Transporting an Artificial Intelligence Model to Predict Emergency Cesarean Delivery: Overcoming Challenges Posed by Interfacility Variation

Research using artificial intelligence (AI) in medicine is expected to significantly influence the practice of medicine and the delivery of health care in the near future. However, for successful deployment, the results must be transported across health care facilities. We present a cross-facilities application of an AI model that predicts the need for an emergency caesarean during birth. The transported model showed benefit; however, there can be challenges associated with interfacility variation in reporting practices.

Evaluation of patients treated by telemedicine in the COVID-19 pandemic by a private clinic in Sao Paulo, Brazil: A non-randomized clinical trial preliminary study

Introduction: As a result of the coronavirus disease 2019 (COVID-19) pandemic the year 2020 brought major changes on the delivery of health care and face to face physician patient communication was significantly reduced and the practice of remote telehealth care using computer technology is assuming a standard of care particularly with COVID-19 patients with attempts to reduce viral spread. Objective: To describe the clinical practice experience using telemedicine towards COVID-19 and the respective clinical outcomes. Methods: We performed a pilot open-label non-randomized controlled clinical trial. The patients were divided into four groups according severity of symptoms: (1) asymptomatic (2) mild symptoms (3) moderate symptoms and (4) severe symptoms and were followed up for five days counted from the beginning of the symptoms. A drug intervention was performed in group 3 for which the protocol followed as suggested by the International Pulmonology Societys consensus for adults with moderate symptoms: first day (attack phase) hydroxychloroquine sulfate 400 mg 12/12h second to fifth day (maintenance phase) 200 mg (half pill) 12/12h. The medication was associated with azithromycin 500mg once a day for five days. For children with moderate symptoms were used: hydroxychloroquine sulfate 6.5 mg/kg/dose every 12 hours in the first day and 3.25 mg/kg/dose every 12 hours from day 2 to 5. The therapeutic response was telemonitored. Group 4 patients were directly oriented to seek hospital care. During the use of the drugs, the patients were telemonitored daily. Results: One hundred eighty-seven patients were seen with mean age of 37,6 years (about 15,6). The most frequent symptom was cough (57,6%) followed by malaise (60,3%) fever (41,1%) headache (56,0%) muscle pain (51,1%). Of all the patients that sought telemedicine service in our center 23% were asymptomatic despite contact with people with probable diagnostic of COVID-19 29,4% reported mild symptoms 43,9% moderate symptoms and 3,7% severe symptoms. It was possible to observe in patients treated their symptoms of COVID-19 (group 3) with hydroxychloroquine and azithromycin for five days presented statistically better improvement of the symptoms when compared to those that did not follow the protocol (p = 0.039). Three patients were hospitalized and discharged after recovery. Conclusions: Our study showed that patients with COVID-19 who had delivery of health care through telemedicine initiated in early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. Our results indicate that the use of telemedicine with diagnosis and drug treatment protocols is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the general population to infected patients in a pandemic situation.

Health System Fragmentation and the Syrian Conflict

This chapter takes the analysis of the politics of health care further by exploring the way in which Syrian health care fragmented during the civil war. It reviews how Syria’s health system has been devastated by a protracted conflict that has left it politicized and fragmented, with multiple subnational health systems functioning within the country’s borders. It also cites four health systems that have emerged as a result of various geopolitical, fiscal, and humanitarian drivers, making the case for increased collaboration among the various fragments of the Syrian health system. The chapter covers the evolution of the subnational health systems and factors influencing the delivery of health care across the country. It uses the COVID-19 pandemic as a lens to highlight crucial challenges for all Syrian health systems.

Telerheumatology: A Narrative Review

Telemedicine (TM), the delivery of health care using telecommunication technologies, has been in use in rheumatology practice for over two decades to maximize access and optimize care. As a direct consequence of the Coronavirus disease 2019 (COVID-19) pandemic in March 2020, rheumatology practice shifted from traditional in-person encounters to TM to ensure the safety of both healthcare professionals and patients. However, there is limited literature on the acceptance, feasibility, and effectiveness of TM in the management of rheumatic diseases. Additionally, there is limited guidance on the implementation of telerheumatology (TR) for both patient care and clinical trials. Here we reviewed the most recent publications related to the application of TR, in the management of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), assessed the perceptions of patients and physicians on TM in rheumatology, and identified several key barriers to TR.

Analysis of surgical disciplines involved doctors’ personal responsibility for improper delivery of health care

Currently, there is a serious increase in citizens’ complaints to the Investigative Committee of the Russian Federation. Accordingly, there has been an increase in criminal cases initiated against health professionals. The group of specialists of maximum risk includes, first of all, doctors of surgical specialties: surgeons; anesthesiologists-resuscitators; obstetricians-gynecologists. Purpose of the study. To analyze the criminal cases against surgeons initiated under the second part of Article 109 of the Criminal Code of the Russian Federation. Material and methods. The search for criminal cases was carried out in the following electronic databases: Court decisions of the Russian Federation (https://court decisions.rf) and the state automated system of the Russian Federation "Justice" (https://bsr.sudrf.ru/bigs/portal.html); the search covers the last 5 years period. Results. 235 court decisions in cases open under Part 2. Art. 109 of the Criminal Code of the Russian Federation have been found. The evaluation of territorial and gender characteristics has been carried out. Defects in the delivery of health care identified by the courts and incriminated to doctors are presented. The attitude of surgical specialties doctors to the charges brought, and the applied terms of the main types of punishment are presented: supervised release and denial of the right to practice. Attention is drawn to the aggravating and mitigating circumstances used by the courts.

Transporting an Artificial Intelligence Model to Predict Emergency Cesarean Delivery: Overcoming Challenges Posed by Interfacility Variation (Preprint)

UNSTRUCTURED Research using artificial intelligence (AI) in medicine is expected to significantly influence the practice of medicine and the delivery of health care in the near future. However, for successful deployment, the results must be transported across health care facilities. We present a cross-facilities application of an AI model that predicts the need for an emergency caesarean during birth. The transported model showed benefit; however, there can be challenges associated with interfacility variation in reporting practices.

Patient participation in the development and delivery of health care services, and implications for quality: Protocol for a scoping review.

Introduction Patient participation is increasingly important in individual patient treatment (micro-level), in institutional decisions (meso level) and in decisions on a governmental level (macro level). Nevertheless there is still conflicting evidence about the impact of involving patients in health service development and limited agreement on how to make it happen. This scoping review will map and describe characteristics of meso level approaches to patient participation and facilitators for successful patient participation. We will summarize existing knowledge about patient participation, and the impact on health care services. Methods The present study undertakes a scoping review of research on patient participation in the development and delivery of health care services and implications for quality, following the PRISMA checklist for scooping reviews (PRISMA-ScR). This review will be guided following Arksey and O’Malley’s framework for scoping reviews. All primary studies in English and Scandinavian languages will be eligible. The participants will be patients or healthcare professionals in healthcare services (older than 16 years old). Searches will be conducted in four electronic databases: MEDLINE, EMBASE, Cochrane and PsycINFO, and in grey literature. The final search results will be exported into EndNote, and from EndNote to Covidence to be screened. Final study selection and eligibility criteria will be developed post hoc based on increased familiarity with the literature. The data charting form will be developed and then pilot tested, before results will be reported in a tabular form with a list of factors. Furthermore, the meaning of the results will be summed up in relation to the study objectives. Dissemination and ethics Results will be disseminated through academic journals, conferences and seminars for health care professionals, patient organizations, included health care institutions, and communicated to policymakers. The project is funded by the Dam Foundation and does not require ethical approval.