Medical Prognosis of Infectious Diseases in Nursing Homes by Applying Machine Learning on Clinical Data Collected in Cloud Microservices

Background: treating infectious diseases in elderly individuals is difficult; patient referral to emergency services often occurs, since the elderly tend to arrive at consultations with advanced, serious symptoms. Aim: it was hypothesized that anticipating an infectious disease diagnosis by a few days could significantly improve a patient’s well-being and reduce the burden on emergency health system services. Methods: vital signs from residents were taken daily and transferred to a database in the cloud. Classifiers were used to recognize patterns in the spatial domain process of the collected data. Doctors reported their diagnoses when any disease presented. A flexible microservice architecture provided access and functionality to the system. Results: combining two different domains, health and technology, is not easy, but the results are encouraging. The classifiers reported good results; the system has been well accepted by medical personnel and is proving to be cost-effective and a good solution to service disadvantaged areas. In this context, this research found the importance of certain clinical variables in the identification of infectious diseases. Conclusions: this work explores how to apply mobile communications, cloud services, and machine learning technology, in order to provide efficient tools for medical staff in nursing homes. The scalable architecture can be extended to big data applications that may extract valuable knowledge patterns for medical research.

Telemonitoring with Electronic Devices in Patients with a Single Ventricle Anatomy

Background A growing number of patients with a single ventricle anatomy, who had a Fontan palliation as a child, are now reaching adulthood. Many need an epimyocardial pacemaker system with an optional telemonitoring (TM) unit, which evaluates the collected data and sends it via Internet to the patient's physician. There are no data on the reliability and clinical relevance of these systems in this patient group. Methods We analyzed data in 48 consecutive patients (mean age 18 years, standard deviation 9 years) with a Fontan or Fontan-like palliation who received a cardiac implantable electronic device with a TM unit from Biotronik (Home Monitoring) or Medtronic (CareLink) between 2005 and 2020 with regard to the reliability and clinical relevance of the downloaded data. Results The observation period was from 4 months to 14 years (mean 7 years, standard deviation 3.9 years). A total of 2.9 event messages (EMs)/patient/month and 1.3 intracardiac electrogram recordings/patient/month were received. Two patients died during follow-up. The combination of regularly arriving statistical data and 313 clinically relevant EMs led to the modification of antiarrhythmic or diuretic medication, hospitalization with cardioversion or ablation, and cortisone therapy to avoid exit block in 21 (44%) patients. Conclusion TM is an instrument to receive functional and physiologic parameters of our Fontan patients. It provides the ability to respond early for signs of system failure, or arrhythmia, even if the patient is not experiencing any problems. It is a useful tool to manage this difficult patient population without frequent hospital visits.

Pelvic congestion syndrome: historical aspects and a modern view on the problem (a literature review)

Pelvic congestion syndrome is a relatively recent, but actual and separate nosological form. Pelvic varicocele is a form of varicose disease, which is increasingly regarded as the main cause of chronic pelvic pain in women with various clinical manifestations. A woman with chronic pelvic pain is a difficult patient with combative behavior, who contacts with physicians in various specialties. There are many causes of chronic pelvic pain, but pelvic congestion syndrome has a special place. In recent years, in addition to widespread use of diagnostic radiology, the relevance of this pathology is beyond any doubt. The aim of the study was to summarize and present literature data on the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of pelvic congestion syndrome by analyzing the literature data. Materials and methods. A non-systematic review was conducted using PubMed, Web of Science, Google and Google Scholar databases. The review included free full-text articles published between 1974 and 2021 using key words: pelvic congestion syndrome, pelvic varices, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, chronic pelvic pain, gonadal veins, ovarian veins, vena ovarica, Nutcracker syndrome, May–Thurner syndrome. Conclusions. Pelvic congestion syndrome is still a rarely diagnosed pathology in patients with chronic pelvic pain. Detailed medical history, physical examination as well as maintaining diagnostic algorithm would allow the disease to be diagnosed correctly and timely. The choice of method for surgical intervention is a key point in the treatment of patients with pelvic congestion syndrome, but today there are no criteria for the choice of one, so the problem is far from being resolved and requires further study and research.

Stress in Anesthesiologists: A Review

Anaesthesia has emerged as one of the most stressful branches owing to the work it involves like emergency, critical care and other difficult patient situations. This occupational stress leads to the development of burnout syndrome among the anesthesiologists. This is characterized by emotional exhaustion, depersonalization and lack of personal accomplishments resulting in medical errors and deterioration of performance. A vast amount of literature is available listing the various causes of this syndrome. Appropriate stress managing strategies are advocated to reduce the stress sources. Keywords: Stress, Anesthesiologists, Anaesthesia

Evaluating communication with parents in paediatric patient encounters: a systematic review protocol

IntroductionBreaking bad news and dealing with difficult patient encounters is a skill that medical residents must learn during their curriculum. Many different tools are available to measure communication quality, but their development and validation processes are often missing. In this paper, we present the protocol of a systematic review aiming to identify the validated tools for measuring communication skills or communication effectiveness with parents in a paediatrics setting in general, including for difficult patient encounters.Methods and analysisWe will conduct our systematic review in accordance with the methodology suggested by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and will report this paper following the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses. We will include the studies in which authors developed and/or validated tools for assessing the quality of communication with families by residents and/or physicians during patient encounters in paediatric settings. Studies assessing communication in telemedicine and studies that use the tool to measure a different outcome than its validation will be excluded. Our search strategy will be developed by a scientific librarian and validated using the Peer Review of Electronic Search Strategy (PRESS) tool. Two reviewers will independently screen the studies for selection, extract data of the ones included and assess their level of risk of bias using the COSMIN Risk of Bias checklist. We will perform a narrative synthesis on the study selection process, the characteristics of studies and study population, the characteristics of tools identified, their process of development and/or validation and their psychometric properties. If sufficient data are available, we will do quantitative analyses for each psychometric property.Ethics and disseminationApproval from an ethics committee is not required, as there is no primary data collection. Our findings will be disseminated through a peer-reviewed publication and at local, national and international conferences.PROSPERO registration numberCRD42020151642.

Assessing patient information and decision-support needs in problematic alcohol use and co-occurring depression to inform shared decision-making interventions

The authors assessed the informational and decision-support needs of patients, families, and clinicians when deciding on treatment for problematic alcohol use and depression. Patients (n = 56), family members (n = 16), and clinicians (n = 65) with experience deciding on treatment for problematic alcohol use and depression were eligible. Participants completed an online decisional needs assessment survey. Stakeholder groups identified numerous difficult patient-level treatment decisions and elevated decisional conflict. Participants preferred patient-led or shared treatment decision-making (75%-95.4%). Patients (32.6%) reported not being as involved in treatment decision-making as preferred, a higher proportion than reported by clinicians (16.4%; p = .056). More patients (19.6%) than clinicians (3.6%) reported clinician-led treatment decision-making, with little or no patient involvement (p = .022). Stakeholder preferences for future decision-support resources included online information for use outside consultations.

Readability Assessment of Oculoplastic Surgery Patient Education Materials

Our study found that the majority of websites analyzed contained patient education material that was at a reading level much higher than recommended for the general public. Difficult patient education material can lead to misinterpretation of health information which can negatively affect patient care. We suggest a multifaceted approach in order to ensure patients are able to comprehend complex medical information and feel comfortable making decisions about treatment options