AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a tota...AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.展开更多
Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a succ...Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.展开更多
Background: Home deliveries is still high globally at 42% WHO 2022, due to high home deliveries, maternal death is also high at 43% globally. In sub-Sahara region home deliveries still high. Giving birth at health fac...Background: Home deliveries is still high globally at 42% WHO 2022, due to high home deliveries, maternal death is also high at 43% globally. In sub-Sahara region home deliveries still high. Giving birth at health facilities in most of sub-Saharan African countries Zambia inclusive is still a challenge whereby more than 51% of first-time mothers give birth at home and this gives a risk of high maternal and perinatal deaths. Therefore Reducing number of home deliveries is important to improve maternal and perinatal health issues. In this study, the aim was to investigate the determinants of home deliveries by pregnant mothers in the Luumbo zone of Gwembe district, Zambia. Purpose: Access to skilled care and facilities with capacity to provide emergency and newborn care is critical to reduce maternal death. In Zambia 42% of women still deliveries from home, suggesting a persistent challenge for women to seek, reach, and receive quality maternity care. This study aimed investigate the determinants of home deliveries by pregnant mothers in Luumbo zone of Gwembe district, Zambia. Methods: The study was conducted among postnatal mothers who came for postnatal care at 6 weeks in Luumbo Chabbobboma clinic in Gwembe district southern province of Zambia. This was a descriptive cross-sectional study where a Simple random sampling technique was used to select 105 women of childbearing age who attended postnatal and had a recent delivery. Data were collected using a researcher-administered structured questionnaire to identify determinants of home deliveries in Luumbo Chabbobboma zone. Data analysis was done using SPSS computer software version 27.0. Both descriptive and inferential (chi-square test) analyses were performed and statistical significance was taken at α ≤ 0.05. Results: The results show that 46 (43.8%) respondents were in the age bracket 20 - 29 years. Of the 105 respondents included in the study, 24 (22.9%) of them delivered from home. The results show that high maternal age (p = 0.03), occupation (p = 0.024), distance to the facility (p = 0.014), means of transportation (p = 0.023), multiparity (p = 0.01), timing and number of ANC visits (p Conclusion: From this population. The major reason why women still deliver at home was long distance to the nearest facility. To reduce maternal and perinatal mortality access to health facilities by pregnant women needs to be improved. There should also be active engagement of the traditional and religious institutions in the area.展开更多
Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods...Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods:This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals.The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.Results:Based on the emerging themes from the qualitative data,the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits,encompassing a diverse patient population with various healthcare needs.However,it faces challenges such as the lack of outcome monitoring,formal training,and workforce constraints.Despite these hurdles,there is a pressing need for the expansion of this service to better serve the community,and collaboration with community pharmacists holds potential to broaden its scope.Ultimately,the findings suggest that pharmacist-led HMR is both warranted and feasible within the Malaysian healthcare context.In order to optimize medicine-use among older people living in the community,approaches for expanding geriatric HMR services in Malaysia must be developed.Conclusions:This study holds profound implications as it attempts to illuminate policy makers in developing countries,enabling them to formulate effective HMR plans.By considering the challenges highlighted within this research,policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.展开更多
BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study pre...BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.展开更多
The concept of smart houses has grown in prominence in recent years.Major challenges linked to smart homes are identification theft,data safety,automated decision-making for IoT-based devices,and the security of the d...The concept of smart houses has grown in prominence in recent years.Major challenges linked to smart homes are identification theft,data safety,automated decision-making for IoT-based devices,and the security of the device itself.Current home automation systems try to address these issues but there is still an urgent need for a dependable and secure smart home solution that includes automatic decision-making systems and methodical features.This paper proposes a smart home system based on ensemble learning of random forest(RF)and convolutional neural networks(CNN)for programmed decision-making tasks,such as categorizing gadgets as“OFF”or“ON”based on their normal routine in homes.We have integrated emerging blockchain technology to provide