Achieving universal eye health remains a global challenge,particularly in low-and middle-income countries where visual impairment and blindness are prevalent.While advances in tertiary eye care have improved outcomes,...Achieving universal eye health remains a global challenge,particularly in low-and middle-income countries where visual impairment and blindness are prevalent.While advances in tertiary eye care have improved outcomes,access to primary eye care(PEC)continues to be inadequate in rural and underserved regions.This gap necessitates innovative,scalable models that provide accessible,affordable,and comprehensive eye care.The Vision Centre(VC)model,pioneered by the Aravind Eye Care System(AECS),exemplifies a sustainable approach to delivering PEC.Designed as permanent facilities in rural communities,VCs are equipped with state-of-the-art diagnostic tools and staffed by trained allied ophthalmic personnel.The integration of teleophthalmology,electronic medical records,and artificial intelligence enhances the model’s capacity to address complex conditions like diabetic retinopathy and glaucoma.VCs have demonstrated significant impact in improving accessibility,reducing financial burdens,and increasing utilization of eye care services.In the fiscal year 2023-2024,AECS VCs recorded nearly one million outpatient visits,achieving a 25%population coverage rate and generating substantial cost savings of ₹647 million(US$7.8 million)for patients.The model's success is underpinned by community engagement,a focus on operational excellence,and a robust referral system to tertiary hospitals.This review explores the evolution,implementation,and impact of the AECS VC model,emphasizing its alignment with the Sustainable Development Goals and Universal Health Coverage.By addressing accessibility and affordability,the VC model serves as a scalable template for primary eye care delivery in resource-limited settings globally.展开更多
In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent he...In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise,but involves certain challenges,such as limited access,low technological literacy,and privacy concerns.These barriers disproportionately affect deprived populations and individuals with severe mental health conditions.We highlight the positive impact of smart healthcare solutions,such as telemedicine and wearable technologies,on patient engagement,remote monitoring,and treatment adherence.To overcome these challenges,we propose strategies,such as improving user-friendliness,ensuring equitable access to digital interventions,enhancing cybersecurity,and integrating smart healthcare into clinical workflows.Training healthcare providers and developing policies to ensure the ethical use of patient data are essential.When implemented thoughtfully,smart healthcare technologies can revolutionize mental health and substance use disorder treatment,improve patient outcomes,and reduce healthcare inequities.展开更多
Communities in developing country mountain areas,in part due to their remoteness,find themselves excluded from social,political and economic systems; and excluded from access to resources. This paper aims to study the...Communities in developing country mountain areas,in part due to their remoteness,find themselves excluded from social,political and economic systems; and excluded from access to resources. This paper aims to study the impact of information and communication technologies (ICTs) on remoteness and exclusion. It utilises two models - the resource movement framework,and the "information chain" - to analyse a telecentre in one district of mountainous Huancavelica,Peru's poorest region,set in the high Andes. It finds ICTs enabling new and positive resource flows for the two key user groups:teenaged school students and young farmers. These help to maintain social networks. They also support information searches that have improved agricultural practice where other information chain resources have been available. But non-use and ineffective use of the telecentre are found where information chain resources are lacking. ICTs have some impacts on intangible elements of remoteness. In this particular example,they also offer access to some previously-excluded resources. But they have not really addressed the systematic exclusions faced by mountain communities. And they so far appear to be a technology of inequality; favouring those residents who begin with better resource endowments.The paper concludes by offering some recommendations for mountain ICT project practice.展开更多
Community volunteers were recruited and trained to deliver person-centred care to patients with dementia or delirium in an acute hospital setting, in a small rural Australian hospital. The volunteer program was ground...Community volunteers were recruited and trained to deliver person-centred care to patients with dementia or delirium in an acute hospital setting, in a small rural Australian hospital. The volunteer program was grounded in action research methodology, and modelled on a previous research project. As a form of evaluation, interviews were conducted with nursing staff eight weeks after implementation of the volunteer program to explore their opinions. Data were analysed through a collaborative process and findings revealed strong benefits from the perspectives of the nursing staff. These benefits included overall improved patient care and improved time management for nursing tasks.展开更多
