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A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data.

Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients’ (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included.

An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality.

The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome.

Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.

The purpose of this paper is to study serum lipids, lipoproteins, homocysteine (Hcy) and platelet-derived growth factor (PDGF), and to evaluate the relationship between serum lipids, lipoproteins, Hcy and PDGF in patients with hypertension.

In total, 85 patients with hypertension (34 males, 51 females) were recruited from October to December 2015 at Saraphi Hospital, Chiang Mai Province using purposive sampling. PDGF mRNA levels of the patients were analyzed using the RT-PCR method. Hcy was analyzed by high-performance liquid chromatography. An enzymatic-colorimetric method was used to measure serum cholesterol, high-density lipoprotein cholesterol and triglyceride. A low-density lipoprotein cholesterol (LDL-C) level was calculated using Friedewald’s formula. Descriptive statistics and the Pearson product moment were also used in the analysis.

Among the patients with hypertension, hypercholesterolemia, high levels of LDL-C, hypertriglyceridemia and hyperhomocysteinemia were found in 54.1, 70.7, 25.9 and 44.7 percent, respectively. In addition, PDGF was significantly correlated with Hcy (r=0.705; p<0.005). There was no association between serum lipids or lipoproteins and Hcy or PDGF in patients with hypertension.

The results of this study provide direction on how serum lipids, lipoproteins, Hcy and PDGF can be used as a guide to improving dietary management as a means of reducing cardiovascular disease, and stroke in patients with hypertension.

This manuscript is not currently under consideration, in press or published elsewhere. This manuscript is truthful original work without fabrication, fraud or plagiarism. The authors have made important scientific contributions to this study. The authors are familiar with the primary data, and have read the entire manuscript and take responsibility for it content. No benefits were received by the authors or any member of the authors’ family or the research team, from any commercial source, directly or indirectly related to this work. Moreover, no one affiliated with has any financial interest related to the subject matter of this manuscript.

A stroke is a serious, life-threatening condition that occurs when the blood supply to a part of the brain is cut off. The earlier a stroke is treated, the less damage is likely to occur. One of the methods that can lead to faster treatment is timely and accurate prediction and diagnosis. This paper aims to compare the binary integer programming-data envelopment analysis (BIP-DEA) model and the logistic regression (LR) model for diagnosing and predicting the occurrence of stroke in Iran.

In this study, two algorithms of the BIP-DEA and LR methods were introduced and key risk factors leading to stroke were extracted.

The study population consisted of 2,100 samples (patients) divided into six subsamples of different sizes. The classification table of each algorithm showed that the BIP-DEA model had more reliable results than the LR for the small data size. After running each algorithm, the BIP-DEA and LR algorithms identified eight and five factors as more effective risk factors and causes of stroke, respectively. Finally, predictive models using the important risk factors were proposed.

The main objective of this study is to provide the integrated BIP-DEA algorithm as a fast, easy and suitable tool for evaluation and prediction. In fact, the BIP-DEA algorithm can be used as an alternative tool to the LR model when the sample size is small. These algorithms can be used in various fields, including the health-care industry, to predict and prevent various diseases before the patient’s condition becomes more dangerous.

The purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.

A modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.

The C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost of the CVD in OC amounted to 1.8 trillion JPY; while the RA amounted to 3.0 trillion JPY.

The LTC burden accounted for a significant proportion of the social burden of chronic diseases. The informal care was maintained by unsustainable structures such as the elderly providing care for the elderly. This result can affect health policy decisions.

The C-COI is more appropriate for estimating the social burden of chronic diseases including the LTC burden and can be calculated using governmental statistics.

This study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.

A qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.

The majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.

This study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.

Malnutrition has a significant effect on the onset and progression of infective pathology. The malnutrition status in COVID-19 cases are not understood well. Prognostic Nutritional Index (PNI) is a new and detailed assessment of nutrition and inflammation cases. This study aims to investigate the effect of PNI on mortality in COVID-19 patients.