secure,decentralized,and trustworthy authentication and recognition of IoT devices.Our system consists of a 5V relay circuit,various sensors,and a Raspberry Pi server and database for managing devices.We have also developed an Android app that communicates with the server interface through an HTTP web interface and an Apache server.The feasibility and efficacy of the proposed smart home automation system have been evaluated in both laboratory and real-time settings.It is essential to use inexpensive,scalable,and readily available components and technologies in smart home automation systems.Additionally,we must incorporate a comprehensive security and privacy-centric design that emphasizes risk assessments,such as cyberattacks,hardware security,and other cyber threats.The trial results support the proposed system and demonstrate its potential for use in everyday life.展开更多
Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest f...Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest from scientists and practitioners, though it is recognized as one of the weakest points of EIA systems globally. Also, EIA follow-up is influenced by the context, mainly in terms of the types of projects or activities and their related impacts on the environment. Therefore, the present paper is focused on the investigation of the follow-up stage applied to the activity of seismic survey coupled with offshore oil & gas exploitation in Brazil. Research was based on a qualitative approach that included document analysis and semi-structured interviews with analysts involved in EIA processes, and sought to generate evidence of effectiveness of the EIA follow-up as conducted by the Federal Environment Agency (Ibama) in order to situate the practice of follow-up in the broader context of international best practice principles. Based on the findings, it was concluded that, due to the peculiarities of offshore seismic survey, it is necessary to promote adaptations in the procedures for monitoring impacts in order to ensure proper alignment with the principles and conceptual foundations that guide EIA practice. Specifically, the timing of the execution of the activity imposes challenges for its integration into the “conventional” cycle that has guided the monitoring of the impacts in the EIA of projects.展开更多
The rise in online home delivery services(OHDS)has had a significant impact on how urban services are supplied and used in recent years.Studies on the spatial accessibility of OHDS are emerging,but few is known about ...The rise in online home delivery services(OHDS)has had a significant impact on how urban services are supplied and used in recent years.Studies on the spatial accessibility of OHDS are emerging,but few is known about the temporal dimension of OHDS accessibility as well as the geographic and socioeconomic differences in the spatiotemporal accessibility of OHDS.This study measures the spatiotemporal accessibility of four types of OHDS,namely leisure,fresh and convenient,medical,and catering services.The geographic and socioeconomic disparities in the spatiotemporal accessibility of these four types of OHDS are then identified using spatial statistical methods and the Kruskal-Wallis test(K-W test).The case study in Nanjing,China,suggests that:1)spatiotemporal accessibility better reflects the temporal variation of OHDS accessibility and avoids overestimation of OHDS accessibility when only considering its spatial dimension.2)The spatiotemporal accessibility of OHDS varies geographically and socioeconomically.Neighborhoods located in the main city or neighborhoods with higher housing prices,higher population density,and higher point of interest(POI)mix have better OHDS spatiotemporal accessibility.Our study contributes to the understanding of OHDS accessibility from a spatiotemporal perspective,and the empirical insights can assist policymakers in creating intervention plans that take into account variations in OHDS spatiotemporal accessibility.展开更多
Neuroarchitecture is a set of characteristics grouped into principles that seek to generate a certain behavior when applied.These principles will vary according to the type of user for whom the design is intended.In t...Neuroarchitecture is a set of characteristics grouped into principles that seek to generate a certain behavior when applied.These principles will vary according to the type of user for whom the design is intended.In this research,these neuroarchitectural principles are identified in the nursing home Mis Abuelitos in Cochachinche,Huánuco.The home was designed and built with notions of nature and the Andean while emphasizing the occupants are the elderly.With this purpose,qualitative research was carried out using two sequential criteria,the first was to identify what these principles are and the second was to recognize the principles within the area.The principles that are assertively used for the elderly occupants were selected.The study observation was performed with observation and photographic sheets and was analyzed with ATLAS.ti processing software.It was obtained that the three neuroarchitectural principles are present in the nursing home which are 67%of the recommended characteristics for the elderly.展开更多
