A novel deep learning technique for analysis and detection of ARMD using OCT scan images

Age-Related Macular Degeneration (ARMD) is a medical situation resulting in blurred or no vision in the middle of the eye view. Though this disease doesn’t make the person completely blind, it makes it very difficult for the person to perform day to day activities like reading, driving, recognizing people etc. This paper aims to detect ARMD though Optical Coherence Tomography (OCT) scans where the drusen in the macula is detected and identify the infected. The images are first passed though Directional Total Variation (DTV) Denoising followed by Active contour algorithm to mark the boundaries of the layers in macula. In deep learning, a convolutional neural network is a class of deep neural networks, most commonly applied to analyzing visual imagery. Then these images categorized as healthy and infected using Convolution Neural Network. Different CNN variant algorithms like Alexnet, VggNet and GoogleNet have been compared in the experiments and the results obtained are better compared to traditional methods.

Temporal patient trajectories: long stories in short admissions

PurposeThe purpose of this paper is to explain how trajectory management in hospitals is challenged by the introduction of accelerated discharge schemes. The patient trajectory is formed by short stays within health-care organizations, which requires a substantial effort for professionals to be successful in clarifying each patient's medical situation. The patients, at the same time, often have complicated illness stories, and professionals only see a limited part of the patient's trajectory.Design/methodology/approachThis paper is based on extensive ethnographic studies in a newly established cardiac day unit introducing same-day discharge schemes for patients with ischemic and arrhythmic heart disease.FindingsThe findings demonstrate that the patient trajectory becomes a “temporal patient trajectory” and encounters a short-term reality, where tensions arise between admission time and the trajectory as a whole. In managing temporal patient trajectories, formal organizing and patient experiences intersect in events that emerge from conversations and span past, present and future in relation to patient treatment. Professionals engage in articulation work to maintain coherence by allowing patients to hold different events together over time.Originality/valueThe paper provides new insights into the challenges of managing trajectories in same-day discharge schemes where the pressure to move quickly and ensure patient discharge is intense. The paper offers a novel theoretical perspective on trajectory management as an ongoing temporal process. The analysis displays temporal tensions between patient experiences and the accelerated discharge scheme and how professionals manage to overcome these tensions by bridging the patient's long illness story and the short trajectory within the cardiac day unit.

Comprehensive methodology for calculating possible sanitary losses of the population and the need for assets and resources of the civilian health care in armed conflicts

Relevance. In the zone of armed conflict (in the risk zone), people receive various injuries. The nature and severity of injuries depend on the combined impact of many damaging factors and the conditions of the medical situation. The number of medical units and institutions for providing medical assistance to those in need can be determined based on accurate forecast of the medical situation in the zone of armed conflict.Intention: To present the methodology for calculating the sanitary losses of the population in the course of an armed conflict and to determine resources of civilian health care in the territories of military operations.Methodology. Generalization and systematization of empirical, statistical and theoretical data are used, as well as traditional analysis of documents and literature on the topic of the study. The methodology is based on the following principles: multifactorial occurrence of sanitary losses; repeatability, multiple effects of damaging factors; the principle of uneven and nonsimultaneous occurrence of sanitary losses in the zone of armed conflict.Results and Discussion. Existing methods of forecasting and assessing the medical situation in the zone of armed conflict have been analyzed. A new algorithm for complex analysis and assessment of the medical situation has been developed.Conclusion. The data obtained can serve an important basis for organizing medical support for the population in the zone of armed conflict, protecting the life and health of those affected.