In the present article, we emphasize the symptom experience perspective in person-centred care and discuss barriers to implementation of this approach. There are obstacles to overcome: the diversity of understandings ...In the present article, we emphasize the symptom experience perspective in person-centred care and discuss barriers to implementation of this approach. There are obstacles to overcome: the diversity of understandings of symptoms in clinical settings, the current biomedical discourse and the incompleteness of symptom research. Since the 19th century, the biomedical perspective has been powerful in conceptualizing symptoms in terms of pathology and diagnosis. Many diagnoses conjure up preconceived notions about the persons receiving them. This perspective may influence person-centred care negatively. Yet symptoms often mean something beyond the diagnosis. Recognizing this discrepancy, it is crucial that we consider a perspective that starts from each person’s symptom experience, thus complementing the biomedical perspective. Using the notion caring about symptoms, we advocate a person-centred approach that includes a symptom experience perspective. This requires health-care professionals to be skilled in listening to patient narratives and acquire knowledge about how symptom experiences can be individually expressed and interpreted. Listening to symptom experiences may give insights into the personal meaning of illness as well as information about bodily and social restrictions caused by symptom distress. In this way, caring about symptoms will improve the prerequisites for establishing person-centred care planning.展开更多
Satisfied employees in healthcare services who have opportunities to develop their professional competence by reflecting on professional challenges play an important role in the quality of care. The aim of the present...Satisfied employees in healthcare services who have opportunities to develop their professional competence by reflecting on professional challenges play an important role in the quality of care. The aim of the present study was to describe the employees’ experience of the benefits of participating in a person-centred clinical supervision setting. The supervision, guided by a professional supervisor, was carried out with a group of six day- and night-shift municipal healthcare professionals for a period of four months during their mandatory work hours. Data were obtained from written individual evaluations and group interviews shortly after the last session and again twelve months later. The results showed that the participants experienced that their internal resources and coping skills had been strengthened by the supervision. They developed abilities to meet the challenges more constructively than before. New understandings gave them the opportunity to alternative actions in practice. Further intervention studies of person-centred clinical supervision must focus on such clinical outcomes as patient safety and professional development.展开更多
This article describes a user-centred method used to design innovative pattern recognition software for technical paper documents. This kind of software can make some errors of interpretation. It will therefore be imp...This article describes a user-centred method used to design innovative pattern recognition software for technical paper documents. This kind of software can make some errors of interpretation. It will therefore be important that human operators are able to identify and correct these mistakes. The identification of errors is a difficult task because operators need to establish co-reference between the initial document and it interpretation. Moreover, users must be able to checks the interpretation without forgetting any area. This task requires the interface is easy to use. The experiments showed that the sequential display of interpretation is the most effective and that the interruptions by user reduce task duration. Moreover, queries by the system may improve error detection. This paper summarizes the main results of the research conducted in the context of this design for enhance the interface, and describes the specifications to which it gave rise.展开更多
The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred...The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.展开更多
Objective:To evaluate efficiency of HAART in the prevention of mother to child HIV transmission.Methods:A longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre...Objective:To evaluate efficiency of HAART in the prevention of mother to child HIV transmission.Methods:A longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre from September 2010 to July 2011.The HIV status of mothers was determined by rapid tests and EUSA.Discordant results were confirmed by real-time PCR.PCR was used to determine HIV status of children born from HIV-positive mothers.Results:Among 1 300 pregnant women tested for HIV,378 were seropositive.Mothers were predominantly housewives(69.7%),and their mean age was(28.32±0.15) years.The overall prevalence of HIV transmission from mother to child was 4.8%(18/378).This prevalence differed significantly from 0.0%(0/114) to 6.8%(18/264) in children born from mothers under HAART and those with mothers under New Prophylactic Protocol(ACT + 3TC + NVP),respectively(P【 0.01).Children’s mortality rate during the medical follow up was 1.3%(5/378).Among 16 women with HIV dubious status by ELISA,the Real Time PCR confirmed 2/16(12.5%) as HIV positive. Conclusions:The protocol of prevention of mother to children HIV transmission(PMTCT) is effective.The rate of HIV vertical transmission is significantly reduced.Early diagnosis determined by PCR of children born from HIV- positive mother is necessary and recommended in the context of PMTCT in Burkina Faso.We also found that PCR is an effective tool to confirm HIV status in pregnant women.展开更多
Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and effic...Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass（LRYGB） and sleeve gastrectomy（LSG） in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index（BMI） §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22（22 males and 46 female） were 58.8 years（55-79 years） and 39.5 kg/m（32.00-60.40 kg/m）.LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia（ASA） score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients（88.63% vs.50%; P,0.01）.The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss（%EWL） at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB（69.2%） as compared to LSG（33.3%）.On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.展开更多
To evaluate the costs of the introduction of a laparoscopic surgery program for gastric cancer in a Western community training hospital and tertiary referral centre for gastric cancer surgery. METHODSAll patients who ...To evaluate the costs of the introduction of a laparoscopic surgery program for gastric cancer in a Western community training hospital and tertiary referral centre for gastric cancer surgery. METHODSAll patients who underwent surgery for gastric cancer with curative intent in 2013 and 2014 were prospectively included. Primary outcomes were costs regarding surgery and hospital stay. RESULTSLaparoscopic gastrectomy was used in 52 patients [mean age 68 years (± 9, range 50 to 87)] and open gastrectomy was used in 25 patients [mean age 70 years (± 10, range 46 to 85)]. Mean costs (in euro’s) of surgical instrumentation were significantly higher for laparoscopic surgery: 2270 ± 670 vs 1181 ± 680 in the open approach (P < 0.001). Costs of theatre use were higher in the laparoscopic group: mean 3819 ± 865 vs 2545 ± 1268 in the open surgery (P < 0.001). Total costs of hospitalization (i.e., costs of surgery and admission) were not different between laparoscopic and open surgery, 8187 ± 4864 and 7673 ± 8064 respectively (P = 0.729). Mean length of hospital stay was 9 ± 12 d in the laparoscopic group vs 14 ± 14 d in the open group (P = 0.044). CONCLUSIONThe introduction of laparoscopic gastrectomy for gastric cancer coincided with higher costs for theatre use and surgical instrumentation compared to the open technique. Total costs were not significantly different due to shorter length of stay and less intensive care unit (ICU) admissions and shorter ICU stay in the laparoscopic group.展开更多
Sperm banking can preserve male fertility effectively, but the current conditions of sperm cryopreservation in China have not been investigated. This retrospective investigation was based on data collected at multiple...Sperm banking can preserve male fertility effectively, but the current conditions of sperm cryopreservation in China have not been investigated. This retrospective investigation was based on data collected at multiple centres in China from January 2003 to December 2008. The collected data included urogenital history, indication for cryopreservation, semen parameters, use rate, type of assisted reproductive technique （ART） treatment and pregnancy outcome. The study population included 1 548 males who had banked their semen during the study period at one of the clinics indicated above. Approximately 1.9% （30/1 548） of the cryopreserved semen samples were collected from cancer patients; about 88.8% （1 374/1 548） of the patients had banked their semen for ART and 8.6% （134/1 548） had a male infertility disease （such as anejaculation, severe oligozoospermia and obstructive azoospermia）. The total use rate of cryopreserved semen was 22.7% （352/1 548）, with 119 live births. The cancer group use rate was 6.7% （2/30）, with one live birth by intracytoplasmic single sperm injection （ICSI）. The ART group use rate was 23.2% （319/1 374）, with 106 live births. The reproductive disease group use rate was 23.1% （31/134）, with 12 live births. The semen parameters in each category varied; the cancer patient and infertility disease groups had poor semen quality. In vitro fertilization （IVF） and ICSI were the most common ART treatments for cryopreserved sperm. Semen cryopreservation as a salvage method is effective, but in many conditions it is underutilized, especially in cancer patients. Lack of awareness, urgency of cancer treatment and financial constraints are the main causes of the low access rate. The concept of fertility preservation should be popularized to make better use of this medical service in China.展开更多