Objective:To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.Methods:This study was qualitative research with a phenomenological design.Data were collected and recorded...Objective:To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.Methods:This study was qualitative research with a phenomenological design.Data were collected and recorded through in-depth interviews with 6 nurses working in MuşState Hospital,Home Healthcare Services Unit using a form consisting of 12 questions on an online platform between May 2021 and July 2021.The audio recordings were transcribed by the researcher and content analysis was performed by creating codes,categories,and themes.Results:The interviews yielded 10 categories and 59 sub-codes.These codes were addressed under the theme of"COVID-19 pandemic".Under this main theme,nurses expressed the problems they experienced in issues such as stress,support mechanisms,and family and social problems during COVID-19.They mentioned that they experienced high stress in this process,as well as social isolation and negative thoughts of society about them and that they could not spare time for themselves and their families.Conclusions:Nurses working in home healthcare services frequently express negativities such as high stress,isolation from society,and increased workload.Therefore,actions should be taken to raise awareness of society on these issues,increase the number of personnel,conduct more research,and share the results with the public.展开更多
BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies f...BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.展开更多
We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their be...We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.展开更多
Objective:Bacillus Calmette-Gue´rin(BCG)instillation is the standard adjuvant treatment for intermediate-and high-risk non-muscle-invasive bladder cancer after transurethral resection.Nevertheless,its toxicity of...Objective:Bacillus Calmette-Gue´rin(BCG)instillation is the standard adjuvant treatment for intermediate-and high-risk non-muscle-invasive bladder cancer after transurethral resection.Nevertheless,its toxicity often causes bladder complications.On follow-up cystoscopy,post-BCG bladder lesions can be pathologically benign,urothelial carcinoma recurrence,or other types of bladder malignancy.Only a small number of case reports have been published on post-BCG bladder lesions.Their clinical features,natural course,and management remain unknown.Methods:We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center.During a long-term follow-up,we took biopsies on tumor-like lesions and described their changes.In addition,we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review.Results:We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years.Those lesions could last,grow,or disappear spontaneously,and remain pathological benign for years.In systematic review,we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information.Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type.Conclusion:Based on previous studies and our experience,benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone,even under narrow band imaging mode.Nonetheless,given most of them have a good prognosis,random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.展开更多
The development and use of Internet of Things(IoT)devices have grown significantly in recent years.Advanced IoT device characteristics are mainly to blame for the wide range of applications that may now be achieved wi...The development and use of Internet of Things(IoT)devices have grown significantly in recent years.Advanced IoT device characteristics are mainly to blame for the wide range of applications that may now be achieved with IoT devices.Corporations have begun to embrace the IoT concept.Identifying true and suitable devices,security faults that might be used for bad reasons,and administration of such devices are only a few of the issues that IoT,a new concept in technological progress,provides.In some ways,IoT device traffic differs from regular device traffic.Devices with particular features can be classified into categories,irrespective of their function or performance.Ever-changing and complex environments,like a smart home,demand this classification scheme.A total of 41 IoT devices were employed in this investigation.To build a multiclass classification model,IoT devices contributed 13 network traffic parameters.To further preprocess the raw data received,preprocessing techniques like Normalization and Dataset Scaling were utilized.Feature engineering techniques can extract features from the text data.A total of 117,423 feature vectors are contained in the dataset after stratification,which are used to further improve the classification model.In this study,a variety of performance indicators were employed to show the performance of the logiboosted algorithms.Logi-XGB scored 80.2%accuracy following application of the logit-boosted algorithms to the dataset for classification,whereas Logi-GBC achieved 77.8%accuracy.Meanwhile,Logi-ABC attained 80.7%accuracy.Logi-CBC,on the other hand,received the highest Accuracy score of 85.6%.The accuracy of Logi-LGBM and Logi-HGBC was the same at 81.37%each.Our suggested Logi-CBC showed the highest accuracy on the dataset when compared to existing Logit-Boosted Algorithms used in earlier studies.展开更多
