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The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

The role and methods of descriptive and analytical epidemiology in the investigation of outbreaks of foodborne disease are described. The relationship between epidemiological and microbiological investigation is addressed, and the need for a sensitive surveillance system to detect outbreaks is shown. Examples are drawn from recent cases or important outbreaks of salmonellosis in England.

The purpose of the paper is to analyze the ventricular tachycardia by soft computing. Ventricular tachycardia is a type of regular and fast heart rate which arises from improper electrical activity in the ventricles of the heart.

In this study, a soft computing approach was applied for the ventricular tachycardia detection. The soft computing was used to detect which factors are the most important for the ventricular tachycardia.

Three factors were used: brain natriuretic peptide, troponin I which is a part of the troponin complex and C-reactive protein which is an annular (ring-shaped), pentameric protein found in blood plasma.

It was found that troponin I has the most influence on the ventricular tachycardia prediction.

This study assesses the prevalence of accidental falls in Thailand's older adult population and the contingent influences surrounding this prevalence.

Data were drawn from the Cross-Sectional National Surveys of Older Persons in Thailand, pooling of four survey datasets which took place in 2007, 2011, 2014 and 2017. Stratified two-stage sampling was employed. Interviews were conducted with sample sizes of 11,370, 11,061, 13,775 and 12,457 senior citizens, aged 60 and above, in the respective survey years. Further investigation was conducted on subjects who reported to be of good health and without any disability, yet experienced accidental falls. The prevalence of accidental falls was examined, and variable aspects concerning fall risk were assessed with probability-weighted multiple logistic regression.

The average prevalence of accidental falls from the four surveys was 4.7%. Significant risk factors identified were advanced age, being female, living in a rural residence, having worked in the previous 7 days, lack of/excessive exercise, alcohol consumption, smoking and having an outdoor lavatory.

Accidental falls tend to increase among community-dwelling seniors aged 60 and above. Falls increase with age and are more common among the women in that demographic. Findings suggest the need for government and local agencies to consider tailoring some public health approaches to the prevention of accidental falls. This study also highlights the necessity of proper work environment maintenance to prevent these falls.

Purpose – Intravenous leiomyomatosis (IVL) is a very rare subtype of leiomyoma, involving the right obstruction of the heart, and is an unusual cause of outflow tract obstruction. The IVL grows from the vessel’s smooth muscle, protruding into the vessel’s lumen, and can expand to the right atrium and even beyond causing death due to blood flow obstruction into the right atrium and even to pulmonary artery.

Design/Methodology/Approach – We present a 33-year-old Indonesian woman with cardiopulmonary symptoms predominantly, and marked by an intravascular leiomyoma extending from inferior vena cava (IVC) to right chamber atrium, with the chief complaint being easily fatigued since seven months.

Findings – Echocardiography observations found a mass in the right atrium and the IVC that caused dynamics obstructed in tricuspid valve, right atrium and ventricle were dilated, no left ventricular (LV) hypertrophy, normal LV and right ventricular (RV) functions, and no valve abnormality except the tricuspid valve gradient being 21 mmHg with mild regurgitation. Venography resulted in a mobile tumor mass in IVC mouth which partially flew into the right atrium, and partially blocked the IVC mouth. Tumor size was 6.4 cm × 4.8 cm. Abdominal multislice computed tomography resulted in a residual soft tissue mass (leiomyoma) along the IVC extended to the right atrium. The tumor mass size in the IVC and the right atrium was bigger compared to tumor mass on July 2008. The correct diagnosis was established during surgery; therefore a two-stage resection was done.

Originality/Value – Surgical resection is the best treatment for intracardiac extension of intravenous leiomyoma. To remove the ilio-caval portion, iliac venotomy was recommended for the tumor in both stages of the surgeries.

The purpose of this paper is to develop a brief screening instrument to identify risk factors of factory workers experiencing mass fainting illness (MFI) due to work-environmental determinants.

A factory-based cross-sectional study was conducted among 740 workers in October 2017 and was completed with face-to-face interviews. Data analyses included univariate logistic regression, backward stepwise linear regression and multiple logistic regression. Sum scores on significant items and receiver operator characteristic curves were used to compute potential cut-off points and the sensitivity and specificity rates.

Significant work-environmental factors were identified as working at very high speeds, having less influence on the choice of working partners, perceived high temperature at work, having less opportunity to do their best at work, and concern about losing a job in the next six months. In developing a screening instrument, a 6.5 cut-off point that corresponded to 99.6 percent sensitivity and 92.2 percent specificity was identified.

The study concludes that this MFI-instrument could potentially be used to prevent MFI. By understanding the policy implications, the government body, employers, workers, development partners and stakeholders should work toward preventing MFI. Implementing a preventive measure is therefore warranted due to the health education impact.

The purpose of this paper is to recognize the vital reasons for including public and patient voices in health policy decision-making, but illustrates the challenge it creates for decision-makers who must consider whether those voices represent patient interests or corporate interests.

This paper takes the form of a narrative review.

The history of flibanserin, a controversial new drug to treat a debatable condition, illustrates how a public relations campaign could circumvent the well-established process to weigh evidence of potential harm vs benefit by one of the most robust drug regulators in the world.

It is both vital to recognize a fundamental problem that exists when corporate interests deceptively assume the mantle of “the patient voice” and then act to reduce that influence while supporting and building capacity in genuinely independent, consumer-focused activities.

This paper suggests that organizations interested in consumer protection and the safe and cost-effective use of health resources create policies and procedures that can foster genuine consumer involvement while recognizing the danger to patient safety and consumer interests when consumer involvement is hijacked by vested interests.

The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and early readmission).

A retrospective cohort study was conducted among patients discharged from three Swiss university hospitals with a primary or secondary International Classification of Diseases, 10th revision (ICD‐10) AMI code in 1999. A total of 1,129 patients' records were abstructed. Demographic characteristics and risk factors at admission were recorded. The main ECG and laboratory findings were further abstracted as well as hospital and discharge management and treatment. The main outcome measure was process quality indicators derived from evidence‐based guidelines, and hospital mortality and early readmissions.

After exclusions, 577 patients with AMI were eligible for this study. The mean (SD) age was 68.2 (13.9). In the assessment of quality indicators patients with potential contra‐indications were excluded. Among cohorts of “ideal candidates” for specific interventions, aspirin was not prescribed within 24 hours after admission in 33 (6.2 percent) patients. Among those, 17 (51.5 percent) died (p<0.0001). The adjusted OR for no aspirin after admission was 3.61 (95 percent CI 1.11‐11.77) for hospital mortality. Further, 78 (19.5 percent) patients did not receive β‐blockers at discharge. Among them nine (11.5 percent) were readmitted (p=0.133). The adjusted OR for no β‐blockers at discharge was 2.15 (95 percent CI 0.86‐5.41) for readmissions. Among patients with AMI, not prescribing aspirin within 24 hours after admission was associated with hospital mortality. However, process indicators derived from evidence‐based guidelines were not related to early readmission in this study.

The paper stresses the importance of clinicians confronting their decisions with recommendations of evidence‐based guidelines for the management and treatment of AMI patients.

This paper reviews and assesses the aim, substance, and impact of Simon Susen’s book, “The Postmodern Turn” in the Social Sciences.

The review follows the structure of Susen’s book, by description and by evaluation.

Susen’s book encompasses a very large volume of literature of the self-defined “postmodern,” then concludes that the covered material has contributed little that is new to the social sciences.

The review has not been previously published, does not replicate any prior assessment known to the author.