Objective:To assess the prevalence of parasitic infections among patients attending Saint Camille Medical Centre and to estimate co-parasitic infections rates.Methods:From January to December 2009,stool samples were c...Objective:To assess the prevalence of parasitic infections among patients attending Saint Camille Medical Centre and to estimate co-parasitic infections rates.Methods:From January to December 2009,stool samples were collected from 11 728 persons,aged from five months to 72 years and suffering from gastroenteritis.After macroscopic description,the stools were examined by light microscopy to search for the presence of parasites.Results:From the 11 728 analyzed stools,6 154(52.47%) were infected with at least one parasite.Protozoan frequently encountered were:Giardia intestinalis(43.47%),Entamoeba histolytica/Entamoeba dispar(30.74%) and Trichomonas irUestinalis(21.72%),while Hymenolepis nana(2.25%) was the most common helminth.Co-infections occurred in 22.34%cases.Within the multi-infected samples,dual and triple infections accounted for 71.18%and 20.00%,respectively.Giardia irUestinalis for protozoan and Hymenolepis nana for helminths were the most implicated co-infections.Conclusions: This study confirms that intestinal parasites are still a public health problem in Burkina Faso.To reduce the incidence of parasitic infections,it is necessary to promote the education of people so that they practice the rules of individual and collective hygiene.展开更多
BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission af...BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.展开更多
Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes(ACS). In the situation where patients d...Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes(ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions(PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction(STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital(PCI-H) arrival(215 vs. 95 min, P < 0.001), symptom-onset to balloon inflation(225 vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times(106 vs. 56 min, P < 0.001). Only 28%(n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60%(n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation;compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.展开更多
Summer precipitation anomalies over eastern China axe characterized spatially by meridionally banded structnres fluctu- ating on interannual and interdecadal timescales, leading to regional droughts and floods. In add...Summer precipitation anomalies over eastern China axe characterized spatially by meridionally banded structnres fluctu- ating on interannual and interdecadal timescales, leading to regional droughts and floods. In addition to long-term trends, how these patterns may change under global warming has important implications for agricultural planning and water resources over this densely populated area. Using the latest Hadley Centre climate model, HadGEM3-GC2, this paper investigates the potential response of summer precipitation patterns over this region, by comparing the leading modes between a 4×CQ simulation and the model＇s pre-industrial control simulation. Empirical Orthogonal Function （EOF） analyses show that the first two leading modes account for about 20% of summer rainfall variability. EOF1 is a monopole mode associated with the developing phase of ENSO events and EOF2 is a dipole mode associated with the decaying phase of ENSO. Under 4×CO2 forcing, the dipole mode with a south-north orientation becomes dominant because of a strengthened influence from exces- sive warming of the Indian Ocean. On interdecadal time scales, the first EOF looks very different from the control simulation, showing a dipole mode of east-west contrast with enhanced influence from high latitudes.展开更多
Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, ...Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.展开更多
An accurate one-centre method for the hydrogen molecule ion is tested. The slow convergence and singularities at the nuclear positions that are problems in the general one-centre method axe solved well by employing th...An accurate one-centre method for the hydrogen molecule ion is tested. The slow convergence and singularities at the nuclear positions that are problems in the general one-centre method axe solved well by employing the optimal radial and angular B-spline basis. Therefore, the accuracy of the one-centre method is improved observably. For the ground state of the H2^＋ in the free field, 7 ×10^-8 accuracy is obtained, which rivals the best one-centre calculation before. As a test, the nuclear distances and the total energies of the 1σ g,u, 1πu, 1δ9,u and 2σg states of the H2^＋ for the magnetic field strength B = 1 a.u. are also obtained. Compared to other results, five-digit accuracy at least can be arrived even for the antibonding states 1σu and 1σu, whose equilibrium distances R is very large.展开更多
AIM To analyse clinical and long-term oncologic results after laparoscopic complete mesocolic excision(CME)for colonic cancer over a 10-year period.METHODS Consecutive patients who received laparoscopic CME at our hos...AIM To analyse clinical and long-term oncologic results after laparoscopic complete mesocolic excision(CME)for colonic cancer over a 10-year period.METHODS Consecutive patients who received laparoscopic CME at our hospital from 2007 to 2017 were prospectively registered and retrospectively analysed.In total,341 patients were included with tumour-nodal-metastasis(TNM)stages 0-Ⅲ.RESULTS The mean age of the patients was 71.9 years.The median length of stay was 5 d.The mean lymph node harvest was 17.8.The mortality rate was 1.2%.Fifteen patients were reoperated on for anastomotic leaks.The local recurrence rate was 2.3%.Five-year TTR and cancer-specific survival CSS were 83.1%and 90.3%.The location of the tumour was not a significant variable for survival in unadjusted and adjusted survival analysis.TNM stage and anastomotic leaks were significant variables with respect to survival.CONCLUSION Laparoscopic CME results in acceptable complication rates and long-term oncologic results.It is important to avoid anastomotic leaks because of their negative effect on survival.展开更多
