(4), 517; https://doi.org/10.3390/healthcare11040517 - 9 Feb 2023

Cited by 3 | Viewed by 2762

Abstract

This study aimed to identify changes in the health behavior and mental health of adolescents due to coronavirus disease 2019 (COVID-19) and the characteristics related to changes in physical activity and depression among health behavior changes. Data were extracted from the 17th Korea [...] Read more.

This study aimed to identify changes in the health behavior and mental health of adolescents due to coronavirus disease 2019 (COVID-19) and the characteristics related to changes in physical activity and depression among health behavior changes. Data were extracted from the 17th Korea Youth Risk Behavior Web-based Survey of 54,835 adolescents. We classified the adolescents into three groups according to changes in physical activity and depression: no change, increased, or decreased. Independent variables included changes in health behavior due to COVID-19, demographic characteristics, health-related behavior, and mental health. Data were analyzed using the χ2-test and multiple logistic regressions using the SPSS Statistics 27 program. Changes in physical activity and depression showing negative changes due to the pandemic were related to factors such as having breakfast, current smoking, current drinking, stress, loneliness, despair, suicidal ideation, suicide plans, and suicide attempts. The related factors differed between the increased and decreased groups. The results of this study confirm that it is necessary to develop programs to promote the health of youth by considering the factors that affect physical activity and depression, which in turn influences the status of their health. Full article

(This article belongs to the Special Issue Research and Survey on Mental Health of Children and Adolescents)

25 pages, 566 KiB

Open AccessEditor’s ChoiceSystematic Review

Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review

by Isabel Díaz Planelles, Elisabet Navarro-Tapia, Óscar García-Algar and Vicente Andreu-Fernández

Healthcare 2023, 11(3), 422; https://doi.org/10.3390/healthcare11030422 - 1 Feb 2023

Cited by 12 | Viewed by 5646

Abstract

The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of [...] Read more.

The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population. Full article

(This article belongs to the Special Issue Potentially Inappropriate Medications and the Risk of Adverse Drug Events in Older Patients)

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11 pages, 1410 KiB

Open AccessEditor’s ChoiceArticle

Preferred Place of End-of-Life Care Based on Clinical Scenario: A Cross-Sectional Study of a General Japanese Population

by Kyoko Hanari, Sandra Y. Moody, Takehiro Sugiyama and Nanako Tamiya

Healthcare 2023, 11(3), 406; https://doi.org/10.3390/healthcare11030406 - 31 Jan 2023

Cited by 3 | Viewed by 2133

Abstract

In Japan, which has an aging society with many deaths, it is important that people discuss preferred place for end-of-life care in advance. This study aims to investigate whether the preferred place of end-of-life care differs by the assumed clinical scenario. This clinical [...] Read more.

In Japan, which has an aging society with many deaths, it is important that people discuss preferred place for end-of-life care in advance. This study aims to investigate whether the preferred place of end-of-life care differs by the assumed clinical scenario. This clinical scenario-based survey used data from a nationwide survey conducted in Japan in December 2017. Participants aged 20 years and older were randomly selected from the general population. The survey contained questions based on three scenarios: cancer, end-stage heart disease, and dementia. For each scenario, respondents were asked to choose the preferred place of end-of-life care among three options: home, nursing home, and medical facility. Eight hundred eighty-nine individuals participated in this study (effective response rate: 14.8%). The proportions of respondents choosing home, nursing home, and medical facility for the cancer scenario were 49.6%, 10.9%, and 39.5%, respectively; for the end-stage heart disease scenario, 30.5%, 18.9%, and 50.6%; and for the dementia scenario, 15.2%, 54.5%, and 30.3% (p < 0.0001, chi-square test). The preferred place of end-of-life care differed by the assumed clinical scenario. In clinical practice, concrete information about diseases and their status should be provided during discussions about preferred place for end-of-life care to reveal people’s preferences more accurately. Full article

(This article belongs to the Special Issue Healthcare Strategies for Patients with Chronic Diseases in an Ageing Society)

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9 pages, 576 KiB

Open AccessEditor’s ChoiceArticle

Evaluation of Midwives’ Practises on Herpetic Infections during Pregnancy: A French Vignette-Based Study

by Adrian Mrozik, Yann Sellier, Déborah Lemaitre and Laurent Gaucher

Healthcare 2023, 11(3), 364; https://doi.org/10.3390/healthcare11030364 - 28 Jan 2023

Cited by 1 | Viewed by 2574

Abstract

(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; [...] Read more.

(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; (2) Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; (3) Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; (4) Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise. Full article

(This article belongs to the Special Issue Maternal, Fetal and Neonatal Health)

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14 pages, 1212 KiB

Open AccessEditor’s ChoiceArticle

Interprofessional Collaboration in Complex Patient Care Transition: A Qualitative Multi-Perspective Analysis

by Franziska Geese and Kai-Uwe Schmitt

Healthcare 2023, 11(3), 359; https://doi.org/10.3390/healthcare11030359 - 27 Jan 2023

Cited by 30 | Viewed by 42171

Abstract

Healthcare professionals often feel challenged by complex patients and the associated care needs during care transition. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study explored experiences of Swiss healthcare professionals [...] Read more.