In total, 334 patients (males, 142; females, 192; 64.5 ± 12.3 years of age) with COVID-19 bronchopneumonia were enrolled in this investigation. Cases were divided into two groups with respect to survival (Group 1: survivor patients, Group 2: non-survivor patients). Demographic and laboratory variables of COVID-19 cases were recorded. Laboratory parameters were calculated from blood samples taken following hospital admission. PNI was calculated according to this formula: PNI = 5 * Lymphocyte count (10⁹/L) + Albumin value (g/L).

When the patients were assessed with respect to laboratory values, leukocytes, neutrophils, CRP, ferritin, creatinine and D-Dimer parameters were significantly lower in Group 1 patients than Group 2 patients. Nevertheless, serum potassium value, lymphocyte count, calcium and albumin values were significantly higher in Group 1 cases than in Group 2 cases. PNI value was significantly lower in Group 2 cases than in Group 1 cases (39.4 ± 3.7 vs 53.1 ± 4.6).

In this retrospective study of COVID-19 cases, it can be suggested that PNI may be a significant risk factor for mortality. In conclusion of this research, high-risk patients with COVID-19 can be determined early, and suitable medical therapy can be begun in the early duration.

The purpose of this paper is to analyze job-related stress, motivation and satisfaction in higher education institutions, and assesses their implications on health in various industries including higher education. In total, 52 higher education faculty and administrators from institutions in more than 16 countries participated in the study that utilized the organizational surveys, Organizational Effectiveness Inventory® from human synergistics. Subgroup analysis was done to compare faculty and administrators; males to females, private, public, for-profit and not-for-profit institutions.

To assess health implications, 160 respondents employed in seven industries were surveyed using a custom medical/stress questionnaire to collect self-reported data on levels of job-related stress, motivation and satisfaction as well as the presence of several medical conditions, including myocardial infarction, stroke, angina pectoris/coronary heart disease, hypertension, gastro-esophageal reflux disease and diabetes mellitus. The results from each of the two surveys were statistically analyzed separately.

Results show undesirable levels of job-related stress, motivation and satisfaction in some segments of higher education employees; as well as associations between poorer health and high stress levels. The study established a potential justification consequently, the authors recommend organizational offerings of: stress relief programs; health fairs and health club memberships; stress management workshops; use of mobile apps for stress relief; job description reviews to eliminate work-related demands; changes to managerial styles that align with the culture of employees; re-evaluation of organizational structure; and enhanced communication amongst workplace management and employees.

Limitations of this study include small sample sizes and the presence of confounding factors that were not considered. In addition, this study did not look into whether occupational position or occupational difficulty compromised the nature of work causing employees to experience lower levels of satisfaction, since the extent to which employees feel satisfied with their work may influence their physical well-being.

There are a number of factors that can affect employees with regards to medical illnesses in a job-related setting. There are three factors in particular that have been shown to negatively affect the health of employees: job-related stress; motivation; and satisfaction. These effects have not been studied in depth in faculty and administrators of higher education institutions, hence this study seeks to achieve that.

The purpose of this paper is to propose the data envelopment analysis (DEA) model that can be used as binary-valued data. Often the basic DEA models were developed by assuming that all of the data are non-negative. However, there are situations where all data are binary. As an example, the information on many diseases in health care is binary data. The existence of binary data in traditional DEA models may change the behavior of the production possibility set (PPS). This study defines a binary summation operator, expresses the modified principles and introduces the extracted PPS of axioms. Furthermore, this study proposes a binary integer programming of DEA (BIP-DEA) for assessing the efficiency scores to use as an alternate tool in prediction.

In this study, the extracted PPS of modified axioms and the BIP-DEA model for assessing the efficiency score is proposed.

The binary integer model was proposed to eliminate the challenges of the binary-value data in DEA.

The importance of the proposed model for many fields including the health-care industry is that it can predict the occurrence or non-occurrence of the events, using binary data. This model has been applied to evaluate the most important risk factors for stroke disease and mechanical disorders. The targets set by this model can help to diagnose earlier the disease and increase the patients’ chances of recovery.