文摘Achieving universal eye health remains a global challenge,particularly in low-and middle-income countries where visual impairment and blindness are prevalent.While advances in tertiary eye care have improved outcomes,access to primary eye care(PEC)continues to be inadequate in rural and underserved regions.This gap necessitates innovative,scalable models that provide accessible,affordable,and comprehensive eye care.The Vision Centre(VC)model,pioneered by the Aravind Eye Care System(AECS),exemplifies a sustainable approach to delivering PEC.Designed as permanent facilities in rural communities,VCs are equipped with state-of-the-art diagnostic tools and staffed by trained allied ophthalmic personnel.The integration of teleophthalmology,electronic medical records,and artificial intelligence enhances the model’s capacity to address complex conditions like diabetic retinopathy and glaucoma.VCs have demonstrated significant impact in improving accessibility,reducing financial burdens,and increasing utilization of eye care services.In the fiscal year 2023-2024,AECS VCs recorded nearly one million outpatient visits,achieving a 25%population coverage rate and generating substantial cost savings of ₹647 million(US$7.8 million)for patients.The model's success is underpinned by community engagement,a focus on operational excellence,and a robust referral system to tertiary hospitals.This review explores the evolution,implementation,and impact of the AECS VC model,emphasizing its alignment with the Sustainable Development Goals and Universal Health Coverage.By addressing accessibility and affordability,the VC model serves as a scalable template for primary eye care delivery in resource-limited settings globally.
文摘In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise,but involves certain challenges,such as limited access,low technological literacy,and privacy concerns.These barriers disproportionately affect deprived populations and individuals with severe mental health conditions.We highlight the positive impact of smart healthcare solutions,such as telemedicine and wearable technologies,on patient engagement,remote monitoring,and treatment adherence.To overcome these challenges,we propose strategies,such as improving user-friendliness,ensuring equitable access to digital interventions,enhancing cybersecurity,and integrating smart healthcare into clinical workflows.Training healthcare providers and developing policies to ensure the ethical use of patient data are essential.When implemented thoughtfully,smart healthcare technologies can revolutionize mental health and substance use disorder treatment,improve patient outcomes,and reduce healthcare inequities.
基金a grant from the International Development Research Centre, Canada, and Microsoft Corporationsupport of the Seminario Permanente de Investigacion Agraria (Permanent Seminar on Agricultural Research), SEPIA
文摘Communities in developing country mountain areas,in part due to their remoteness,find themselves excluded from social,political and economic systems; and excluded from access to resources. This paper aims to study the impact of information and communication technologies (ICTs) on remoteness and exclusion. It utilises two models - the resource movement framework,and the "information chain" - to analyse a telecentre in one district of mountainous Huancavelica,Peru's poorest region,set in the high Andes. It finds ICTs enabling new and positive resource flows for the two key user groups:teenaged school students and young farmers. These help to maintain social networks. They also support information searches that have improved agricultural practice where other information chain resources have been available. But non-use and ineffective use of the telecentre are found where information chain resources are lacking. ICTs have some impacts on intangible elements of remoteness. In this particular example,they also offer access to some previously-excluded resources. But they have not really addressed the systematic exclusions faced by mountain communities. And they so far appear to be a technology of inequality; favouring those residents who begin with better resource endowments.The paper concludes by offering some recommendations for mountain ICT project practice.
文摘Community volunteers were recruited and trained to deliver person-centred care to patients with dementia or delirium in an acute hospital setting, in a small rural Australian hospital. The volunteer program was grounded in action research methodology, and modelled on a previous research project. As a form of evaluation, interviews were conducted with nursing staff eight weeks after implementation of the volunteer program to explore their opinions. Data were analysed through a collaborative process and findings revealed strong benefits from the perspectives of the nursing staff. These benefits included overall improved patient care and improved time management for nursing tasks.
