Smart Bio-Impedance-Based Sensor for Guiding Standard Needle Insertion

A venipuncture is the most common non-invasive medical procedure, and is frequently used with patients; however, a high probability of post-injection complications accompanies intravenous injection. The most common complication is a hematoma, which is associated with puncture of the uppermost and lowermost walls. To simplify and reduce complications of the venipuncture procedure, and as well as automation of this process, a device that can provide information of the needle tip position into patient’s tissues needs to be developed. This paper presents a peripheral vascular puncture control system based on electrical impedance measurements. A special electrode system was designed to achieve the maximum sensitivity for puncture identification using a traditional needle, which is usually used in clinical practice. An experimental study on subjects showed that the electrical impedance signal changed significantly once the standard needle entered the blood vessel. On basis of theoretical and experimental studies, a decision rule of puncture identification based on the analysis of amplitude-time parameters of experimental signals was proposed. The proposed method was tested on 15 test and 9 control samples, with the results showing that 97% accuracy was obtained.

Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play

Background: Phlebotomy is a medical procedure that is performed frequently in the blood collection activities of medical institutions. The procedure involves close interaction with different types of patients—some of whom are cooperative and others, who, for many reasons, are not (for example, patients who have a fear of needles). Blood extraction is an essential skill in several medical specialties, such as in laboratory sciences. Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy. In this paper, I propose a lesson plan for teaching communication skills to medical laboratory sciences and nursing students based on Gagne’s instructional design. Methods: The training session included two main parts: training session using Gange’s instructional design and at the end of the session, the participants were surveyed for the effectiveness of the training session. Results: 17 participants were included in the study. Overall, the majority of the participants were highly satisfied with the effectiveness of the training session in teaching communication skills with all seven survey questions receiving a mean score of 4.58 on a Likert scale of 1-5. Conclusion: We demonstrated the effectiveness of Gange’s instructional beyond theoretical lesson planning to teach communication skills through role-play in phlebotomy education.

Artificial Intelligence-Based Solution in Personalized Computer-Aided Arthroscopy of Shoulder Prostheses

Background: Early recognition of prostheses before reoperation can reduce perioperative morbidity and mortality. Because of the intricacy of the shoulder biomechanics, accurate classification of implant models before surgery is fundamental for planning the correct medical procedure and setting apparatus for personalized medicine. Expert surgeons usually use X-ray images of prostheses to set the patient-specific apparatus. However, this subjective method is time-consuming and prone to errors. Method: As an alternative, artificial intelligence has played a vital role in orthopedic surgery and clinical decision-making for accurate prosthesis placement. In this study, three different deep learning-based frameworks are proposed to identify different types of shoulder implants in X-ray scans. We mainly propose an efficient ensemble network called the Inception Mobile Fully-Connected Convolutional Network (IMFC-Net), which is comprised of our two designed convolutional neural networks and a classifier. To evaluate the performance of the IMFC-Net and state-of-the-art models, experiments were performed with a public data set of 597 de-identified patients (597 shoulder implants). Moreover, to demonstrate the generalizability of IMFC-Net, experiments were performed with two augmentation techniques and without augmentation, in which our model ranked first, with a considerable difference from the comparison models. A gradient-weighted class activation map technique was also used to find distinct implant characteristics needed for IMFC-Net classification decisions. Results: The results confirmed that the proposed IMFC-Net model yielded an average accuracy of 89.09%, a precision rate of 89.54%, a recall rate of 86.57%, and an F1.score of 87.94%, which were higher than those of the comparison models. Conclusion: The proposed model is efficient and can minimize the revision complexities of implants.