Healthcare professionals often feel challenged by complex patients and the associated care needs during care transition. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study explored experiences of Swiss healthcare professionals regarding complex patient care transition and the potential of IPC. Professionals from nursing, medicine, psychology, physiotherapy, dietetics and nutrition, social service, occupational therapy, and speech therapy were included. A qualitative between-method triangulation design was applied, with two focus group discussions and ten individual interviews. The combination of different data-collection methods allowed us to explore complex patient care transition and to systematically add perspectives of healthcare professionals from different care settings. Three main themes were identified: (1) Participants described their vision of an ideal complex patient care transition, i.e., the status they would like to see implemented; (2) participants reported challenges in complex patient care transition as experienced today; and (3) participants suggested ways to improve complex patient care transition by IPC. This study highlighted that healthcare professionals regarded IPC as an effective intervention to improve complex patient care transition. It emerged that sustainable implementation of IPC across care organizations is currently limited in Switzerland. In the absence of strong and direct promotion of IPC by the healthcare system, professionals in clinical practice can further promote IPC by finding hands-on solutions to overcome organizational boundaries. Full article

(This article belongs to the Section Chronic Care)

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15 pages, 2356 KiB

Open AccessEditor’s ChoiceArticle

Factors That Influence, Exacerbate, Contribute or Promote Violence in Couples

by Claudia Sánchez, Cecilia Mota, Jorge Carreño and María Eugenia Gómez

Healthcare 2023, 11(2), 281; https://doi.org/10.3390/healthcare11020281 - 16 Jan 2023

Viewed by 2679

Abstract

Life as a couple, and their ability to solve problems or not, can result in the relationship being satisfactory and functional or unsatisfactory and dysfunctional, which increases the risk of violence with serious implications. For that reason, it is important to isolate the [...] Read more.

Life as a couple, and their ability to solve problems or not, can result in the relationship being satisfactory and functional or unsatisfactory and dysfunctional, which increases the risk of violence with serious implications. For that reason, it is important to isolate the risk factors to prevent and treat unsatisfactory and dysfunctional relationships. The qualitative interpretive exploratory method was used, analysing 50 sessions of group psychotherapy with patients from a reproductive health institution whose relationships faced violent problems. The identified factors were the lack of autonomy in one of the partners, unresolved internal factors, a combination of external factors and factors caused by their interaction; symmetrical and asymmetrical violence, subjugation of one before the other, intergenerational violence, family violence during childhood and normalisation of violence. Isolating factors to understand relationship problems at risk of manifesting violence opens the possibility of effective, specific and preventive treatments of family and intimate partner violence. Full article

(This article belongs to the Special Issue Perinatal Mental Health and Care)

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16 pages, 656 KiB

Open AccessEditor’s ChoiceArticle

Effect of the Active Aging-in-Place–Rehabilitation Nursing Program: A Randomized Controlled Trial

by Ana da Conceição Alves Faria, Maria Manuela F. P. S. Martins, Olga Maria Pimenta Lopes Ribeiro, João Miguel Almeida Ventura-Silva, Esmeralda Faria Fonseca, Luciano José Moreira Ferreira and José Alberto Laredo-Aguilera

Healthcare 2023, 11(2), 276; https://doi.org/10.3390/healthcare11020276 - 16 Jan 2023

Cited by 8 | Viewed by 4693

Abstract

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place–rehabilitation nursing program (AAP-RNP) [...] Read more.

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place–rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults. Full article

(This article belongs to the Special Issue Frailty in Community-Dwelling Older People)

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24 pages, 1504 KiB

Open AccessEditor’s ChoiceArticle

The Association between Physical Activity, Self-Compassion, and Mental Well-Being after COVID-19: In the Exercise and Self-Esteem Model Revised with Self-Compassion (EXSEM-SC) Perspective

by Ming-Yu Claudia Wong, Hong-Wang Fung and Guangzhe Frank Yuan

Healthcare 2023, 11(2), 233; https://doi.org/10.3390/healthcare11020233 - 12 Jan 2023

Cited by 11 | Viewed by 4931

Abstract

During the great life-altering challenges brought by Coronavirus 2019, school closures and lack of access to exercise and social interactions may have increased students’ negative emotions. The current research acts as a follow-up study to the development of the EXSEM-SC, using the Repeated [...] Read more.

During the great life-altering challenges brought by Coronavirus 2019, school closures and lack of access to exercise and social interactions may have increased students’ negative emotions. The current research acts as a follow-up study to the development of the EXSEM-SC, using the Repeated Measures Panel Analysis Framework (RMPAF) to examine the stability of the model in revealing the relationship between physical activity, self-compassion, and mental well-being among Hong Kong adolescents. It is also aimed at examining the changes in physical activity, self-compassion, and mental well-being among Hong Kong adolescents between, before, and after the peak of COVID-19 using the EXSEM-SC Model. The RMPAF has involved 572 (60% Female, Mage = 13.63, SD =1.31) Hong Kong secondary school students. Furthermore, using the abductive qualitative approach, a total of 25 (Mage = 14.84, SD = 1.40) students were involved in the in-depth interviews to further investigate the relationships within the EXSEM-SC. The quantitative results showed that the relationship between physical activity and self-compassion could be demonstrated by the EXSEM-SC, with a satisfactory goodness-of-fit index in the SEMs, as well as satisfying model construct consistency. Moreover, it showed no significant differences in the level of physical activity, self-compassion, and mental well-being during and after the peak of COVID-19. The qualitative results demonstrated two new categories within the EXSEM-SC variables, which are personality traits and injuries experiences. With the stability of the EXSEM-SC model among adolescents, it is expected that the physical activity intervention, which is based on the EXSEM-SC model, could also aim at easing Hong Kong adolescent’s mental health issues. In addition, in terms of generating a long-term impact among students, the physical activity and self-compassionate intervention should be promoted among schools. However, the quantitative properties of the two new categories in the qualitative outcomes should be involved in future investigation. Full article

(This article belongs to the Special Issue Research and Survey on Mental Health of Children and Adolescents)

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19 pages, 674 KiB

Open AccessEditor’s ChoiceReview

Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review

by Ilga Ruschak, Pilar Montesó-Curto, Lluís Rosselló, Carina Aguilar Martín, Laura Sánchez-Montesó and Loren Toussaint

Healthcare 2023, 11(2), 223; https://doi.org/10.3390/healthcare11020223 - 11 Jan 2023

Cited by 39 | Viewed by 7142

Abstract

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder of unknown etiology that affects up to 5.0% of the world population. It has a high female predominance, between 80 and 96%. Due to the low number of diagnosed men, research work has focused mainly [...] Read more.

