Ambiguous and Incomplete: Natural Language Processing Reveals Problematic Reporting Styles in Thyroid Ultrasound Reports

Objective Natural language processing (NLP) systems convert unstructured text into analyzable data. Here, we describe the performance measures of NLP to capture granular details on nodules from thyroid ultrasound (US) reports and reveal critical issues with reporting language. Methods We iteratively developed NLP tools using clinical Text Analysis and Knowledge Extraction System (cTAKES) and thyroid US reports from 2007 to 2013. We incorporated nine nodule features for NLP extraction. Next, we evaluated the precision, recall, and accuracy of our NLP tools using a separate set of US reports from an academic medical center (A) and a regional health care system (B) during the same period. Two physicians manually annotated each test-set report. A third physician then adjudicated discrepancies. The adjudicated “gold standard” was then used to evaluate NLP performance on the test-set. Results A total of 243 thyroid US reports contained 6,405 data elements. Inter-annotator agreement for all elements was 91.3%. Compared with the gold standard, overall recall of the NLP tool was 90%. NLP recall for thyroid lobe or isthmus characteristics was: laterality 96% and size 95%. NLP accuracy for nodule characteristics was: laterality 92%, size 92%, calcifications 76%, vascularity 65%, echogenicity 62%, contents 76%, and borders 40%. NLP recall for presence or absence of lymphadenopathy was 61%. Reporting style accounted for 18% errors. For example, the word “heterogeneous” interchangeably referred to nodule contents or echogenicity. While nodule dimensions and laterality were often described, US reports only described contents, echogenicity, vascularity, calcifications, borders, and lymphadenopathy, 46, 41, 17, 15, 9, and 41% of the time, respectively. Most nodule characteristics were equally likely to be described at hospital A compared with hospital B. Conclusions NLP can automate extraction of critical information from thyroid US reports. However, ambiguous and incomplete reporting language hinders performance of NLP systems regardless of institutional setting. Standardized or synoptic thyroid US reports could improve NLP performance.

Здравоохранение Калмыкии после возвращения калмыков на родину в 1957 г.

Introduction. This article examines the health care sector in Kalmykia after the return of the Kalmyk people from the places of deportation in 1957. The chronological framework covers several periods: the state of health care in the abolished Kalmyk ASSR after the illegal deportation of the Kalmyks; the first years since the restoration of the Kalmyk Autonomous Region in 1957 and the return of the rehabilitated people. The article aims to study the state of health care in Kalmykia after the deportation of the Kalmyk people and after their return in 1957. The article also examines the state of the health sector in the region in the post-deportation period, including staffing and material problems, and the state and development of the sector upon the return of the Kalmyks. Materials and methods. The problem-chronological principle became the basis of this article. In accordance with it, the transformations in the sector under study were examined during the historical periods in question. A quantitative (statistical) method was also used, which made it possible to trace the dynamics of changes in the health care network and personnel. The sources were archival documents of the State Archives of the Russian Federation and the National Archives of the Republic of Kalmykia. Results. The article shows the state and changes in the health care sector of Kalmykia in the time periods under study. The regional health care institutions managed to organize their work in a difficult historical period, after the people’s return from exile. Conclusions. Despite heavy losses and difficulties, health workers in the Republic managed to resume their work, begin the restoration of medical institutions, the health care system after the deportation. Thanks to the dedication of medical workers, the republic’s health care system was restored after its complete destruction.

Raising the level of the regional healthcare development

The article is devoted to the consideration of the possibilities of change management in the regional health care system. The research methodology includes the provisions of theories of change management, innovation management, concepts of organizational development, strategic management. The author's approach to managing changes in the Russian healthcare system at the regional level was developed using a systemic, multilevel, integrative, interdisciplinary approach, methods of comparative, factor analysis, instrumental methods of statistics. The study revealed shortcomings of the management systems in the healthcare during the pandemic. Proposed current approaches to change management, author's approach to their assessment in regional health care. The studies carried out show the high potential of the Russian medical science, the sanitary and epidemiological service, the rapid adaptation of the healthcare system in the face of the challenges associated with the pandemic. Along with the success of the Russian healthcare, serious problems have been identified in the management of the industry, including due to insufficient resource provision. A conclusion is made about the possibilities of increasing the level of development of the regional healthcare as a result changes in the industry through integration of medical science and practical healthcare, active implementation of innovations, digitalization, public-private partnership tools that contribute to preservation of the human potential and strengthening the socio-demographic, economic security of the region.

