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The purpose of this study is to develop an efficient prediction model using vital signs and standard medical score systems, which predicts the clinical severity level of the patient in advance based on the quick sequential organ failure assessment (qSOFA) medical score method.

To predict the clinical severity level of the patient in advance, the authors have formulated a training dataset that is constructed based on the qSOFA medical score method. Further, along with the multiple vital signs, different standard medical scores and their correlation features are used to build and improve the accuracy of the prediction model. It is made sure that the constructed training set is suitable for the severity level prediction because the formulated dataset has different clusters each corresponding to different severity levels according to qSOFA score.

From the experimental result, it is found that the inclusion of the standard medical scores and their correlation along with multiple vital signs improves the accuracy of the clinical severity level prediction model. In addition, the authors showed that the training dataset formulated from the temporal data (which includes vital signs and medical scores) based on the qSOFA medical scoring system has the clusters which correspond to each severity level in qSOFA score. Finally, it is found that RAndom k-labELsets multi-label classification performs better prediction of severity level compared to neural network-based multi-label classification.

This paper helps in identifying patient' clinical status.

The purpose of this paper is to assess the nutritional status and quality of life in patients according to the clinical severity of liver cirrhosis.

A total of 151 cirrhotics were selected for study. Nutritional assessment was done by anthropometry, subjective global assessment, malnutrition universal screening tool, biochemical estimations and 72‐hour dietary recall. Quality of life was assessed by chronic liver disease questionnaire.

Child's status was A/B/C in 29/68/59, respectively. Muscle and fat depletion was significantly higher in grade C patients as compared to grade A and B patients. Incidence of malnutrition was lowest in grade A patients (72.4 percent) and highest in grade C patients (90.74 percent) (p = 0.00). Calorie and protein intake was significantly lower in grade C patients compared to grade A and B patients (p = 0.00). Child Pugh score was found to be an independent risk factor for various nutritional and clinical parameters.

The data presented reflect the assessment of a very small cohort of these patients and should be done on a larger scale.

Looking into the high prevalence of malnutrition and the negative impact of disease severity, nutritional assessment of these patients should be done on a regular basis and nutritional therapy planned accordingly.

Data on malnutrition from India are scarce. This study is a small attempt to throw light on the nutritional status and its variation according to clinical severity of liver cirrhosis.

The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization’s (WHO’s) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11.

A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences.

The WG recommended a synonym set (“synset”) ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as “a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills”. The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features.

Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.

Dietary fiber and energy intakes seem to be related to disability and anthropometric indices in multiple sclerosis (MS), a chronic inflammatory disorder of the central nervous system. So, this study was designed to investigate the association between dietary fiber and energy intakes with systemic inflammation, disease severity and anthropometric measurements in MS subjects.

Four subtypes of 261 MS volunteers were recruited (female = 210, male = 51; mean age 38.9 ± 8.3). A 168-item food frequency questionnaire and nutritionist IV software were used to estimate the amounts of dietary, insoluble, soluble, crude fiber and energy intakes. Serum hs-CRP, extended disability status scale (EDSS), height, weight and Deurenberg equation were also used to evaluate systemic inflammation, disease severity, body mass index (BMI) and percentage body fat, respectively.

Mean differences among the three hs-CRP and EDSS subgroups for dietary fibers and energy intake were significant (p < 0.001). Dietary fiber intake (M = 19.9 ± 4.3 g/day) was a good predictor for EDSS (B = −0.196, p = 0.012), and insoluble fiber intake was introduced as the best predictor of hs-CRP (B = −3.293, p < 0.001). Energy intake predicted both BMI (B = 0.007, p < 0.001) and percentage body fat (B = 0.015, p < 0.001).

Hypocaloric and high prebiotic fiber diet may suppress systemic inflammation and thereby modulate disease severity, as well as control anthropometric indices.

This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve the quality of care by ensuring economic sustainability, it is necessary to redefine the concept of competition in healthcare and align it with the concept of maximizing value for patients.

Performance measurement is a crucial aspect of the analysis of health-care organizations. Porter developed an effective analytical technique and presented the measurement of health-care outcomes based on health conditions, the efficiency of health-care organizations and the type of service provided.

Clinical outcomes and data on the costs of care of each patient are essential to evaluate improvement in treatment value over time. Engaging in the evaluation of what happens to patients in their course of care enables the expansion of the measurement of outcomes because it measures all the health services related to it.