More often than not, we’re in sync: patient and caregiver well-being over time in stem cell transplantation

Background Hematopoietic stem cell transplantation (HSCT) is an aggressive medical procedure which significantly impacts the shared emotional well-being of patients and family caregivers (FC). Prior work has highlighted the significant overlap in well-being among patients and FCs; however, how this interdependence may change over the course of HSCT has received less attention. Methods We conducted secondary analyses of a supportive intervention delivered to 154 FCs of HSCT patients and examined relationships at baseline, 6 weeks, 3 and 6 months post-HSCT. Actor Partner Interdependence Modeling examined patient quality of life (QOL) and FC anxiety/depression. Results The data did not fit a multigroup approach limiting our ability to test intervention effects; however, bivariate analyses indicated FC depression significantly correlated to patient QOL at baseline (r = − .32), 6 weeks (r = − .22) and 6 months post-HSCT (r = − .34; p’s < .05); whereas FC anxiety was only correlated with patient QOL at the first two timepoints (p’s < .05). There was an unexpected, partner effect such that worse patient QOL at 6-weeks significantly related to lower FC depression at 3-months (B = .193; p = .026) and changed direction with patient QOL at 3-months being related to more FC depression at 6-months (B = − .187; p = .001). Conclusions These findings highlight the significant, yet nuanced, interdependence of patient QOL and FC well-being during HSCT. Specifically, greater interdependence was observed between patient QOL and FC depression compared to FC anxiety, suggesting potential treatment targets for patients and their families. Trial was registered at ClinicalTrials.gov Identifier: NCT02037568; first registered: January 16, 2014; https://clinicaltrials.gov/ct2/show/NCT02037568

The Completeness and Accuracy of Hepatoma Coding for Medical Procedure Based on ICD-9 CM at Public Hospital in Padang

Background: Hepatoma or hepatocellular carcinoma (KHS) is a primary malignant tumor of the liver originating from hepatocytes and the 3rd cause of death from cancer in the world. The history of a hepatoma patient can be seen based on the patient's medical record. The filling of medical record is done by doctors, nurses and medical record personel. However, in medical record filling, incompleteness is often found and cause inaccurate information. Accuracy coding important for financial of hospital.Methods: Type of research is quantitative descriptive, which is to determine the completeness and accuracy of the medical records for hepatoma cases and procedure code using criteria for document quantitative analysis in a public hospital, Padang. The study design used a retrospective analytical approach. The variables in the study were completeness of discharge summary and accuracy of hepatoma procedure based on ICD-9 CM. The population in this study were inpatient medical record documents for Hepatoma cases at a public hospital, Padang from June to August 2019, which were 45 medical record documents (discharge summary form) of hepatoma inpatients.Results: From 45 hepatoma patient medical record documents, filling of item name, medical record number, date of admission, indication of the patient being treated, history, physical examination, diagnostic examination, procedures, medications given, medicines used at home, PPBS doctor's signature, DPJP doctor's hand is complete 100% . Highest incompleteness of filling was found at code ICD (47%) and address item (43%). From 45 discharge summary , accuracy procedure code at hepatome case shows 100 % accurate in ultrasonoggrafi abdomen and ultrasonografi thorax. While that EKG 98% accurate and 95 % rontgen thorax.Conclusions: In general, item data of discahrege summary for hepatoma medical record are completenes; highest incompleteness of filling was found at code ICD (47%) and address item (43%); Accuracy of code procedure more than 90% in each code procedure.

The Outcomes of Patients with Mental Ilness Undergoing Surgical Procedures

Mental illness influences 3 % of the population and incorporates handicapping despondency and uneasiness, just as maniacal issues, such as bipolar and Schizophrenia. Patients with Schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the critical factor in reducing their potential mortality afterward. Patients with SMI were substantially less liable to have a significant medical procedure in the wake of controlling for age, other segment measures, and illness trouble. Patients of a similar age, sex, race, and comorbidity status having a previous genuine psychological instability passed on a significantly diminished probability of careful mediation. Clinical and careful hospitalizations for people with Schizophrenia had in some measure double the chances of a few kinds of unfriendly occasions than those for people without Schizophrenia. During the emergency clinic confirmation, these antagonistic occasions were related to poor clinical and financial results. Endeavors to decrease these unfriendly occasions should turn into an examination need.

Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study

The aim of this study was to analyse medical management in geriatric patients in the Hospital Emergency Departments in the Biała Podlaska County and Chełm County (Poland) between 2016 and 2018 in a group of patients ≥65 years of age. We analysed medical records of 829 patients transported to Hospital Emergency Departments by Medical Emergency Teams. The research was conducted in the period from June 2019 to March 2020. We analysed emergency medical procedure forms and medical records of patients transported to the hospitals. Cardiovascular diseases were diagnosed in 40% of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the Hospital Emergency Departments in more than 2/3 of cases. The concordance between the diagnoses made by the Medical Emergency Teams and those made at the Hospital Emergency Departments was confirmed for 78% patients admitted to the department (n = 647), whereas the concordance of classification at the group level was estimated at 71.7% (n = 594). Further in-patient treatment was initiated in some of the patients admitted to the department (n = 385). The mean time of hospital stay was 10.1 days. In conclusion, differences between the initial diagnosis made by the heads of the Medical Emergency Teams and the diagnosis made by the doctor on duty in the Hospital Emergency Departments depended on the chapter of diseases in the ICD-10 classification, but they were acceptable. The majority of the patients were transported to Hospital Emergency Departments. The most common groups of diseases that require Hospital Emergency Departments admission include cardiovascular diseases, injuries due to external causes, and respiratory diseases. A moderate percentage of patients were qualified for further specialist treatment in hospital departments.

Rheumatoid Arthritis Diagnosis: Deep Learning vs. Humane

Rheumatoid arthritis (RA) is a systemic autoimmune disease that preferably affects small joints. As the well-timed diagnosis of the disease is essential for the treatment of the patient, several works have been conducted in the field of deep learning to develop fast and accurate automatic methods for RA diagnosis. These works mainly focus on medical images as they use X-ray and ultrasound images as input for their models. In this study, we review the conducted works and compare the methods that use deep learning with the procedure that is commonly followed by a medical doctor for the RA diagnosis. The results show that 93% of the works use only image modalities as input for the models as distinct from the medical procedure where more patient medical data are taken into account. Moreover, only 15% of the works use direct explainability methods, meaning that the efforts for solving the trustworthiness issue of deep learning models were limited. In this context, this work reveals the gap between the deep learning approaches and the medical doctors’ practices traditionally applied and brings to light the weaknesses of the current deep learning technology to be integrated into a trustworthy context inside the existed medical infrastructures.

Coercing to sterilization: classification of species

The article provides a concept of coerced sterilization and structuring of its varieties. The problems and the status of protecting the realization of reproductive rights both at national and international levels have been studied. This research is based on the analysis of the experience and legislation of such countries as Ukraine, Central America and Africa countries, USA, Germany, China, Uzbekistan, Tunisia, Singapore, India, Czech Republic, Japan, Armenia, Azerbaijan, Kyrgyzstan, Kazakhstan, Moldova and others, illustrating the coercion of persons to surgical sterilization. The UN, WHO and other international and governmental organizations' international legal acts, laws, decisions of the European Court of Human Rights (ECHR) have been studied. The authors have used statistics from international organizations, expert opinions, doctrinal ideas and views on this issue. First, it is proved that this type of sterilization occurs under the pressure of psychological, political, material circumstances. Many states either contribute financially to this phenomenon or establish discriminatory rules against those who do not wish to undergo this medical procedure. Then the classification of this type of sterilization is given: convicted persons, transgender people, HIV-infected persons and representatives of the poorest layers of the population in overpopulated regions are subject to coerced sterilization. The existence of this problem is also due to insufficient legal regulation, gaps in solving the problem of the responsibility for bribery or mental coercion to sterilization, which leads to profanity, so we can overcome obstacles to human reproductive rights only by eliminating or reducing the negative impact of these factors. On the basis of the conducted research it is offered the ways on improving the prevention and punishment of cases of forcing individuals to renounce the right to reproduce one's kind.