The Effects of Website Traits and Medical Skepticism on Patients’ Willingness to Follow Online Medical Advice (Preprint)

BACKGROUND As people increasingly turn to online sources for medical information, we offer some insight into what website traits influence patient’s credibility assessment. Specifically, we control for brand and content length, while manipulating three website traits: (1) authorship, (2) format, and (3) tone. Further, we focus on medical skepticism to understand how patients with high levels of medical skepticism may react to online medical information differently. Medical skepticism is related to a patient’s doubts about the value of conventional medical care, and therefore skeptics may have different practices and criteria when conducting their own online medical searches. OBJECTIVE This study evaluates how website traits impact the likelihood that patients follow online medical advice and how this varies in patients with differing levels of medical skepticism. METHODS This experiment presented participants with a hypothetical medical situation about leg cramps and offered a website with treatment advice. We varied the websites the participants observed across three traits: (1) authorship: patient or physician, (2) format: article or discussion forum, (3) tone: objective or experience-based. The 2,305 participants were randomly assigned one of eight possible conditions and then asked the extent to which they would follow the advice. Healthcare patterns and coverage, demographics, and their level of medical skepticism were captured. RESULTS Our panel data was selected to be demographically representative of the population of internet users in the United States. The 2,305 complete responses were analyzed with OLS regression. Our analysis reveals that people are more likely to accept online medical advice authored by a physician (P-value<.001) and presented with an objective tone (P-value<.001), but those preferences erode as levels of medical skepticism increase. Medical skepticism was measured via a previously established index on a 0-4 scale, and the average score was 2.26 with a standard deviation of 0.84. Individuals with higher levels of medical skepticism were more likely to follow online medical advice in our experiment (P-value<.001). Individuals with low levels of medical skepticism found online discussion forums more credible, while those with high levels of medical skepticism preferred articles (P-value<.01). We discuss the interactions between medical skepticism and all three website traits manipulated in the experiment. CONCLUSIONS Our findings suggest that, generally, physician authorship and an objective tone create more persuasive online medical advice. But, there are differences in how patients with high levels of medical skepticism react to online medical resources. Medical skeptics are less discerning regarding the author’s credentials and the presentation tone of the information. Further, those with higher levels of medical skepticism prefer article format presentations, whereas those with lower levels prefer forum-style formatting.

The Cultural, Educational And Medical Situation In The Labor Settlements Established In Uzbekistan

The article reveals the issues of cultural, educational and medical situation in the labor settlements established in Uzbekistan, the living conditions of labor migrants with the help of archival sources and scientific literatures as well.

Influence of COVID-19 confinement measures on appendectomies in Germany—a claims data analysis of 9797 patients

Purpose COVID-19 pandemic had multiple influences on the social, industrial, and medical situation in all affected countries. Measures of obligatory medical confinement were suspensions of scheduled non-emergent surgical procedures and outpatients’ clinics as well as overall access restrictions to hospitals and medical practices. The aim of this retrospective study was to assess if the obligatory confinement (lockdown) had an effect on the number of appendectomies (during and after the period of lockdown). Methods This retrospective study was based on anonymized nationwide administrative claims data of the German Local General Sickness Fund (AOK). Patients admitted for diseases of the appendix (ICD-10: K35-K38) or abdominal and pelvic pain (ICD-10: R10) who underwent an appendectomy (OPS: 5-470) were included. The study period included 6 weeks of German lockdown (16 March–26 April 2020) as well as 6 weeks before (03 February–15 March 2020) and after (27 April–07 June 2020). These periods were compared to the respective one in 2018 and 2019. Results The overall number of appendectomies was significantly reduced during the lockdown time in 2020 compared to that in 2018 and 2019. This decrease affects only appendectomies due to acute simple (ICD-10: K35.30, K35.8) and non-acute appendicitis (ICD-10: K36-K38, R10). Numbers for appendectomies in acute complex appendicitis remained unchanged. Female patients and in the age group 1–18 years showed the strongest decrease in number of cases. Conclusion The lockdown in Germany resulted in a decreased number of appendectomies. This affected mainly appendectomies in simple acute and non-acute appendicitis, but not complicated acute appendicitis. The study gives no evidence that the confinement measures resulted in a deterioration of medical care for appendicitis.