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder of unknown etiology that affects up to 5.0% of the world population. It has a high female predominance, between 80 and 96%. Due to the low number of diagnosed men, research work has focused mainly on women. The extensive body of literature on sex differences in pain in the general population suggests that men and women differ in their responses to pain, with greater sensitivity to pain and a higher risk of clinical pain commonly observed among women. This review aims to: (1) determine how pain is assessed or what types of questionnaires are used, (2) examine whether there are differences in pain characteristics between men and women with FMS and (3) describe how pain is conceptualized or manifested in patients at a qualitative level. In this study, the scoping review method of articles published in the last 5 years (2016–2022) was used. Ten articles were included. The most used questionnaires and scales to assess pain were the PVAS (Pain Visual Analogue Scale) and the FIQ (Fibromyalgia Impact Questionnaire). On the other hand, five categories were obtained: (1) qualities of pain, (2) uncertainty and chaos, (3) pain as an aggravating factor, (4) adaptation to the new reality and (5) the communication of pain. It has been observed that both subjective perception and widespread pain are higher in women. Men, on the other hand, have a worse impact of the pathology, more painful experiences and more catastrophic thoughts about pain. An updated knowledge of pain in FMS and whether it differs according to sex would be beneficial for clinicians to make an earlier diagnosis and treatment and, in turn, benefit patients suffering from this chronic disease. Full article

(This article belongs to the Section Pain Management)

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22 pages, 4797 KiB

Open AccessEditor’s ChoiceArticle

Adverse Effects of COVID-19 Vaccination: Machine Learning and Statistical Approach to Identify and Classify Incidences of Morbidity and Postvaccination Reactogenicity

by Md. Martuza Ahamad, Sakifa Aktar, Md. Jamal Uddin, Md. Rashed-Al-Mahfuz, A. K. M. Azad, Shahadat Uddin, Salem A. Alyami, Iqbal H. Sarker, Asaduzzaman Khan, Pietro Liò, Julian M. W. Quinn and Mohammad Ali Moni

Healthcare 2023, 11(1), 31; https://doi.org/10.3390/healthcare11010031 - 22 Dec 2022

Cited by 18 | Viewed by 4112

Abstract

Good vaccine safety and reliability are essential for successfully countering infectious disease spread. A small but significant number of adverse reactions to COVID-19 vaccines have been reported. Here, we aim to identify possible common factors in such adverse reactions to enable strategies that [...] Read more.

Good vaccine safety and reliability are essential for successfully countering infectious disease spread. A small but significant number of adverse reactions to COVID-19 vaccines have been reported. Here, we aim to identify possible common factors in such adverse reactions to enable strategies that reduce the incidence of such reactions by using patient data to classify and characterise those at risk. We examined patient medical histories and data documenting postvaccination effects and outcomes. The data analyses were conducted using a range of statistical approaches followed by a series of machine learning classification algorithms. In most cases, a group of similar features was significantly associated with poor patient reactions. These included patient prior illnesses, admission to hospitals and SARS-CoV-2 reinfection. The analyses indicated that patient age, gender, taking other medications, type-2 diabetes, hypertension, allergic history and heart disease are the most significant pre-existing factors associated with the risk of poor outcome. In addition, long duration of hospital treatments, dyspnoea, various kinds of pain, headache, cough, asthenia, and physical disability were the most significant clinical predictors. The machine learning classifiers that are trained with medical history were also able to predict patients with complication-free vaccination and have an accuracy score above 90%. Our study identifies profiles of individuals that may need extra monitoring and care (e.g., vaccination at a location with access to comprehensive clinical support) to reduce negative outcomes through classification approaches. Full article

(This article belongs to the Special Issue Graph Machine Learning in Healthcare)

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10 pages, 762 KiB

Open AccessEditor’s ChoiceHypothesis

The Ecological-Dynamics Framework for Medical Skills

by Kersi Taraporewalla, André van Zundert, Marcus O. Watson and Ian Renshaw

Healthcare 2023, 11(1), 38; https://doi.org/10.3390/healthcare11010038 - 22 Dec 2022

Cited by 4 | Viewed by 2603

Abstract

Physicians are required to move and manipulate equipment to achieve motor tasks such as surgical operations, endotracheal intubations, and intravenous cannulation. Understanding how movements are generated allows for the analysis of performance, skill development, and methods of teaching. Ecological-Dynamics (ECD) is a theoretical [...] Read more.

Physicians are required to move and manipulate equipment to achieve motor tasks such as surgical operations, endotracheal intubations, and intravenous cannulation. Understanding how movements are generated allows for the analysis of performance, skill development, and methods of teaching. Ecological-Dynamics (ECD) is a theoretical framework successfully utilized in sports to explain goal-directed actions and guide coaching and performance analysis via a Constraint-Led Approach (CLA). Its principles have been adopted by other domains including learning music and mathematics. Healthcare is yet to utilize ECD for analyzing and teaching practical skills. This article presents ECD theory and considers it as the approach to understand skilled behavior and developing training in medical skills. Full article

(This article belongs to the Section Critical Care)

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23 pages, 867 KiB

Open AccessEditor’s ChoiceEssay

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary

by Rafael Zegarra-Parodi, Francesca Baroni, Christian Lunghi and David Dupuis

Healthcare 2023, 11(1), 10; https://doi.org/10.3390/healthcare11010010 - 21 Dec 2022

Cited by 13 | Viewed by 8897

Abstract

Historical osteopathic principles and practices (OPP)—considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body’s self-healing ability into care—are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their [...] Read more.

