Development of a Short-Form McGill Pain Questionnaire for use in Libyan Populations

Objectives: The Short-Form McGill Pain Questionnaire (SF-MPQ) is an English language based tool used to assess sensory, affective and evaluative aspects of pain. The aim of this study was to develop a culturally valid version of SF-MPQ for use in Libya for pain patients. Setting: Data was collected at the Ibn Sina Hospital, Sirt, Libya. Design: The SF-MPQ was translated and back-translated into Arabic by 4 university teachers and 8 university students fluent in Arabic and English to generate an Arabic version of the SF-MPQ. A Libyan dialect equivalent was created following discussion with 4 physicians and 6 pain patients. A group of 40 pain patients (mean age 35.3 years) attending an outpatient Physiotherapy clinic in Sirt City completed the Libyan SF-MPQ. Results: It was found that the Libyan SF-MPQ scored 0.15 for Cronbach's alpha indicating poor internal reliability. SFMPQ descriptors "Shooting" and "Gnawing" were problematic during translation and only three words "Throbbing", "Cramping" and "Tiring-Exhausting" met criterion for content validity. Intensity scores for sensory descriptors of pain chosen by the 40 patients was high and scores for affective descriptors low. Conclusions: The Libyan SF-MPQ had poor internal reliability suggesting that further development of the tool is needed. Nevertheless, this first version of the Libyan SF-MPQ will be of value for health care professionals, especially as the intensity of pain in the population of Libyan patients was high. The findings of this research emphasise the need for sociallyoriented research on cultural attitudes towards reporting of pain

The suitability of care pathways for integrating processes and information systems in healthcare

Purpose: This paper examines the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for IT and as a key strategy to reducing waiting times. Approach: We conducted a qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways. Findings: Care pathways are typically modelled in an ad-hoc manner with little reference to formal syntax or semantics. Research limits: The research reviews a small selection of existing pathways. The feature set used for evaluation could be further refined. Future research should examine the suitability of applying existing process modelling techniques to care pathways and explore the motivations for modelling care pathways in an ad-hoc manner. Practical implications: The development of care pathways can aid process improvement and the integration of information systems. However, while syntax and semantics are not standardised the impact of care pathways in the work of Department of Health agencies, in particular Connecting for Health, is likely to be limited. Value: The results provide insight into the limitations of the state of the art in care pathway models. This highlights a significant omission in the Department of Health’s approach and identifies an important direction for further development that will aid Connecting for Health, healthcare organisations and healthcare professionals to deliver more effective services

Towards Unsupervised Detection of Process Models in Healthcare

Process mining techniques can play a significant role in understanding healthcare processes by supporting analysis of patient records in electronic health record systems. Healthcare processes are complex and patterns of care may vary considerably within similar cohorts of patients. Process mining often creates "spaghetti" models and require significant domain expert input to refine. Machine learning approaches such as Hidden Markov Models (HMM) may assist this refinement process. HMMs have been advocated for patient pathways clustering purposes; however these models can also be utilized for detecting hidden processes to help event abstraction. We explore use of an unsupervised method for detecting hidden healthcare sub-processes using HMMs, in particular the Viterbi algorithm. We describe an approach to enrich the event log with HMM-derived states and remodeling the healthcare processes as state transitions using a process mining tool. Our method is applied to event data for 'Altered Mental Status' patients that was extracted from a US hospital database (MIMIC-III). The results are promising and show a successful reduction of model complexity and detection of several hidden processes unsupervised by a domain expert

A Fitted Random Sampling Scheme for Load Distribution in Grid Networks

Grid networks provide the ability to perform higher throughput computing by taking advantage of many networked computer’s resources to solve large-scale computation problems. As the popularity of the Grid networks has increased, there is a need to efficiently distribute the load among the resources accessible on the network. In this paper, we present a stochastic network system that gives a distributed load-balancing scheme by generating almost regular networks. This network system is self-organized and depends only on local information for load distribution and resource discovery. The in-degree of each node is refers to its free resources, and job assignment and resource discovery processes required for load balancing is accomplished by using fitted random sampling. Simulation results show that the generated network system provides an effective, scalable, and reliable load-balancing scheme for the distributed resources accessible on Grid networks

A systematic review with meta-analysis of studies comparing response to experimentally-evoked pain between obese and non-obese individuals

© 2018 Astita et al. Background: The relationship between obesity and pain remains unclear. The aim of this systematic review was to determine whether response to experimentally-evoked pain differed between obese and non-obese individuals. Studies that compared responses to experimentally-evoked pain between obese and non-obese human participants post-puberty (i.e. >16 years) were sought. Eligible studies published between January 1950 and May 2017 were identified by searching OVID, MEDLINE, EMBASE and Science Direct. Explanation: Methodological quality of included studies was assessed using the ‘QualSyst’ questionnaire. Of 1106 references identified only nine studies (683 participants) were eligible for review. Pressure pain was assessed in five studies and electrical pain in three studies. Two studies investigated thermal pain. Obesity was categorized according to body mass index (BMI) or as weight as a percentage of ideal body weight. Six of the nine included studies were of low methodological quality. There was a lack of extractable data to pool for meta-analysis of studies using thermal or electrical pain. A forest plot of data extracted from four studies on pressure pain threshold found no differences between obese and non-obese groups (overall effect size was Z=0.57, p=0.57). Conclusion: Small sample size was the main limitation in all studies. Participants with obesity were more sensitive to mechanical noxious stimuli than non-obese participants in three of five studies. However, overall, it was not possible to determine whether there are differences in pain sensitivity response to experimental stimuli between obese and non-obese individuals

