Interrelated Decision-Making Model for Diabetes

Diabetes is one of the growing chronic diseases. Proper treatment is needed to produce its effects. Past studies have proposed an Interrelated Decision-making Model (IDM) as an intelligent decision support system (IDSS) solution for healthcare. This model can provide accurate results in determining the treatment of a particular patient. Therefore, the purpose of this study is to develop a diabetic IDM to see the increased decision-making accuracy with the IDM concept. The IDM concept allows the amount of data to increase with the addition of data records at the same level of care, and the addition of data records and attributes from the previous or subsequent levels of care. The more data or information, the more accurate a decision can be made. Data were developed to make diagnostic predictions for each stage of care in the development of type 2 diabetes. The development of data for each stage of care was confirmed by specialists. However, the experiments were performed using simulation data for two stages of care only. Four data sets of different sizes were provided to view changes in forecast accuracy. Each data set contained 2 data sets of primary care level and secondary care level with 4 times the change of the number of attributes from 25 to 58 and the number of records from 300 to 11,000. Data were developed to predict the level of diabetes confirmed by specialist doctors. The experimental results showed that on average, the J48 algorithm showed the best model (99%) followed by Logistics (98%), RandomTree (95%), NaiveBayes Updateable (93%), BayesNet (84%) and AdaBoostM1 (67%). Ratio analysis also showed that the accuracy of the forecast model has increased up to 49%. The MAPKB model for the care of diabetes is designed with data change criteria dynamically and is able to develop the latest dynamic prediction models effectively.v

Room Type and Social Cohesion in Senior-living Facilities

Private rooms are generally preferred by senior-living residents. However, having roommates may help residents to build and maintain social networks in the facility, leading to promoted social cohesion and mental health. The differences in social cohesion among senior-living residents who resided in private or shared rooms need investigation. This research collected empirical data from eight senior-living facilities in Beijing and Shanghai, China. Focusing on social cohesion, room type, and personal factors, on-site questionnaire surveys recruited 345 residents receiving independent living, assisted living, or nursing care services. Facility environments were measured and rated by researchers through on-site observation. Controlling for personal and facility factors, ANOVA tests were employed to investigate the differences in social cohesion among residents who resided in private, double, or triple rooms. Room type was found significant to the social cohesion in assisted-living and nursing care residents. At the assisted-living level, compared with private and double rooms, triple rooms were more likely to contribute to social cohesion (p<=0.01). At the nursing care level, residents with less numbers of roommates (private versus double and double versus triple) had stronger social cohesion (p<=0.05). At the independent-living level, no factors significant to social cohesion were found. These findings can be used to guide the new design, renovation, and modification of senior-living environments to promote social cohesion. Recommendations for future research and practice implications for senior-living professionals and facility designers are discussed. Senior-living facilities should be built to be social-friendly through design and planning and within the context of its cultural characteristics.

RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test

Background Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. Methods Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 “must not detect RLEP” samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 “must detect RLEP” samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001–10.000 bacilli/extract), low-positive samples of MB leprosy patients (1–1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. Results Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43–27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93–100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. Conclusions The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.

Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

Acute psychosis and serotonin syndrome in the setting of “Triple-C” overdose: a case report

Background Over-the-counter medication overdose is a difficult diagnostic challenge for many physicians as common drug screening assays cannot detect these substances. We present a case of acute psychosis, serotonin syndrome, and anticholinergic overdose-like properties in the setting of Coricidin HBP Cough & Cold tablets, known by their street name Triple-C. This is the first case report we are aware of involving a patient presenting with these symptoms and requiring critical-care-level support. Case presentation A 31-year-old African American female with a past medical history of anxiety, childhood asthma, previous methamphetamine abuse, and coronavirus disease 2019 infection in August 2020 was brought to the emergency department by the local police department with altered mental status. Initial blood work, including extended drug screens, were unremarkable for a definitive diagnosis. This patient required critical-care-level support and high sedation because of her symptoms. Collateral history revealed the patient regularly consumed Triple-C daily for the 6 weeks prior to admission. A trial off sedation was attempted after 24 hours with no complications. The patient admitted to regular Triple-C consumption and auditory hallucinations since adolescence. She was discharged safely after 48 hours back into the community. She was lost to follow-up with psychiatry and internal medicine; however, she was evaluated in the emergency room 1 month later with a similar psychiatric presentation. Conclusion Overdose of Triple-C should be kept in the differential diagnosis of patients presenting with a triad of psychosis, serotonin syndrome, and anticholinergic overdose, in the setting of unknown substance ingestion.

Separación Madre - Recién Nacido hospitalizado en pandemia: Un acontecimiento para reflexionar

RESUMENLa pandemia por el virus SARS-CoV-2, ha provocado cambios en los protocolos de atención en todos los servicios del país, incluidas las unidades de neonatología, dificultando la cercanía entre las madres y sus recién nacidos, y poniendo en riesgo la generación del vínculo y posterior apego seguro entre el niño y la madre. La hospitalización neonatal, gatilla en las madres afecciones psicoemocionales, debidas principalmente por la consecuente separación. Existe evidencia del impacto que genera en las madres la hospitalización neonatal durante el período de pandemia. Se visualiza la insuficiencia de protocolos establecidos para permitir la cercanía materna con el neonato en contexto de pandemia, por lo que se plantea la necesidad de replantear los protocolos de visita y definir estrategias de detección precoz de alteraciones de salud mental en las madres que han sido separadas de sus neonatos. Se efectúa una reflexión respecto de las acciones, prioridades y desafíos que las matronas y matrones debemos considerar para velar por el bienestar del binomio. Así como la detección a nivel primario de salud, mediante acciones de matronería, que parece ser una intervención ética.Palabras Claves: SARS-CoV-2; Salud Materna, Cuidado Perinatal, Matronería.ABSTRACTThe pandemic caused by the SARS-CoV-2 virus has caused changes in the care protocols in all the neonatology units, making it difficult for mothers and their newborns to be close. And, is a risk of generating a healthy bond and subsequent sure attachment between the child and the mother. Neonatal hospitalization triggers psycho-emotional conditions in mothers, mainly due to the consequent separation.Was identified publications related to the experience of mothers of hospitalized newborns during the pandemic period. In addition, fundamental aspects of the mothers' mental health are pointed out during this parenting period. A reflection is proposed regarding the actions, priorities, and challenges that midwives must consider to ensure the well-being of the couple, especially in the context of a pandemic. The insufficiency of established protocols to care for the mental health of mothers of hospitalized newborns is visualized, for which reason early detection strategies and timely referral to the health care network are proposed for mothers who have been separated from their neonates. Detection at the primary health care level, through midwifery actions, seems to be an ethical intervention.Key Words: SARS-CoV-2; Maternal Health; Perinatal Care; Midwifery.