Historical osteopathic principles and practices (OPP)—considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body’s self-healing ability into care—are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a ‘traditional-minded’ group following historical OPP despite evidence against those models and an ‘evidence-minded’ group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients’ values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes. Full article

(This article belongs to the Collection Osteopathic and Manual Therapy Healthcare Reconceptualization: Health Needs and New Evidence)

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12 pages, 1850 KiB

Open AccessEditor’s ChoiceCommentary

Vignette Research Methodology: An Essential Tool for Quality Improvement Collaboratives

by Kurlen S. E. Payton and Jeffrey B. Gould

Healthcare 2023, 11(1), 7; https://doi.org/10.3390/healthcare11010007 - 20 Dec 2022

Cited by 10 | Viewed by 4643

Abstract

Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, [...] Read more.

Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, some practice variation is due to the individual preference or style of the clinicians. Quality improvement collaboratives are commonly used to disseminate quality care on a wide scale. Practice variation is a notable barrier to any quality improvement effort. A detailed and accurate understanding of practice variation can help optimize the quality improvement efforts. The traditional survey methods do not capture the complex nuances of practice variation. Vignette methods have been shown to accurately measure the actual practice variation and quality of care delivered by clinicians. Vignette methods are cost-effective relative to other methods of measuring quality of care. This review describes our experience and lessons from implementing vignette research methods in quality improvement collaboratives in California neonatal intensive care units. Vignette methodology is an ideal tool to address practice variation in quality improvement collaboratives, actively engage a large number of participants, and support more evidence-based practice to improve outcomes. Full article

(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

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10 pages, 762 KiB

Open AccessEditor’s ChoiceArticle

Fetal Movement Counting in Prolonged Pregnancies: The COMPTAMAF Prospective Randomized Trial

by Louise Moniod, Agathe Hovine, Béatrice Trombert, Florence Rancon, Paul Zufferey, Laura Chauveau, Céline Chauleur and Tiphaine Raia-Barjat

Healthcare 2022, 10(12), 2569; https://doi.org/10.3390/healthcare10122569 - 18 Dec 2022

Cited by 2 | Viewed by 2758

Abstract

In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, [...] Read more.

In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, open-label study conducted from October 2019 to March 2022. Intention-to-treat analyses were performed on 278 patients randomized into two 1:1 groups (control group and FM counting group). The primary outcome was a composite score of neonatal morbidity (presence of two of the following items: fetal heart rate abnormality at delivery, Apgar score of <7 at 5 min, umbilical cord arterial pH of <7.20, and acute respiratory distress with mutation in neonatal intensive care unit). There was no significant difference between the two groups in the rate of neonatal morbidity (14.0% in the FM counting group versus 22.9% in the standard information group; p = 0.063; OR 0.55, 95% CI 0.29–1.0). In this study, fetal movement counting for women in prolonged pregnancy failed to demonstrate a significant reduction in adverse neonatal outcomes. Full article

(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

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14 pages, 274 KiB

Open AccessEditor’s ChoiceArticle

Through Thick and Thin: The Meaning of Dementia for the Intimacy of Ageing Couples

by Päivi Eskola, Outi Jolanki and Mari Aaltonen

Healthcare 2022, 10(12), 2559; https://doi.org/10.3390/healthcare10122559 - 17 Dec 2022

Cited by 10 | Viewed by 3084

Abstract

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from [...] Read more.

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from the perspective of an older couple’s spousal relationship and related intimacy. This qualitative study explores the meanings of emotional and physical intimacy and the changes brought by dementia in the couplehood of persons with dementia and their spousal carers. The data comprise semi-structured interviews with 35 persons. The interviews were analysed using inductive qualitative content analysis. Four themes describing the meanings of relational intimacy were identified: intimacy as a striving force, intimacy turning into worrisome behaviour, intimacy as physical and emotional dependency, and intimacy turning into one-sided caring for a partner. Dementia changes the intimate relationship in many ways, but shared affection and long-term partnership help maintain the spousal relationship. While dementia may bring about conflicts and behavioural challenges in an intimate relationship, the couple’s shared intimacy and a sense of responsibility for one another may serve as a resource and support the continuity of couplehood. Full article

(This article belongs to the Special Issue Dementia and Care)

12 pages, 1324 KiB

Open AccessEditor’s ChoiceArticle

Persistence to Medications for Benign Prostatic Hyperplasia/Benign Prostatic Obstruction-Associated Lower Urinary Tract Symptoms in the ASL TO4 Regione Piemonte (Italy)

by Lucrezia Greta Armando, Raffaella Baroetto Parisi, Elisa Remani, Mariangela Esiliato, Cristina Rolando, Valeria Vinciguerra, Abdoulaye Diarassouba, Clara Cena and Gianluca Miglio

Healthcare 2022, 10(12), 2567; https://doi.org/10.3390/healthcare10122567 - 17 Dec 2022

Cited by 3 | Viewed by 2446

Abstract

Background: Pharmacological treatment of benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO)-associated lower urinary tract symptoms (LUTS) aims at improving patients’ quality of life by managing urinary symptoms and preventing complications and disease progression. However, continuous use of drugs to treat BPH/BPO-associated LUTS decreases [...] Read more.