文摘In the present article, we emphasize the symptom experience perspective in person-centred care and discuss barriers to implementation of this approach. There are obstacles to overcome: the diversity of understandings of symptoms in clinical settings, the current biomedical discourse and the incompleteness of symptom research. Since the 19th century, the biomedical perspective has been powerful in conceptualizing symptoms in terms of pathology and diagnosis. Many diagnoses conjure up preconceived notions about the persons receiving them. This perspective may influence person-centred care negatively. Yet symptoms often mean something beyond the diagnosis. Recognizing this discrepancy, it is crucial that we consider a perspective that starts from each person’s symptom experience, thus complementing the biomedical perspective. Using the notion caring about symptoms, we advocate a person-centred approach that includes a symptom experience perspective. This requires health-care professionals to be skilled in listening to patient narratives and acquire knowledge about how symptom experiences can be individually expressed and interpreted. Listening to symptom experiences may give insights into the personal meaning of illness as well as information about bodily and social restrictions caused by symptom distress. In this way, caring about symptoms will improve the prerequisites for establishing person-centred care planning.
基金received funding from University College,Nord-Trondelag,Norway.
文摘Satisfied employees in healthcare services who have opportunities to develop their professional competence by reflecting on professional challenges play an important role in the quality of care. The aim of the present study was to describe the employees’ experience of the benefits of participating in a person-centred clinical supervision setting. The supervision, guided by a professional supervisor, was carried out with a group of six day- and night-shift municipal healthcare professionals for a period of four months during their mandatory work hours. Data were obtained from written individual evaluations and group interviews shortly after the last session and again twelve months later. The results showed that the participants experienced that their internal resources and coping skills had been strengthened by the supervision. They developed abilities to meet the challenges more constructively than before. New understandings gave them the opportunity to alternative actions in practice. Further intervention studies of person-centred clinical supervision must focus on such clinical outcomes as patient safety and professional development.
文摘This article describes a user-centred method used to design innovative pattern recognition software for technical paper documents. This kind of software can make some errors of interpretation. It will therefore be important that human operators are able to identify and correct these mistakes. The identification of errors is a difficult task because operators need to establish co-reference between the initial document and it interpretation. Moreover, users must be able to checks the interpretation without forgetting any area. This task requires the interface is easy to use. The experiments showed that the sequential display of interpretation is the most effective and that the interruptions by user reduce task duration. Moreover, queries by the system may improve error detection. This paper summarizes the main results of the research conducted in the context of this design for enhance the interface, and describes the specifications to which it gave rise.
基金supported by the Japan Society for Promotion of Science(ID No.S15190)and awards to Professor Elisabeth Severinsson for her work at the Department of Midwifery and Women’s Health at The University of Tokyosupported by a grant from the University College of Southeast Norway.
文摘The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.
基金the Episcopal Italian Conference in Roma,Italy,for the financial support
文摘Objective:To evaluate efficiency of HAART in the prevention of mother to child HIV transmission.Methods:A longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre from September 2010 to July 2011.The HIV status of mothers was determined by rapid tests and EUSA.Discordant results were confirmed by real-time PCR.PCR was used to determine HIV status of children born from HIV-positive mothers.Results:Among 1 300 pregnant women tested for HIV,378 were seropositive.Mothers were predominantly housewives(69.7%),and their mean age was(28.32±0.15) years.The overall prevalence of HIV transmission from mother to child was 4.8%(18/378).This prevalence differed significantly from 0.0%(0/114) to 6.8%(18/264) in children born from mothers under HAART and those with mothers under New Prophylactic Protocol(ACT + 3TC + NVP),respectively(P【 0.01).Children’s mortality rate during the medical follow up was 1.3%(5/378).Among 16 women with HIV dubious status by ELISA,the Real Time PCR confirmed 2/16(12.5%) as HIV positive. Conclusions:The protocol of prevention of mother to children HIV transmission(PMTCT) is effective.The rate of HIV vertical transmission is significantly reduced.Early diagnosis determined by PCR of children born from HIV- positive mother is necessary and recommended in the context of PMTCT in Burkina Faso.We also found that PCR is an effective tool to confirm HIV status in pregnant women.
