Suchergebnisse

Traditional triage tools hospitals use face limitations in handling the increasing number of patients and analyzing complex data. These ongoing challenges in patient triage necessitate the development of more effective prediction methods. This study aims to use machine learning (ML) to create an automated triage model for remote patients in telemedicine systems, providing more accurate health services and health assessments of urgent cases in real time. A comparative study was conducted to ascertain how well different supervised machine learning models, like SVM, RF, DT, LR, NB, and KNN, evaluated patient triage outcomes for outpatient care. Hence, data from diverse, rapidly generated sources is crucial for informed patient triage decisions. Collected through IoMT-enabled sensors, it includes sensory data (ECG, blood pressure, SpO2, temperature) and non-sensory text frame measurements. The study examined six supervised machine learning algorithms. These models were trained using patient medical data and validated by assessing their performance. Supervised ML technology was implemented in Hadoop and Spark environments to identify individuals with chronic illnesses accurately. A dataset of 55,680 patient records was used to evaluate methods and determine the best match for disease prediction. The simulation results highlight the powerful integration of ML in telemedicine to analyze data from heterogeneous IoMT devices, indicating that the Decision Tree (DT) algorithm outperformed the other five machine learning algorithms by 93.50% in terms of performance and accuracy metrics. This result provides practical insights for developing automated triage models in telemedicine systems.

Die Qualität privater Dienstleistungen in der Gesundheitsfürsorge wird in Ägypten höher eingeschätzt als die staatlicher Einrichtungen. Trotz eines flächendeckenden öffentlichen Gesundheitsdienstes ziehen es viele Ägypter unabhängig von Einkommen, Wohnort, Geschlecht oder Alter vor, auf eigene Kosten einen ambulante medizinische Behandlung zu suchen. (DSE/DÜI)

Abstract. Background: Young people receiving tertiary mental health care are at elevated risk for suicidal behavior, and understanding which individuals are at increased risk during care is important for treatment and suicide prevention. Aim: We aimed to retrospectively identify risk factors for attempted suicide during outpatient care and predict which young people did or did not attempt during care. Method: Penalized logistic regression analysis was performed in a small high-risk sample of 84 young people receiving care at Orygen's Youth Mood Clinic (age: 14–25 years, 51% female) to predict suicide attempt during care (N = 16). Results: Prediction of suicide attempt during care was only moderately accurate (Area Under the Receiver Operating Curve range 0.71; sensitivity 0.57) using a combination of sociodemographic, psychosocial, and clinical variables. The features that best discriminated both groups included suicidal ideation during care, history of suicide attempt prior to care, changes in appetite reported on the PHQ-9, history of parental separation, and parental mental illness. Limitation: Replication of findings in an independent validation sample is needed. Conclusion: While prediction of suicide attempt during care was only moderately successful, we were able to identify individual risk factors for suicidal behavior during care in a high-risk sample.

INTRODUCTION: Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India's. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients. METHODS: The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode. RESULTS: The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others. CONCLUSIONS AND RECOMMENDATIONS: The findings have implications for the desired mix of public and private providers in India's health-system. Poor regulation of for-profit providers was an important ...

OBJECTIVES: There are currently no reliable estimates of the prevalence of gastrointestinal disease in the US Military Veterans. Hence, the study aims to determine its prevalence in military Veterans in the United States. METHODS: This study utilized a retrospective, correlational design using a patient record database from the Department of Veteran's Affairs. The participants in the study were Veterans diagnosed with gastrointestinal disease. Specific gastrointestinal diseases include more than 500,000 ambulatory care visits annually in the United States, which included peptic ulcer disease, gastroesophageal reflux disease, diverticular disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome, and functional dyspepsia, as well as the symptoms of constipation and nausea/vomiting. This study revealed the exact prevalence of gastrointestinal disease diagnosed in Veterans served in outpatient settings by the Veterans Health Administration and broke down this prevalence over time and by the Veteran period of service. RESULTS: Findings revealed that gastrointestinal disease prevalence among Veterans varied according to their period of service. CONCLUSIONS: Findings may help improve screening for Veterans with this increased risk factor. However, further research should be performed to verify the prevalence of gastrointestinal disease in Veterans as compared to the general American population.

Addressing homelessness among veterans has been a top policy priority for the U.S. Department of Veterans Affairs (VA) since 2009. Part of the multitiered strategy to prevent and end homelessness among veterans was the implementation of a universal screen for housing instability among all veteran outpatients at VA facilities. Data from more than six million veterans responding to this screen have provided insight into veterans' housing instability, as well as the characteristics of individuals and structural forces that may influence housing insecurity among veterans; the current article synthesizes these findings. Although the universal screen for housing instability has been effective at linking veterans with needed resources, questions remain regarding the best ways to ensure that they remain in safe, affordable, adequate, and permanent housing.

ZusammenfassungZur Einbindung von Spiritualität/Religiosität (S/R) in die klinische Behandlung gibt es mittlerweile verschiedene konzeptuelle Ansätze, die unter dem Begriff Spiritual Care gefasst werden können. Bisher finden diese Konzepte außerhalb des klinischen Kontextes nur wenig Berücksichtigung, obwohl Spiritualität und Religiosität sowohl als Ressource, aber auch als Stressor nicht übersehen werden sollten. Der Artikel stellt die derzeitige Situation der interdisziplinären Zusammenarbeit mit Blickrichtung auf den Einbezug von S/R im klinischen Setting dar, um im Anschluss daran am Beispiel von Psychotherapeuten und Seelsorgern zu überlegen, inwiefern die konzeptuellen Ansätze auch für das ambulante Setting genutzt werden könnten. Es wird dabei im Rahmen der Diskussion auch auf Möglichkeiten und Herausforderungen der Zusammenarbeit eingegangen.

In Korea, until recently, both physicians and pharmacists were allowed to prescribe and dispense drugs for outpatient care. Along with other deep-rooted structural problems, this worked against the quality and efficiency of the health care system. To rectify this problem, the Korean government launched a drug policy reform in July 2000. However, the drug policy reform was more drastic than initially intended�봡riven by political factors, the reform ended up bringing about complete separation of medical institutions and pharmacies. Also, unlike in many other countries, Korea did not take a gradual approach, but instead, it implemented the reform all at once and nation-wide. As a result, the reform has faced criticism and protests, thereby generating unprecedented social turmoil and even strikes by physicians. Still, it is not clear what benefits Korea gained from this reform, when we look at the price which has had to be paid, including greater inconvenience, worsened access to medical care, increased drug spending, increased market share for multinational drug producers, and a greater deficit in the budget of the Korea�셲 national health insurance system. Based on Korea�셲 costly experience, we attempt to draw some policy implications for the future development of a better health care system. ; open

Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.