Background: Pharmacological treatment of benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO)-associated lower urinary tract symptoms (LUTS) aims at improving patients’ quality of life by managing urinary symptoms and preventing complications and disease progression. However, continuous use of drugs to treat BPH/BPO-associated LUTS decreases over time. The aim of this retrospective observational study was to describe use of α1-adrenoceptor antagonists (ABs) and steroid 5α-reductase inhibitors (5ARIs) by adult (age ≥ 40 years) men in the ASL TO4, a Local Health Authority in the northern area of the city of Turin (Italy). Methods: Persistence measures were adopted as a robust, informative, and feasible way to understand medication-taking behavior and to assess patient compliance. Results: A total of 4309 men (median age 71 years) were enrolled. Monotherapy was the treatment option prescribed to the largest part of the study population. However, ≥two drugs were prescribed to a substantial proportion of men (23%). Men prescribed alfuzosin or dutasteride had significantly greater persistence, which decreased over time. Conclusions: Unmet needs and areas of intervention for healthcare systems aimed at improving the use of drugs for BHP/BPO-associated LUTS in the ASL TO4 Regione Piemonte were identified. Full article

(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication: Second Edition)

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13 pages, 521 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

The Association between Bundled Payment Participation and Changes in Medical Episode Outcomes among High-Risk Patients

by Joshua M. Liao, Erkuan Wang, Ulysses Isidro, Jingsan Zhu, Deborah S. Cousins and Amol S. Navathe

Healthcare 2022, 10(12), 2510; https://doi.org/10.3390/healthcare10122510 - 12 Dec 2022

Cited by 2 | Viewed by 1945

Abstract

Background: Bundled payments for medical conditions are associated with stable quality and savings through shorter skilled nursing facility (SNF) length of stay. However, effects among clinically higher-risk patients remain unknown. Objective: To evaluate whether the association between participation in bundled payments for medical [...] Read more.

Background: Bundled payments for medical conditions are associated with stable quality and savings through shorter skilled nursing facility (SNF) length of stay. However, effects among clinically higher-risk patients remain unknown. Objective: To evaluate whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients. Design: Retrospective difference-in-differences analysis; Participants: 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Exposures were 5 measures of clinically high-risk groups: advanced age (>85 years old), high case-mix, disabled, frail, and prior institutional post-acute care provider utilization. Main Measures: Primary outcomes were SNF length of stay and 90-day unplanned readmissions. Secondary outcomes included quality, utilization, and spending measures. Key Results: SNF length of stay was differentially lower among frail patients (aDID −0.4 days versus non-frail patients, 95% CI −0.8 to −0.1 days), patients with advanced age (aDID −0.8 days versus younger patients, 95% CI −1.2 to −0.3 days), and those with prior institutional post-acute care provider utilization (aDID −1.1 days versus patients without prior utilization, 95% CI −1.6 to −0.6 days), compared to non-frail, younger, and patients without prior utilization, respectively. BPCI participation was also associated with differentially greater SNF LOS among disabled patients (aDID 0.8 days versus non-disabled patients, 95% CI 0.4 to 1.2 days, p < 0.001). Bundled payment participation was not associated with differential changes in readmissions in any high-risk group but was associated with changes in secondary outcomes for some groups. Conclusions: Changes under medical bundles affected, but did not indiscriminately apply to, high-risk patient groups. Full article

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6 pages, 2000 KiB

Open AccessEditor’s ChoiceCase Report

Severe Recurrent COVID-Associated Pulmonary Aspergillosis: A Challenging Case

by Luigi Vetrugno, Gian Marco Anzellotti, Regina Frontera, Zoe Parinisi, Barbara Sessa, Cristian Deana and Salvatore Maurizio Maggiore

Healthcare 2022, 10(12), 2483; https://doi.org/10.3390/healthcare10122483 - 8 Dec 2022

Cited by 1 | Viewed by 1624

Abstract

We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and [...] Read more.

We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and mechanical ventilation. We therefore strongly encourage a high degree of attention to fungal complications, even after viral recovery and ICU discharge. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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6 pages, 580 KiB

Open AccessEditor’s ChoiceBrief Report

Safety Evaluation of Remdesivir for COVID-19 Patients with eGFR < 30 mL/min without Renal Replacement Therapy in a Japanese Single-Center Study

by Takumi Umemura, Yoshikazu Mutoh, Takahito Mizuno, Mao Hagihara, Hideo Kato, Tetsuya Yamada, Yoshiaki Ikeda, Hiroshige Mikamo and Toshihiko Ichihara

Healthcare 2022, 10(11), 2299; https://doi.org/10.3390/healthcare10112299 - 17 Nov 2022

Cited by 6 | Viewed by 3001

Abstract

There are limited reports on the safety of remdesivir for patients with severe kidney disease. We investigated the safety of remdesivir administration for COVID-19 patients with estimated glomerular filtration rate (eGFR) <30 mL/min. This single-center retrospective study was conducted between March 2020 and [...] Read more.

There are limited reports on the safety of remdesivir for patients with severe kidney disease. We investigated the safety of remdesivir administration for COVID-19 patients with estimated glomerular filtration rate (eGFR) <30 mL/min. This single-center retrospective study was conducted between March 2020 and April 2022 at Tosei General Hospital, Japan. Propensity score matching was performed between patients with eGFR ≤ 30 mL/min and eGFR >30 mL/min with remdesivir administration. The primary outcome was 30-day mortality after the first administration. Adverse events, including development of acute kidney injury (AKI), liver function disorder, anemia, and thrombocytopenia 48 h after the end of remdesivir administration, were evaluated. After propensity score matching, 23 patients were selected from each group. There were no differences in the 30-day mortality (risk ratio [RR] 1.00; 95% confidence interval [CI] 0.18–5.56). Development of AKI and liver function disorder was not statistically different between the two groups (RR 1.05; 95% CI 0.96–1.14 and RR 0.48; 95% CI 0.04–5.66, respectively). There was no trend toward a significant increase in adverse events in the eGFR < 30 mL/min group and severe renal dysfunction had little effect on the safety of remdesivir treatment. Full article

(This article belongs to the Special Issue Pharmacist-Led Intervention)

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9 pages, 1307 KiB

Open AccessEditor’s ChoiceArticle

Long-Haul COVID Patients: Prevalence of POTS Are Reduced but Cerebral Blood Flow Abnormalities Remain Abnormal with Longer Disease Duration

by C. (Linda) M. C. van Campen and Frans C. Visser

Healthcare 2022, 10(10), 2105; https://doi.org/10.3390/healthcare10102105 - 21 Oct 2022

Cited by 15 | Viewed by 13813

Abstract

Background: Postural orthostatic tachycardia syndrome (POTS) has been described early after the onset of the COVID-19 infection, but also orthostatic hypotension (OH). In the present study, we hypothesized that orthostatic intolerance decreases over time. Methods: In 29 long-haul COVID-19 (LHC) patients, a tilt [...] Read more.