Parent feedback: perception of parents and pediatric residents in Asian culture

Background Residency programs have used feedback of parents as a part of multisource feedback to improve residents’ skills. However, there is no evidence showing how parents can appropriately be engaged in pediatric resident feedback in our context. This study aimed to investigate: 1) the resident skills assessed by parents in perception of Thai parents and pediatric residents and 2) the parent characteristics making credible feedback in perception of Thai pediatric residents. Methods The participating parents were asked to rate their confident to assess residents’ skills according to 17 items of the PARENTS questionnaire (Likert scale 1–5). To enhance the reasons of parent’s confident, the parents responded to think aloud interviews. We conducted focus groups in order to explore the resident perception on parents’ assessable resident skills and credible parent characteristics. Results There were 51 parents revealing the mean confident scores of 17 items ranged from 4.06 to 4.37. The parents felt confident to assess the residents’ skills according to the questionnaire because they directly experienced the residents’ performance during admissions. Five resident focus groups were conducted. In resident perception, residents’ skills in communication, collaboration, leadership and professionalism were assessable by parents. The characteristics affecting the feedback credibility included parents’ prior experience, personal behavior and confrontation to medical situation. Conclusions Thai residency programs may use parent feedback for residents’ performance improvement as both parents and residents are able to identify the parents’ assessable skills. The feedback process should consider the credible parents’ characteristics to increase the acceptability and avoid the bias.

Constitutional and ethical medical points of view on the importance of hospitalization of a patient with emergency cardiovascular pathology

The article discusses the constitutional, ethical and medical aspects of hospitalization of patients with a life-threatening cardiovascular event. In itself, a medical condition is a complex biological event with many unpredictable aspects of its own course and adverse events and reactions in case of medical intervention. A doctor, as the central subject of medical care, faces four categories of difficulties: law, organizational, biomedical and ethical. Medical care is regulated by both article 41 of the Constitution of the Russian Federation and departmental acts of the health care system. Actually, doctor as a part of the healthcare system implement this right. The article provides an example of delivered judgment regarding complicated course of acute coronary syndrome. It shows the complexity of the medical situation, that regards the issues of doctor’s legal liability.

Thinking about diagnosis

Diagnosis performs a useful function because it allows us to classify patients into groups. This enables us to: … ● study diagnostic groups, so that we can learn more about aetiology, prognosis, risks, and treatment through research; ● communicate briefly but effectively with other healthcare professionals about a specific patient— rather than having to list the specific features in every case, we have a convenient shorthand; ● predict the likely aetiology, prognosis, risks, and effective treatments in a specific patient, based on evidence from other people with that diagnosis. The process of diagnosis in mental health is not uni­versally accepted as being appropriate. This stems from concerns that diagnosis: … ● labels people with mental illness with names that may be unhelpful and stigmatizing, such as ‘personality disorder’ or ‘schizophrenia’; ● excessively simplifies the details of a particular person’s predicament, so that a person’s uniqueness is not acknowledged; ● relies upon an understanding of illness (existing classification systems) that does not reflect real illness categories, and therefore has low validity; ● relies upon the interpretation of the individual clinician, and therefore has low reliability— clinicians presented with the same information (the same patient) may draw different diagnostic conclusions…. We would argue that the rationale for diag­nosis is strong, that no realistic alternative exists, and that the advantages of this approach far out­weigh the disadvantages. When diagnostic assess­ment is conducted thoroughly and appropriately, it focuses very much on the detail of the patient’s psychological, physical, and social situation, and emphasizes the particular aspects of an individual’s case. It is therefore crucial that, when you are pre­senting a case, you stress those points, so that your case description is rich and individual, rather than being bland and general. The former reflects a real, unique person; the latter reflects a textbook description. In psychiatry, diagnosis is rarely just one simple term describing the patient’s medical situation. As we have seen so far while considering assessment, there is usually more than one issue, and sometimes many, whether within the biological, psychological, or social domains. This complexity needs to be reflected in the shorthand of diagnosis. One way in which psychiatric diagnosis has achieved this in an ordered way is by adopting a multiaxial classification, in which several axes reflect different aspects of the patient’s situation.