文摘Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass（LRYGB） and sleeve gastrectomy（LSG） in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index（BMI） §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22（22 males and 46 female） were 58.8 years（55-79 years） and 39.5 kg/m（32.00-60.40 kg/m）.LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia（ASA） score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients（88.63% vs.50%; P,0.01）.The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss（%EWL） at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB（69.2%） as compared to LSG（33.3%）.On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.
文摘To evaluate the costs of the introduction of a laparoscopic surgery program for gastric cancer in a Western community training hospital and tertiary referral centre for gastric cancer surgery. METHODSAll patients who underwent surgery for gastric cancer with curative intent in 2013 and 2014 were prospectively included. Primary outcomes were costs regarding surgery and hospital stay. RESULTSLaparoscopic gastrectomy was used in 52 patients [mean age 68 years (± 9, range 50 to 87)] and open gastrectomy was used in 25 patients [mean age 70 years (± 10, range 46 to 85)]. Mean costs (in euro’s) of surgical instrumentation were significantly higher for laparoscopic surgery: 2270 ± 670 vs 1181 ± 680 in the open approach (P < 0.001). Costs of theatre use were higher in the laparoscopic group: mean 3819 ± 865 vs 2545 ± 1268 in the open surgery (P < 0.001). Total costs of hospitalization (i.e., costs of surgery and admission) were not different between laparoscopic and open surgery, 8187 ± 4864 and 7673 ± 8064 respectively (P = 0.729). Mean length of hospital stay was 9 ± 12 d in the laparoscopic group vs 14 ± 14 d in the open group (P = 0.044). CONCLUSIONThe introduction of laparoscopic gastrectomy for gastric cancer coincided with higher costs for theatre use and surgical instrumentation compared to the open technique. Total costs were not significantly different due to shorter length of stay and less intensive care unit (ICU) admissions and shorter ICU stay in the laparoscopic group.
文摘Sperm banking can preserve male fertility effectively, but the current conditions of sperm cryopreservation in China have not been investigated. This retrospective investigation was based on data collected at multiple centres in China from January 2003 to December 2008. The collected data included urogenital history, indication for cryopreservation, semen parameters, use rate, type of assisted reproductive technique （ART） treatment and pregnancy outcome. The study population included 1 548 males who had banked their semen during the study period at one of the clinics indicated above. Approximately 1.9% （30/1 548） of the cryopreserved semen samples were collected from cancer patients; about 88.8% （1 374/1 548） of the patients had banked their semen for ART and 8.6% （134/1 548） had a male infertility disease （such as anejaculation, severe oligozoospermia and obstructive azoospermia）. The total use rate of cryopreserved semen was 22.7% （352/1 548）, with 119 live births. The cancer group use rate was 6.7% （2/30）, with one live birth by intracytoplasmic single sperm injection （ICSI）. The ART group use rate was 23.2% （319/1 374）, with 106 live births. The reproductive disease group use rate was 23.1% （31/134）, with 12 live births. The semen parameters in each category varied; the cancer patient and infertility disease groups had poor semen quality. In vitro fertilization （IVF） and ICSI were the most common ART treatments for cryopreserved sperm. Semen cryopreservation as a salvage method is effective, but in many conditions it is underutilized, especially in cancer patients. Lack of awareness, urgency of cancer treatment and financial constraints are the main causes of the low access rate. The concept of fertility preservation should be popularized to make better use of this medical service in China.
文摘Objective:To assess the prevalence of parasitic infections among patients attending Saint Camille Medical Centre and to estimate co-parasitic infections rates.Methods:From January to December 2009,stool samples were collected from 11 728 persons,aged from five months to 72 years and suffering from gastroenteritis.After macroscopic description,the stools were examined by light microscopy to search for the presence of parasites.Results:From the 11 728 analyzed stools,6 154(52.47%) were infected with at least one parasite.Protozoan frequently encountered were:Giardia intestinalis(43.47%),Entamoeba histolytica/Entamoeba dispar(30.74%) and Trichomonas irUestinalis(21.72%),while Hymenolepis nana(2.25%) was the most common helminth.Co-infections occurred in 22.34%cases.Within the multi-infected samples,dual and triple infections accounted for 71.18%and 20.00%,respectively.Giardia irUestinalis for protozoan and Hymenolepis nana for helminths were the most implicated co-infections.Conclusions: This study confirms that intestinal parasites are still a public health problem in Burkina Faso.To reduce the incidence of parasitic infections,it is necessary to promote the education of people so that they practice the rules of individual and collective hygiene.