Building a health-care system based on the value and continuous improvement of care and services provided is a goal shared by many countries and international organizations. Today, the analysis of outcomes is important for making informed decisions, directing and planning clinical and organizational changes by improving the quality of care and services.

The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome.

Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions.

Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses.

Results support the utilization of low-cost, community-based treatments for a highly marginalized population.

Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

Autism spectrum disorders (ASD) are heterogeneous disorders, and heterogeneity lies both at genetic and phenotypic levels. To better understand the etiology and pathway that may contribute to autism symptomatology, it is important to study milder expressions of autism characteristics – autistic traits or milder expressions of autism phenotype, especially in intergenerational context. This study aims to see the trend of association, if any, between child autism symptom and mothers’ autism phenotype as well as mothers’ theory of mind and to see if mothers’ theory of mind was associated with their own autistic traits.

Data were collected from 96 mothers of children with varying symptom severity of autism (mild, moderate and severe) using Autism Spectrum Quotient and faux pas recognition test. Analysis of variance, trend analysis and t-test were done.

Results showed a linear trend of relationship between mothers’ autism phenotype and child symptom severity. However, the groups did not have significant differences in theory of mind. Only a few components of theory of mind were found to be associated with autistic traits. These findings question the prevailing idea that theory of mind can be a reliable endophenotype of autism.

There has been a lack of research assessing the possible link between parents’ autism phenotype and symptom severity of ASD children. This study is a preliminary step towards that direction. This study indicates a probability of shared genetic liability between mothers and offspring, which would have important consequences for understanding the mechanisms that lead to autism.

This study offers implications for treatment planning of those with clinical ASD. An awareness of parental factors is critical for any holistic intervention plan when a family seeks treatment for their child. This study suggests that while individualising interventions, clinicians may consider possible presence of high levels of autistic traits and related cognitive features present in the probands’ parents.

There has been lack of research assessing the possible link between parents’ autism phenotype and symptom severity of ASD children. This study, even though preliminary, is a step towards that direction. This study suggests that autism traits might be influenced by common genetic variation and indicates a probability of shared genetic liability between mothers and offspring, which would have important consequences for understanding the mechanisms that lead to autism.

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

The purpose of this paper is to evaluate the common themes leading or contributing to clinical incidents in a UK teaching hospital.

A root‐cause analysis was conducted on patient safety incidents. Commonly occurring root causes and contributing factors were collected and correlated with incident timing and severity.

In total, 65 root‐cause analyses were reviewed, highlighting 202 factors implicated in the clinical incidents and 69 categories were identified. The 14 most commonly occurring causes (encountered in four incidents or more) were examined as a key‐root or contributory cause. Incident timing was also analysed; common factors were encountered more frequently during out‐hours – occurring as contributory rather than a key‐root cause.

In total, 14 commonly occurring factors were identified to direct interventions that could prevent many clinical incidents. From these, an “Organisational Safety Checklist” was developed to involve departmental level clinicians to monitor practice.

This study demonstrates that comprehensively investigating incidents highlights common factors that can be addressed at a local level. Resilience against clinical incidents is low during out‐of‐hours periods, where factors such as lower staffing levels and poor service provision allows problems to escalate and become clinical incidents, which adds to the literature regarding out‐of‐hours care provision and should prove useful to those organising hospital services at departmental and management levels.

Process management approaches all pursue standardization, of which evidence-based medicine (EBM) is the most common form in healthcare. While EBM addresses improvement in clinical performance, it is unclear whether EBM also enhances operational performance. Conversely, operational process standardization (OPS) does not necessarily yield better clinical performance. The authors have therefore looked at the relationship between clinical practise standardization (CPS) and OPS and the way in which they jointly affect operational performance. The paper aims to discuss this issue.

The authors conducted a comparative case study analysis of a cataract surgery treatment at five Belgium hospital sites. Data collection involved 218 h of observations of 274 cataract surgeries. Both qualitative and quantitative methods were used.

Findings suggest that CPS does not automatically lead to improved resource or throughput efficiency. This can be explained by the low level of OPS across the five units, notwithstanding CPS. The results indicate that a wide range of variables on different levels (patient, physician and organization) affect OPS.

Considering one type of care treatment in which clinical outcome variations are small complicates translating the findings to unstructured and complex care treatments.

With the introduction of OPS as a complementary view of CPS, the study clearly shows the potential of OPS to support CPS in practice. Operations matters in healthcare standardization, but only when it is managed in a deliberate way on a hospital and policy level.