Energy is essential to practically all exercises and is imperative for the development of personal satisfaction.So,valuable energy has been in great demand for many years,especially for using smart homes and structure...Energy is essential to practically all exercises and is imperative for the development of personal satisfaction.So,valuable energy has been in great demand for many years,especially for using smart homes and structures,as individuals quickly improve their way of life depending on current innovations.However,there is a shortage of energy,as the energy required is higher than that produced.Many new plans are being designed to meet the consumer’s energy requirements.In many regions,energy utilization in the housing area is 30%–40%.The growth of smart homes has raised the requirement for intelligence in applications such as asset management,energy-efficient automation,security,and healthcare monitoring to learn about residents’actions and forecast their future demands.To overcome the challenges of energy consumption optimization,in this study,we apply an energy management technique.Data fusion has recently attracted much energy efficiency in buildings,where numerous types of information are processed.The proposed research developed a data fusion model to predict energy consumption for accuracy and miss rate.The results of the proposed approach are compared with those of the previously published techniques and found that the prediction accuracy of the proposed method is 92%,which is higher than the previously published approaches.展开更多
Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden ...Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old;69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.展开更多
Smart home devices are vulnerable to a variety of attacks.The matter gets more complicated when a number of devices collaborate to launch a colluding attack(e.g.,Distributed-Denial-of-Service(DDoS))in a network(e.g.,S...Smart home devices are vulnerable to a variety of attacks.The matter gets more complicated when a number of devices collaborate to launch a colluding attack(e.g.,Distributed-Denial-of-Service(DDoS))in a network(e.g.,Smart home).To handle these attacks,most studies have hitherto proposed authentication protocols that cannot necessarily be implemented in devices,especially during Device-to-Device(D2D)interactions.Tapping into the potential of Ethereum blockchain and smart contracts,this work proposes a lightweight authentication mechanism that enables safe D2D interactions in a smart home.The Ethereum blockchain enables the implementation of a decentralized prototype as well as a peer-to-peer distributed ledger system.The work also uses a single server queuing system model and the authentication mechanism to curtail DDoS attacks by controlling the number of service requests in the system.The simulation was conducted twenty times,each with varying number of devices chosen at random(ranging from 1 to 30).Each requester device sends an arbitrary request with a unique resource requirement at a time.This is done to measure the system's consistency across a variety of device capabilities.The experimental results show that the proposed protocol not only prevents colluding attacks,but also outperforms the benchmark protocols in terms of computational cost,message processing,and response times.展开更多
Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up...Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.展开更多
基金Supported by the Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.YNZD2201903)the Scientific Research Foundation of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.KYQD20180306)the Nursing Project of the Eye Hospital of Wenzhou Medical University(No.YNHL2201908).
文摘AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
文摘Background:Much has been written about the loss to follow-up in the transition between pediatric and adult Congenital Heart Disease(CHD)care centers.Much less is understood about the loss to follow-up(LTF)after a successful transition.This is critical too,as patients lost to specialised care are more likely to experience mor-bidity and premature mortality.Aims:To understand the prevalence and reasons for loss to follow-up(LTF)at a large Australian Adult Congenital Heart Disease(ACHD)centre.Methods:Patients with moderate or highly complex CHD and gaps in care of>3 years(defined as LTF)were identified from a comprehensive ACHD data-base.Structured telephone interviews examined current care and barriers to clinic attendance.Results:Overall,407(22%)of ACHD patients(n=1842)were LTF.The mean age at LTF was 31(SD 11.5)years and 54%were male;311(76%)were uncontactable.Compared to adults seen regularly,lost patients were younger,with a greater socio-economic disadvantage,and had less complex CHD(p<0.05 for all).We interviewed 59 patients(14%).The top 3 responses for care absences were“feeling well”(61%),losing track of time(36%),and not needing fol-low-up care(25%).Conclusions:A large proportion of the ACHD population becomes lost to specialised cardiac care,even after a successful transition.This Australian study reports younger age,moderate complexity defects,and socio-economic disadvantage as predictive of loss to follow-up.This study highlights the need for novel approaches to patient-centered service delivery even beyond the age of transition and resources to maintain patient engagement within the ACHD service.