文摘BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.
文摘Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes(ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions(PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction(STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital(PCI-H) arrival(215 vs. 95 min, P < 0.001), symptom-onset to balloon inflation(225 vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times(106 vs. 56 min, P < 0.001). Only 28%(n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60%(n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation;compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.
基金jointly sponsored by the National Key R&D Program of China(Grant No.2016YFA0600404)the National Natural Science Foundation of China(Grant Nos.41530532 and 41605057)+1 种基金the China Special Fund for Meteorological Research in the Public Interest(Grant No.GYHY201506001-1)the Jiangsu Collaborative Innovation Center for Climate Change,and the UK-China Research & Innovation Partnership Fund through the Met Office Climate Science for Service Partnership(CSSP) China as part of the Newton Fund
文摘Summer precipitation anomalies over eastern China axe characterized spatially by meridionally banded structnres fluctu- ating on interannual and interdecadal timescales, leading to regional droughts and floods. In addition to long-term trends, how these patterns may change under global warming has important implications for agricultural planning and water resources over this densely populated area. Using the latest Hadley Centre climate model, HadGEM3-GC2, this paper investigates the potential response of summer precipitation patterns over this region, by comparing the leading modes between a 4×CQ simulation and the model＇s pre-industrial control simulation. Empirical Orthogonal Function （EOF） analyses show that the first two leading modes account for about 20% of summer rainfall variability. EOF1 is a monopole mode associated with the developing phase of ENSO events and EOF2 is a dipole mode associated with the decaying phase of ENSO. Under 4×CO2 forcing, the dipole mode with a south-north orientation becomes dominant because of a strengthened influence from exces- sive warming of the Indian Ocean. On interdecadal time scales, the first EOF looks very different from the control simulation, showing a dipole mode of east-west contrast with enhanced influence from high latitudes.
文摘Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.
基金Supported by the National Natural Science Foundation of China under Grant No 10674154 and 10747167.
文摘An accurate one-centre method for the hydrogen molecule ion is tested. The slow convergence and singularities at the nuclear positions that are problems in the general one-centre method axe solved well by employing the optimal radial and angular B-spline basis. Therefore, the accuracy of the one-centre method is improved observably. For the ground state of the H2^＋ in the free field, 7 ×10^-8 accuracy is obtained, which rivals the best one-centre calculation before. As a test, the nuclear distances and the total energies of the 1σ g,u, 1πu, 1δ9,u and 2σg states of the H2^＋ for the magnetic field strength B = 1 a.u. are also obtained. Compared to other results, five-digit accuracy at least can be arrived even for the antibonding states 1σu and 1σu, whose equilibrium distances R is very large.
文摘AIM To analyse clinical and long-term oncologic results after laparoscopic complete mesocolic excision(CME)for colonic cancer over a 10-year period.METHODS Consecutive patients who received laparoscopic CME at our hospital from 2007 to 2017 were prospectively registered and retrospectively analysed.In total,341 patients were included with tumour-nodal-metastasis(TNM)stages 0-Ⅲ.RESULTS The mean age of the patients was 71.9 years.The median length of stay was 5 d.The mean lymph node harvest was 17.8.The mortality rate was 1.2%.Fifteen patients were reoperated on for anastomotic leaks.The local recurrence rate was 2.3%.Five-year TTR and cancer-specific survival CSS were 83.1%and 90.3%.The location of the tumour was not a significant variable for survival in unadjusted and adjusted survival analysis.TNM stage and anastomotic leaks were significant variables with respect to survival.CONCLUSION Laparoscopic CME results in acceptable complication rates and long-term oncologic results.It is important to avoid anastomotic leaks because of their negative effect on survival.