Background: Postural orthostatic tachycardia syndrome (POTS) has been described early after the onset of the COVID-19 infection, but also orthostatic hypotension (OH). In the present study, we hypothesized that orthostatic intolerance decreases over time. Methods: In 29 long-haul COVID-19 (LHC) patients, a tilt test was performed, including measurements of cerebral blood flow (CBF) by extracranial Doppler. The time interval between the onset of infection and the tilt test varied between 3 and 28 months. Results: In the first 12 months after the infection, 71% of the LHC patients showed POTS and after 24 months none of them. In the first 12 months, 29% of patients had a normal heart rate and blood pressure response (normHRBP) and after 24 months 75% (distribution of POTS, OH, and a normHRBP over time: p < 0.0001). Linear regression showed that, over time, there was a decrease in the abnormal CBF during the tilt (p = 0.024) but remained abnormal. Conclusion: In LHC patients, hemodynamic abnormalities of a tilt test change over time. Patients studied early after the onset of the disease mainly exhibit POTS, but patients studied later in the time course mainly show a normHRBP or OH. In addition, the abnormal CBF reduction improves over time, but CBF remains abnormal. Full article

(This article belongs to the Collection Why Some Patients Never Fully Recover: Post Active Phase of Infection Syndromes (PAPIS))

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9 pages, 444 KiB

Open AccessEditor’s ChoiceArticle

Benefits of Cardio-Pulmonary Rehabilitation in Moderate to Severe Forms of COVID-19 Infection

by Clara Douin, Kevin Forton, Michel Lamotte, Alexis Gillet and Philippe Van de Borne

Healthcare 2022, 10(10), 2044; https://doi.org/10.3390/healthcare10102044 - 17 Oct 2022

Cited by 4 | Viewed by 2286

Abstract

Our aim was to evaluate the benefits of cardio-pulmonary rehabilitation on severe to moderate COVID-19 patients. 25 discharged COVID-19 patients underwent a cardio-pulmonary test (CPET), a spirometry test and a measure of carbon monoxide lung diffusion capacity (DLCO) at the beginning of their [...] Read more.

Our aim was to evaluate the benefits of cardio-pulmonary rehabilitation on severe to moderate COVID-19 patients. 25 discharged COVID-19 patients underwent a cardio-pulmonary test (CPET), a spirometry test and a measure of carbon monoxide lung diffusion capacity (DLCO) at the beginning of their rehabilitation program and after 23 ± 5 rehabilitation sessions. This rehabilitation program combined interval training exercises on a bike and resistance exercises for major muscle groups. We then compared their progress in rehabilitation to that obtained with cardiac patients. At the beginning of their rehabilitation program, COVID-19 patients presented a reduced physical capacity with a maximal aerobic capacity (VO₂ max) at 71% of predicted value, a maximal workload at 70% of predicted value and an exercise hyperventilation measured by a higher VE/VCO₂ slope. Exercise was mainly limited by muscle deconditioning. After rehabilitation, the VO₂ max and maximal workload increased in COVID 19 patients by 18% and 26%, respectively. In patients with ischemic heart disease the post-rehabilitation gains in VO2 max and maximal workload were 22% and 25%, respectively. Moreover, exercise hyperventilation decreased by 10% in both groups. On the other hand, the intrinsic pulmonary function of COVID 19 patients improved following natural recovery. In conclusion, even if cardio-pulmonary rehabilitation is probably not the only parameter which explains the partial recovery of moderate to severe COVID-19 patients, it certainly helps to improve their physical capacity and reduce exercise hyperventilation. Full article

(This article belongs to the Special Issue Physiotherapy and Cardiothoracic Care in Acute and Chronic Care)

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12 pages, 5569 KiB

Open AccessEditor’s ChoiceArticle

Orthostatic Intolerance in Long-Haul COVID after SARS-CoV-2: A Case-Control Comparison with Post-EBV and Insidious-Onset Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients

by C. (Linda) M. C. van Campen and Frans C. Visser

Healthcare 2022, 10(10), 2058; https://doi.org/10.3390/healthcare10102058 - 17 Oct 2022

Cited by 20 | Viewed by 16392

Abstract

Background: As complaints of long-haul COVID patients are similar to those of ME/CFS patients and as orthostatic intolerance (OI) plays an important role in the COVID infection symptomatology, we compared 14 long-haul COVID patients with 14 ME/CFS patients with a post-viral Ebstein-Barr (EBV) [...] Read more.