文摘Background: Home deliveries is still high globally at 42% WHO 2022, due to high home deliveries, maternal death is also high at 43% globally. In sub-Sahara region home deliveries still high. Giving birth at health facilities in most of sub-Saharan African countries Zambia inclusive is still a challenge whereby more than 51% of first-time mothers give birth at home and this gives a risk of high maternal and perinatal deaths. Therefore Reducing number of home deliveries is important to improve maternal and perinatal health issues. In this study, the aim was to investigate the determinants of home deliveries by pregnant mothers in the Luumbo zone of Gwembe district, Zambia. Purpose: Access to skilled care and facilities with capacity to provide emergency and newborn care is critical to reduce maternal death. In Zambia 42% of women still deliveries from home, suggesting a persistent challenge for women to seek, reach, and receive quality maternity care. This study aimed investigate the determinants of home deliveries by pregnant mothers in Luumbo zone of Gwembe district, Zambia. Methods: The study was conducted among postnatal mothers who came for postnatal care at 6 weeks in Luumbo Chabbobboma clinic in Gwembe district southern province of Zambia. This was a descriptive cross-sectional study where a Simple random sampling technique was used to select 105 women of childbearing age who attended postnatal and had a recent delivery. Data were collected using a researcher-administered structured questionnaire to identify determinants of home deliveries in Luumbo Chabbobboma zone. Data analysis was done using SPSS computer software version 27.0. Both descriptive and inferential (chi-square test) analyses were performed and statistical significance was taken at α ≤ 0.05. Results: The results show that 46 (43.8%) respondents were in the age bracket 20 - 29 years. Of the 105 respondents included in the study, 24 (22.9%) of them delivered from home. The results show that high maternal age (p = 0.03), occupation (p = 0.024), distance to the facility (p = 0.014), means of transportation (p = 0.023), multiparity (p = 0.01), timing and number of ANC visits (p Conclusion: From this population. The major reason why women still deliver at home was long distance to the nearest facility. To reduce maternal and perinatal mortality access to health facilities by pregnant women needs to be improved. There should also be active engagement of the traditional and religious institutions in the area.
基金funded by the Taylor’s University Flagship Research Grant(TUFR/2017/002/03).
文摘Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods:This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals.The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.Results:Based on the emerging themes from the qualitative data,the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits,encompassing a diverse patient population with various healthcare needs.However,it faces challenges such as the lack of outcome monitoring,formal training,and workforce constraints.Despite these hurdles,there is a pressing need for the expansion of this service to better serve the community,and collaboration with community pharmacists holds potential to broaden its scope.Ultimately,the findings suggest that pharmacist-led HMR is both warranted and feasible within the Malaysian healthcare context.In order to optimize medicine-use among older people living in the community,approaches for expanding geriatric HMR services in Malaysia must be developed.Conclusions:This study holds profound implications as it attempts to illuminate policy makers in developing countries,enabling them to formulate effective HMR plans.By considering the challenges highlighted within this research,policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.
文摘BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.
基金funded by Princess Nourah bint Abdulrahman University Researchers Supporting Project Number(PNURSP2024R333)Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.
文摘The concept of smart houses has grown in prominence in recent years.Major challenges linked to smart homes are identification theft,data safety,automated decision-making for IoT-based devices,and the security of the device itself.Current home automation systems try to address these issues but there is still an urgent need for a dependable and secure smart home solution that includes automatic decision-making systems and methodical features.This paper proposes a smart home system based on ensemble learning of random forest(RF)and convolutional neural networks(CNN)for programmed decision-making tasks,such as categorizing gadgets as“OFF”or“ON”based on their normal routine in homes.We have integrated emerging blockchain technology to provide secure,decentralized,and trustworthy authentication and recognition of IoT devices.Our system consists of a 5V relay circuit,various sensors,and a Raspberry Pi server and database for managing devices.We have also developed an Android app that communicates with the server interface through an HTTP web interface and an Apache server.The feasibility and efficacy of the proposed smart home automation system have been evaluated in both laboratory and real-time settings.It is essential to use inexpensive,scalable,and readily available components and technologies in smart home automation systems.Additionally,we must incorporate a comprehensive security and privacy-centric design that emphasizes risk assessments,such as cyberattacks,hardware security,and other cyber threats.The trial results support the proposed system and demonstrate its potential for use in everyday life.
文摘Follow-up of environmental impacts is an integral part of the Environmental Impact Assessment (EIA) process, closely related to the effectiveness of the instrument. EIA follow-up has been receiving a lot of interest from scientists and practitioners, though it is recognized as one of the weakest points of EIA systems globally. Also, EIA follow-up is influenced by the context, mainly in terms of the types of projects or activities and their related impacts on the environment. Therefore, the present paper is focused on the investigation of the follow-up stage applied to the activity of seismic survey coupled with offshore oil & gas exploitation in Brazil. Research was based on a qualitative approach that included document analysis and semi-structured interviews with analysts involved in EIA processes, and sought to generate evidence of effectiveness of the EIA follow-up as conducted by the Federal Environment Agency (Ibama) in order to situate the practice of follow-up in the broader context of international best practice principles. Based on the findings, it was concluded that, due to the peculiarities of offshore seismic survey, it is necessary to promote adaptations in the procedures for monitoring impacts in order to ensure proper alignment with the principles and conceptual foundations that guide EIA practice. Specifically, the timing of the execution of the activity imposes challenges for its integration into the “conventional” cycle that has guided the monitoring of the impacts in the EIA of projects.
