Personalizing Medication Recommendation with a Graph-Based Approach

The broad adoption of electronic health records (EHRs) has led to vast amounts of data being accumulated on a patient’s history, diagnosis, prescriptions, and lab tests. Advances in recommender technologies have the potential to utilize this information to help doctors personalize the prescribed medications. However, existing medication recommendation systems have yet to make use of all these information sources in a seamless manner, and they do not provide a justification on why a particular medication is recommended. In this work, we design a two-stage personalized medication recommender system called PREMIER that incorporates information from the EHR. We utilize the various weights in the system to compute the contributions from the information sources for the recommended medications. Our system models the drug interaction from an external drug database and the drug co-occurrence from the EHR as graphs. Experiment results on MIMIC-III and a proprietary outpatient dataset show that PREMIER outperforms state-of-the-art medication recommendation systems while achieving the best tradeoff between accuracy and drug-drug interaction. Case studies demonstrate that the justifications provided by PREMIER are appropriate and aligned to clinical practices.

A METAHEURISTIC APPROACH FOR TETROLET BASED MEDICAL IMAGE COMPRESSION

Over recent times, medical imaging plays a significant role in clinical practices. Storing and transferring the huge volume of images becomes complicated without an efficient image compression technique. This paper proposes a compression algorithm that uses a Haar based wavelet transform called Tetrolet transform, which reduces the noise on the input images and decomposes with a 4 x 4 blocks of equal squares called tetrominoes. It opts for a decomposing using optimal scheme for achieving the input image into a sparse representation which gives a much-detailed performance for texture and edge information better than wavelet transform. Set Partitioning in Hierarchical Trees (SPIHT) is used for encoding the significant coefficients to achieve efficient image compression. It has been investigated with various metaheuristic algorithms. Experimental results prove that the proposed method outperforms the other transform-based compression in terms of PSNR, CR, and Complexity. Also, the proposed method shows an improved result with another state of work.

A Metaheuristic Approach for Tetrolet-Based Medical Image Compression

Over recent times, medical imaging plays a significant role in clinical practices. Storing and transferring the huge volume of images becomes complicated without an efficient image compression technique. This paper proposes a compression algorithm that uses a Haar based wavelet transform called Tetrolet transform, which reduces the noise on the input images and decomposes with a 4 x 4 blocks of equal squares called tetrominoes. It opts for a decomposing using optimal scheme for achieving the input image into a sparse representation which gives a much-detailed performance for texture and edge information better than wavelet transform. Set Partitioning in Hierarchical Trees (SPIHT) is used for encoding the significant coefficients to achieve efficient image compression. It has been investigated with various metaheuristic algorithms. Experimental results prove that the proposed method outperforms the other transform-based compression in terms of PSNR, CR, and Complexity. Also, the proposed method shows an improved result with another state of work.

Caring for depression in the dying is complex and challenging – survey of palliative physicians

Background Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians’ reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. Methods In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. Results Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. Conclusions Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Challenges of COVID-19: the Experience of Bule Hora University Nursing Students (Qualitative Study Approach)

Background COVID-19 brings several challenges to nursing education that involves both classroom theory and clinical-based practical education. These challenges affect the function of health care and academic institution. The students were vulnerable to the challenges of COVID-19 in the clinical care setting. The aim of this study was to explore the challenges of COVID-19 experienced by nursing students during their clinical practice education. Methods The qualitative study method used a phenomenological approach. A total of four Focus group discussions were conducted in this study. Each FGD consists of six participants in which twelve from third and twelve from fourth-year nursing students. The Quota sampling technique was applied in this study to enroll study participants. The moderator who fluently speaks the English language and Note taker was involved in the study to guide group discussion and to record the data. ATLAS.ti version-7 software was used for coding and forming quotations. Results After data analysis, four main themes and twelve subthemes emerged in this study. The main themes of this study were; Risks to contracting COVID-19, Negative impact on health care, Worry, and Loss of experienced staff. Conclusion Nursing students faced many challenges of COVID-19 during clinical practices. These challenges affect nursing students in learning practical skills and health care facilities to provide quality care. The students give emphasize on their learning by implementing COVID-19 prevention protocols. In addition, health care workers focused on safe procedural practices.

Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

Joint EANM/SNMMI/ESTRO practice recommendations for the use of 2-[18F]FDG PET/CT external beam radiation treatment planning in lung cancer V1.0

Purpose 2-[18F]FDG PET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies. Methods A literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO). Results and conclusion This guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-[18F]FDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.

Healing Architecture in Healthcare: A Scoping Review

Objectives: The purpose of this scoping review is to identify evidence on how characteristics of healing architecture in clinical contexts impact clinical practice and patient experiences. Based on these insights, we advance a more practice-based approach to the study of how healing architectures work. Background: The notion of “healing architecture” has recently emerged in discussions of the spatial organization of healthcare settings, particularly in the Nordic countries. This scoping review summarizes findings from seven articles which specifically describe how patients and staff experience characteristics of healing architecture. Methods: This scoping review was conducted using the framework developed by Arksey and O’Malley. We referred to the decision tool developed by Pollock et al. to confirm that this approach was the most appropriate evidence synthesis type to identify characteristics related to healing architecture and practice. To ensure the rigor of this review, we referred to the methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Results: There are two main findings of the review. First, there is no common or operative definition of healing architecture used in the selected articles. Secondly, there is limited knowledge of how healing architecture shapes clinical and patient outcomes. Conclusions: We conclude that further research is needed into how healing architectures make a difference in everyday clinical practices, both to better inform the development of evidence-based designs in the future and to further elaborate criteria to guide postoccupancy evaluations of purpose-built sites.

Challenges and Attitude towards Research among Physicians of Bangladesh: A Cross Sectional Questionnaire Survey.

In the history of human civilization, research has played a significant role. There is no doubt that meeting the challenges of the 21st century will be tough if we are not world leaders in science and technology. The objective of this study was to assess physicians' attitude about research and the challenges they confront when doing research. From July to December 2020, a cross-sectional questionnaire survey was performed among physicians in Bangladesh. The questionnaire poll had 626 responses in total. There were 55.6 % female physicians and 44.4% male physicians among them. The majority of physicians (87.6%) felt that conducting research is critical to become a specialist. Research methodology training at the medical colleges are extremely beneficial, according to a substantial percentage of physicians (72.2%). Research methodology should be included in undergraduate curriculum, according to 89% of physicians. Research is beneficial as it aids critical thinking and policy implementation, according to almost all respondents (96.7%). The majority of respondents cited insufficient research training (92%), insufficient funding (92.2%), insufficient time (61%), insufficient familiarity with statistical analysis (88%), insufficient skill to design and conduct a research project and write a scientific paper (90%), as barriers to research. Priority on teaching and clinical practices over research and lack of interest to do research also mentioned by 93.3% and 61% responded respectively. Consequently, this study identified challenges and attitude of physicians towards research. This finding will guide for further studies to find out effective interventions to address the obstacles raised by research participants. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 10-19