Background: As complaints of long-haul COVID patients are similar to those of ME/CFS patients and as orthostatic intolerance (OI) plays an important role in the COVID infection symptomatology, we compared 14 long-haul COVID patients with 14 ME/CFS patients with a post-viral Ebstein-Barr (EBV) onset and 14 ME/CFS patients with an insidious onset of the disease. Methods: In all patients, OI analysis by history taking and OI assessed during a tilt test, as well as cerebral blood flow measurements by extracranial Doppler, and cardiac index measurements by suprasternal Doppler during the tilt test were obtained in all patients. Results: Except for disease duration no differences were found in clinical characteristics. The prevalence of POTS was higher in the long-haul patients (100%) than in post-EBV (43%) and in insidious-onset (50%) patients (p = 0.0002). No differences between the three groups were present in the prevalence of OI, heart rate and blood pressure changes, changes in cerebral blood flow or in cardiac index during the tilt test. Conclusion: OI symptomatology and objective abnormalities of OI (abnormal cerebral blood flow and cardiac index reduction during tilt testing) are comparable to those in ME/CFS patients. It indicates that long-haul COVID is essentially the same disease as ME/CFS. Full article

(This article belongs to the Collection Why Some Patients Never Fully Recover: Post Active Phase of Infection Syndromes (PAPIS))

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8 pages, 249 KiB

Open AccessEditor’s ChoiceArticle

YouTube: Is It a Reliable Source of Nutrition Information on COVID-19 Pandemic?

by Elif Inan-Eroglu and Zehra Buyuktuncer

Healthcare 2022, 10(10), 1911; https://doi.org/10.3390/healthcare10101911 - 29 Sep 2022

Cited by 1 | Viewed by 2067

Abstract

Data on the nutrition-related misinformation about COVID-19 are limited. This study analysed the quality and accuracy of the nutrition information available on YouTube about current COVID-19 pandemic as well as assessed the content of the videos. YouTube was searched using the terms “nutrition [...] Read more.

Data on the nutrition-related misinformation about COVID-19 are limited. This study analysed the quality and accuracy of the nutrition information available on YouTube about current COVID-19 pandemic as well as assessed the content of the videos. YouTube was searched using the terms “nutrition and COVID-19” in Turkish on 1 February 2021. Videos were filtered according to relevancy, and the first 280 videos were analysed. A total of 218 videos were reviewed and classified as “misleading” or “relevant” depending on the information provided. The transparency, utility, reliability, and accuracy of video contents were assessed. The videos attracted a cumulative 6,258,694 views. There were 178 (81.7%) fully relevant and 40 (18.3%) misleading videos. Approximately 80% of the videos shared by health professionals were relevant videos. Government organisations only shared relevant videos. Relevant videos had higher reliability, accuracy, and quality than misleading videos. The nutrition-related content of COVID-19 videos is suboptimal on YouTube. As the COVID-19 pandemic worsens, and nutrition could improve immunity, health professionals and educational and government organisations need to engage more in the spread of nutrition-related COVID-19 information to Internet platforms based on nutrition guidelines and the latest scientific evidence. This will be a practical and immediately implementable public health strategy to effectively spread the right information. Full article

(This article belongs to the Special Issue The Role of Social Media in Innovative Digital Health)

14 pages, 661 KiB

Open AccessEditor’s ChoiceArticle

An Automated Algorithm for Determining Sleep Using Single-Channel Electroencephalography to Detect Delirium: A Prospective Observational Study in Intensive Care Units

by Kentaro Matsui, Nobuo Sato, Masafumi Idei, Masako Arakida, Yusuke Seino, Jun-ya Ishikawa, Masashi Nakagawa, Rie Akaho, Katsuji Nishimura and Takeshi Nomura

Healthcare 2022, 10(9), 1776; https://doi.org/10.3390/healthcare10091776 - 15 Sep 2022

Cited by 4 | Viewed by 2973

Abstract

The relationship between polysomnography-based objective sleep and delirium in the intensive care unit (ICU) is inconsistent across studies, suggesting limitations in manually determining the sleep stage of critically ill patients. We objectively measured 24-h sleep using a single-channel electroencephalogram (SleepScope [SS]) and an [...] Read more.

The relationship between polysomnography-based objective sleep and delirium in the intensive care unit (ICU) is inconsistent across studies, suggesting limitations in manually determining the sleep stage of critically ill patients. We objectively measured 24-h sleep using a single-channel electroencephalogram (SleepScope [SS]) and an under-mattress sleep monitor (Nemuri SCAN [NSCAN]), both of which have independent algorithms that automatically determine sleep and wakefulness. Eighteen patients (median age, 68 years) admitted to the ICU after valvular surgery or coronary artery bypass grafting were included, and their sleep time was measured one day after extubation. The median total sleep times (TSTs) measured by SS (TST-SS) and NSCAN were 548 (48–1050) and 1024 (462–1257) min, respectively. Two patients with delirium during the 24-h sleep measurement had very short TST-SS of 48 and 125 min, and the percentage of daytime sleep accounted for >80% in both SS and NSCAN. This preliminary case series showed marked sleep deprivation and increased rates of daytime sleeping in ICU patients with delirium. Although data accuracy from under-mattress sleep monitors is contentious, automated algorithmic sleep/wakefulness determination using a single-channel electroencephalogram may be useful in detecting delirium in ICU patients and could even be superior to polysomnography. Full article

(This article belongs to the Special Issue Symptoms and Experiences of Patients after Intensive Care)

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15 pages, 976 KiB

Open AccessEditor’s ChoiceReview

Patient Satisfaction with Telemedicine in Adults with Diabetes: A Systematic Review

by Hidetaka Hamasaki

Healthcare 2022, 10(9), 1677; https://doi.org/10.3390/healthcare10091677 - 2 Sep 2022

Cited by 10 | Viewed by 4303

Abstract

Patient satisfaction assessment is essential for improving the quality of healthcare. Diabetes management using telemedicine technology is promising in the 21st century. However, the number of randomised controlled trials (RCTs) examining the effect of telemedicine on satisfaction in patients with diabetes is limited. [...] Read more.