基金Under the auspices of National Natural Science Foundation of China (No.42330510)。
文摘The rise in online home delivery services(OHDS)has had a significant impact on how urban services are supplied and used in recent years.Studies on the spatial accessibility of OHDS are emerging,but few is known about the temporal dimension of OHDS accessibility as well as the geographic and socioeconomic differences in the spatiotemporal accessibility of OHDS.This study measures the spatiotemporal accessibility of four types of OHDS,namely leisure,fresh and convenient,medical,and catering services.The geographic and socioeconomic disparities in the spatiotemporal accessibility of these four types of OHDS are then identified using spatial statistical methods and the Kruskal-Wallis test(K-W test).The case study in Nanjing,China,suggests that:1)spatiotemporal accessibility better reflects the temporal variation of OHDS accessibility and avoids overestimation of OHDS accessibility when only considering its spatial dimension.2)The spatiotemporal accessibility of OHDS varies geographically and socioeconomically.Neighborhoods located in the main city or neighborhoods with higher housing prices,higher population density,and higher point of interest(POI)mix have better OHDS spatiotemporal accessibility.Our study contributes to the understanding of OHDS accessibility from a spatiotemporal perspective,and the empirical insights can assist policymakers in creating intervention plans that take into account variations in OHDS spatiotemporal accessibility.
文摘Neuroarchitecture is a set of characteristics grouped into principles that seek to generate a certain behavior when applied.These principles will vary according to the type of user for whom the design is intended.In this research,these neuroarchitectural principles are identified in the nursing home Mis Abuelitos in Cochachinche,Huánuco.The home was designed and built with notions of nature and the Andean while emphasizing the occupants are the elderly.With this purpose,qualitative research was carried out using two sequential criteria,the first was to identify what these principles are and the second was to recognize the principles within the area.The principles that are assertively used for the elderly occupants were selected.The study observation was performed with observation and photographic sheets and was analyzed with ATLAS.ti processing software.It was obtained that the three neuroarchitectural principles are present in the nursing home which are 67%of the recommended characteristics for the elderly.
文摘Objective:To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.Methods:This study was qualitative research with a phenomenological design.Data were collected and recorded through in-depth interviews with 6 nurses working in MuşState Hospital,Home Healthcare Services Unit using a form consisting of 12 questions on an online platform between May 2021 and July 2021.The audio recordings were transcribed by the researcher and content analysis was performed by creating codes,categories,and themes.Results:The interviews yielded 10 categories and 59 sub-codes.These codes were addressed under the theme of"COVID-19 pandemic".Under this main theme,nurses expressed the problems they experienced in issues such as stress,support mechanisms,and family and social problems during COVID-19.They mentioned that they experienced high stress in this process,as well as social isolation and negative thoughts of society about them and that they could not spare time for themselves and their families.Conclusions:Nurses working in home healthcare services frequently express negativities such as high stress,isolation from society,and increased workload.Therefore,actions should be taken to raise awareness of society on these issues,increase the number of personnel,conduct more research,and share the results with the public.
文摘BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.
文摘We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.
基金the National Natural Science Foundation of China(No.82172871)the Innovation Cultivation Fund of the Seventh Medical Center of People’s Liberation Army General Hospital(QZX-2023-17)the Youth Innovation Fund of People’s Liberation Army General Hospital(22QNFC095).
文摘Objective:Bacillus Calmette-Gue´rin(BCG)instillation is the standard adjuvant treatment for intermediate-and high-risk non-muscle-invasive bladder cancer after transurethral resection.Nevertheless,its toxicity often causes bladder complications.On follow-up cystoscopy,post-BCG bladder lesions can be pathologically benign,urothelial carcinoma recurrence,or other types of bladder malignancy.Only a small number of case reports have been published on post-BCG bladder lesions.Their clinical features,natural course,and management remain unknown.Methods:We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center.During a long-term follow-up,we took biopsies on tumor-like lesions and described their changes.In addition,we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review.Results:We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years.Those lesions could last,grow,or disappear spontaneously,and remain pathological benign for years.In systematic review,we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information.Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type.Conclusion:Based on previous studies and our experience,benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone,even under narrow band imaging mode.Nonetheless,given most of them have a good prognosis,random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.