Regional Health Care Profiles – An Improved Method For Generating Case Studies On The Catchment Areas of Envisaged Primary Health Care Units In Austria: A Report To The Infact Joint Action

Background: The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. Results: We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2,122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area.Conclusions: The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

REGIONAL OPPORTUNITIES AND ETHICAL RISKS OF MEDICAL TOURISM (ОN THE EXAMPLE OF THE VOLGOGRAD REGION)

The article examines medical tourism as a promising area of modern health care within the framework of the federal project "Development of the export of medical services", part of the national project "Health". The authors examine the possibilities of regional health care within the framework of the project "Development of medical services export in the Volgograd region". The data on the number and geography of visitors, financial revenues to the regional budget for the ensuring, paid medical services are presented. The risks of regional health care that hinder the development of medical tourism are described and the ways to avoid them are indicated. At the present stage of the development of Russian healthcare, the provision of medical tourism services is not legally formalized, so more attention should be paid to ethical regulation in this area.

Diurnal Variation in SARS-CoV-2 PCR Test Results: Test Accuracy May Vary by Time of Day

False negative tests for SARS-CoV-2 are common and have important public health and medical implications. We tested the hypothesis of diurnal variation in viral shedding by assessing the proportion of positive versus negative SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) tests and cycle time (Ct) values among positive samples by the time of day. Among 86,342 clinical tests performed among symptomatic and asymptomatic patients in a regional health care network in the southeastern United States from March to August 2020, we found evidence for diurnal variation in the proportion of positive SARS-CoV-2 tests, with a peak around 1400 h and 1.7-fold variation over the day after adjustment for age, sex, race, testing location, month, and day of week and lower Ct values during the day for positive samples. These findings have important implications for public health testing and vaccination strategies.

Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis

Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes.Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models.Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71).Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.

Demographic Profile of the Population Residing in the Metals and Mining Areas in the European Part of the Arctic Zone of the Russian Federation

Introduction: The relevance of the study is determined by the national goals of strategic development providing for sustainable population growth and an increase in active life expectancy, primarily in demographically disadvantaged areas to which most of the regions of the Russian Arctic Zone belong. Objective: To assess changes in the demographic structure of the Murmansk Region, one of the most industrially developed regions of the Russian Arctic, and the loss of its labor potential in 1989–2019 in order to substantiate the necessity to consider these changes for better planning of health care and adjusting the resource provision of the regional health care system. Materials and methods: We studied demographic characteristics of the population residing in administrative areas of the Murmansk Region with the main town-forming metals and mining enterprises by comparing data for 1989 with those for the years 1999, 2009, and 2015–2019 to establish trends in medical demography situation. The average age of the population was estimated as the arithmetic mean based on distribution of the population by age groups. Results: We established a significant decrease in the size of population of the Murmansk Region in 1989–2019 (by 34.8 %) accompanied by changes in the demographic profile. The increase in the average age of the population was attributed to the sharp decline in the child population, a decrease in the number of people of working age (16–59 years), and a significant increase in the population of older age groups. Changes in the age structure of the population had a significant effect on the old age dependency ratio, which demonstrated a 2.7 and 3.2-fold increase over the three 1989-to-2019 decades in the region and its industrial monotowns, respectively. Conclusion: The negative structural demographic trend resulted in a pronounced regressive regional age and sex pyramid, which by 2019 had a characteristic unstable shape with a relatively narrow base and a slope of its top to the left due to the significant predominance of the female population in the older age group. The observed changes in the demographic profile of the population suggest the need to consider this trend when planning local social policy including the volume and resource provision of health care services.

Reshaping the Regional Order of Health Care Resources in China: The Institutional Participants in an Inter-City Integrated Delivery System

Over the past decades, pro-growth policies in China led to rapid economic development but overlooked the provision of health care services. Recently, increasing attention is paid to the emergence of integrated delivery systems (IDS) in China, which is envisioned to consolidate regional health care resources more effectively by facilitating patient referral among hospitals. IDS at an inter-city scale is particularly interesting because it involves both the local governments and the hospitals. Incentives among them will affect the development of an inter-city IDS. This paper thereby builds an economic model to examine both the inter-local government and inter-hospital incentives when participating in an inter-city IDS in China. The findings suggest that while inter-hospital incentives matter, inter-local government incentives should also be considered because the missing incentives at the local government level may oppose the development of inter-city IDSs.