Patient satisfaction assessment is essential for improving the quality of healthcare. Diabetes management using telemedicine technology is promising in the 21st century. However, the number of randomised controlled trials (RCTs) examining the effect of telemedicine on satisfaction in patients with diabetes is limited. This systematic review aimed to summarise the current evidence on patient satisfaction with telemedicine in adults with diabetes and discuss related issues and future directions of telemedicine in patients with diabetes. The author systematically searched PubMed/MEDLINE, Embase and The Cochrane Library, and a total of six RCTs were eligible for this review. Patient satisfaction with telemedicine was as high as conventional face-to-face care; however, telemedicine appeared not to significantly increase patient satisfaction compared with conventional face-to-face care in the included studies. Significant heterogeneity was noted between the studies, including participants’ age, study duration, the method of assessing patient satisfaction and types of telemedicine. Further studies are required to provide firm evidence to healthcare providers who are willing to use telemedicine in diabetes management. Telemedicine technology has been advancing and is a key tool in providing high-quality healthcare to patients with diabetes in the 21st century. Full article

(This article belongs to the Special Issue Healthcare Strategies for Patients with Chronic Diseases in an Ageing Society)

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16 pages, 1357 KiB

Open AccessEditor’s ChoiceArticle

Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study

by Dora Janela, Fabíola Costa, Anabela C. Areias, Maria Molinos, Robert G. Moulder, Jorge Lains, Virgílio Bento, Justin K. Scheer, Vijay Yanamadala, Steven P. Cohen and Fernando Dias Correia

Healthcare 2022, 10(8), 1595; https://doi.org/10.3390/healthcare10081595 - 22 Aug 2022

Cited by 6 | Viewed by 3683

Abstract

Chronic hip pain is a cause of disability worldwide. Digital interventions (DI) may promote access while providing proper management. This single-arm interventional study assesses the clinical outcomes and engagement of a completely remote multimodal DI in patients with chronic hip pain. This home-based [...] Read more.

Chronic hip pain is a cause of disability worldwide. Digital interventions (DI) may promote access while providing proper management. This single-arm interventional study assesses the clinical outcomes and engagement of a completely remote multimodal DI in patients with chronic hip pain. This home-based DI consisted of exercise (with real-time biofeedback), education, and cognitive-behavioral therapy. Outcomes were calculated between baseline and program end, using latent growth curve analysis. Primary outcome was the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes were pain, intent to undergo surgery, mental health, productivity, patient engagement (exercise sessions frequency), and satisfaction. Treatment response was assessed using a 30% pain change cut-off. A completion rate of 74.2% (396/534), alongside high patient engagement (2.9 exercise sessions/week, SD 1.1) and satisfaction (8.7/10, SD 1.6) were observed. Significant improvements were observed across all HOOS sub-scales (14.7–26.8%, p < 0.05), with 66.8% treatment responders considering pain. Marked improvements were observed in surgery intent (70.1%), mental health (54%), and productivity impairment (60.5%) (all p < 0.001). The high engagement and satisfaction reported after this DI, alongside the clinical outcome improvement, support the potential of remote care in the management of chronic hip conditions. Full article

(This article belongs to the Special Issue Digital Therapeutics in Healthcare)

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21 pages, 14208 KiB

Open AccessEditor’s ChoiceArticle

All Pedicle Screw versus Hybrid Hook–Screw Instrumentation in the Treatment of Thoracic Adolescent Idiopathic Scoliosis (AIS): A Prospective Comparative Cohort Study

by Athanasios I. Tsirikos and Tristan E. McMillan

Healthcare 2022, 10(8), 1455; https://doi.org/10.3390/healthcare10081455 - 3 Aug 2022

Cited by 9 | Viewed by 2733

Abstract

Background: Posterior spinal correction and fusion remains the most common surgical treatment in AIS. Surgeons currently favour all pedicle screw (AS) correction techniques with alternative implants being less utilised. The purpose of this study was to assess whether a hybrid hook–screw (HS) construct [...] Read more.

Background: Posterior spinal correction and fusion remains the most common surgical treatment in AIS. Surgeons currently favour all pedicle screw (AS) correction techniques with alternative implants being less utilised. The purpose of this study was to assess whether a hybrid hook–screw (HS) construct could achieve similar outcomes. Methods: A single centre, prospective cohort study was conducted. Patients with moderate and severe thoracic AIS (Lenke 1) were included. Clinical and radiological results of a standardised hybrid HS technique were compared with those obtained with an AS construct. All patients had a minimum 2-year follow-up. Results: 160 patients were included in this series (80 patients/group). The HS group had significantly reduced surgical time, blood loss and implant density. Both techniques achieved ≥75% scoliosis correction. The HS group was superior in restoring thoracic kyphosis and global sagittal balance with an average 31% increase in kyphosis compared to 10% with the AS group (p < 0.001). There was significant improvement in SRS-22 scores at 2 years postoperative (p < 0.001) in both groups. There were no neurological or visceral complications related to instrumentation, no detected non-union and no reoperations. The HS implant cost was significantly lower than that of AS, with a mean instrumentation saving of almost £2000/patient. Conclusion: A standardised hybrid HS technique achieved excellent correction of thoracic scoliosis, high patient satisfaction and low complication rates in patients with thoracic AIS. These results were comparable to the AS group. The HS technique achieved better correction of thoracic kyphosis and sagittal balance than the AS technique, together with reduced surgical time, blood loss and implant cost. Full article

(This article belongs to the Special Issue Pediatric Spine Health)

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16 pages, 2426 KiB

Open AccessEditor’s ChoiceArticle

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

by Salvatore Corrao, Giuseppe Natoli, Alessandro Nobili, Pier Mannuccio Mannucci, Francesco Perticone, Vincenzo Arcoraci and Christiano Argano

Healthcare 2022, 10(8), 1459; https://doi.org/10.3390/healthcare10081459 - 3 Aug 2022

Cited by 8 | Viewed by 3692

Abstract

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing [...] Read more.

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

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