文摘The development and use of Internet of Things(IoT)devices have grown significantly in recent years.Advanced IoT device characteristics are mainly to blame for the wide range of applications that may now be achieved with IoT devices.Corporations have begun to embrace the IoT concept.Identifying true and suitable devices,security faults that might be used for bad reasons,and administration of such devices are only a few of the issues that IoT,a new concept in technological progress,provides.In some ways,IoT device traffic differs from regular device traffic.Devices with particular features can be classified into categories,irrespective of their function or performance.Ever-changing and complex environments,like a smart home,demand this classification scheme.A total of 41 IoT devices were employed in this investigation.To build a multiclass classification model,IoT devices contributed 13 network traffic parameters.To further preprocess the raw data received,preprocessing techniques like Normalization and Dataset Scaling were utilized.Feature engineering techniques can extract features from the text data.A total of 117,423 feature vectors are contained in the dataset after stratification,which are used to further improve the classification model.In this study,a variety of performance indicators were employed to show the performance of the logiboosted algorithms.Logi-XGB scored 80.2%accuracy following application of the logit-boosted algorithms to the dataset for classification,whereas Logi-GBC achieved 77.8%accuracy.Meanwhile,Logi-ABC attained 80.7%accuracy.Logi-CBC,on the other hand,received the highest Accuracy score of 85.6%.The accuracy of Logi-LGBM and Logi-HGBC was the same at 81.37%each.Our suggested Logi-CBC showed the highest accuracy on the dataset when compared to existing Logit-Boosted Algorithms used in earlier studies.
文摘Energy is essential to practically all exercises and is imperative for the development of personal satisfaction.So,valuable energy has been in great demand for many years,especially for using smart homes and structures,as individuals quickly improve their way of life depending on current innovations.However,there is a shortage of energy,as the energy required is higher than that produced.Many new plans are being designed to meet the consumer’s energy requirements.In many regions,energy utilization in the housing area is 30%–40%.The growth of smart homes has raised the requirement for intelligence in applications such as asset management,energy-efficient automation,security,and healthcare monitoring to learn about residents’actions and forecast their future demands.To overcome the challenges of energy consumption optimization,in this study,we apply an energy management technique.Data fusion has recently attracted much energy efficiency in buildings,where numerous types of information are processed.The proposed research developed a data fusion model to predict energy consumption for accuracy and miss rate.The results of the proposed approach are compared with those of the previously published techniques and found that the prediction accuracy of the proposed method is 92%,which is higher than the previously published approaches.
文摘Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old;69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.
文摘Smart home devices are vulnerable to a variety of attacks.The matter gets more complicated when a number of devices collaborate to launch a colluding attack(e.g.,Distributed-Denial-of-Service(DDoS))in a network(e.g.,Smart home).To handle these attacks,most studies have hitherto proposed authentication protocols that cannot necessarily be implemented in devices,especially during Device-to-Device(D2D)interactions.Tapping into the potential of Ethereum blockchain and smart contracts,this work proposes a lightweight authentication mechanism that enables safe D2D interactions in a smart home.The Ethereum blockchain enables the implementation of a decentralized prototype as well as a peer-to-peer distributed ledger system.The work also uses a single server queuing system model and the authentication mechanism to curtail DDoS attacks by controlling the number of service requests in the system.The simulation was conducted twenty times,each with varying number of devices chosen at random(ranging from 1 to 30).Each requester device sends an arbitrary request with a unique resource requirement at a time.This is done to measure the system's consistency across a variety of device capabilities.The experimental results show that the proposed protocol not only prevents colluding attacks,but also outperforms the benchmark protocols in terms of computational cost,message processing,and response times.
基金supported by grants from the National Natural Science Foundation of China,grant no. 81370041, 81771233, 81671655the Outstanding Clinical Discipline Project of Shanghai Pudonggrant no.PWYgy2018-04.
文摘Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.