Vaccines and immunization: The past, present and future in Nigeria

Vaccines are arguably the most important public health tools available today. Since the successful eradication of smallpox with the use of the vaccine, many vaccines have become available to man. Of great importance to public and child health are the vaccines against the so-called six killer diseases of childhood-measles, pertussis, diphtheria, tetanus, tuberculosis and poliomyelitis. In the last 2 decades, effective vaccines against the major causes of pneumonia, another childhood killer, have become available. Data from many parts of the world including African countries have shown the benefits of the pneumococcal and Haemophilus influenzae type b vaccines. The scientific world is still searching for appropriate candidate vaccines for malaria and HIV infection. Despite the availability and effectiveness of many vaccines, the benefits to a country is highly dependent on a viable and sustainable health system which include adequate financing, dynamic and motivated workforce, strong partnerships and effective community participation. If well deployed, available vaccines as elucidated in this discourse can accelerate the achievements of the Millennium Development Goals in Nigeria and many other developing countries.Key words: Vaccines, Immunizations, Nigeria

Multiple sclerosis susceptibility alleles in African Americans.

Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by complex genetics and multifaceted gene-environment interactions. Compared to whites, African Americans have a lower risk for developing MS, but African Americans with MS have a greater risk of disability. These differences between African Americans and whites may represent differences in genetic susceptibility and/or environmental factors. SNPs from 12 candidate genes have recently been identified and validated with MS risk in white populations. We performed a replication study using 918 cases and 656 unrelated controls to test whether these candidate genes are also associated with MS risk in African Americans. CD6, CLEC16a, EVI5, GPC5, and TYK2 contained SNPs that are associated with MS risk in the African American data set. EVI5 showed the strongest association outside the major histocompatibility complex (rs10735781, OR=1.233, 95% CI=1.06-1.43, P-value=0.006). In addition, RGS1 seems to affect age of onset whereas TNFRSF1A seems to be associated with disease progression. None of the tested variants showed results that were statistically inconsistent with the effects established in whites. The results are consistent with shared disease genetic mechanisms among individuals of European and African ancestry

Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq

Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team

Are regulations safe? Reflections from developing a digital cancer decision support tool

PURPOSE Informatics solutions to early diagnosis of cancer in primary care are increasingly prevalent, but it is not clear whether existing and planned standards and regulations sufficiently address patients' safety nor whether these standards are fit for purpose. We use a patient safety perspective to reflect on the development of a computerized cancer risk assessment tool embedded within a UK primary care electronic health record system. METHODS We developed a computerized version of the CAncer Prevention in ExetER studies risk assessment tool, in compliance with the European Union's Medical Device Regulations. The process of building this tool afforded an opportunity to reflect on clinical concerns and whether current regulations for medical devices are fit for purpose. We identified concerns for patient safety and developed nine practical recommendations to mitigate these concerns. RESULTS We noted that medical device regulations (1) were initially created for hardware devices rather than software, (2) offer one-shot approval rather than supporting iterative innovation and learning, (3) are biased toward loss-transfer approaches that attempt to manage the fallout of harm instead of mitigating hazards becoming harmful, and (4) are biased toward known hazards, despite unknown hazards being an expected consequence of health care as a complex adaptive system. Our nine recommendations focus on embedding less-reductionist and stronger system perspectives into regulations and standards. CONCLUSION Our intention is to share our experience to support research-led collaborative development of health informatics solutions in cancer. We argue that regulations in the European Union do not sufficiently address the complexity of healthcare information systems with consequences for patient safety. Future standards and regulations should continue to follow a system-based approach to risk, safety, and accident avoidance

Process Mining in Frail Elderly Care: A Literature Review

Process mining has proved to be a valuable technique for extracting process knowledge from data within information systems. Much work has been conducted in applying process mining to domains such as logistics, banking, transportation and many areas of the government, including healthcare. Frail elderly people who have an increased risk of adverse outcomes are amongst the main users of healthcare services and understanding healthcare processes for the frail elderly is challenging because of their diverse and complex needs combined with an often high number of co-morbidities. This paper aims to provide an overview of work applying process mining techniques to improving the care of frail elderly people. We conducted a literature search using broad criteria to identify 1,047 potential papers followed by a review of titles, abstract and content which identified eight papers where process mining techniques have been successfully applied to the care of frail elderly people. Our review shows that, to date, there has been limited application of process mining to support this important segment of the population. We summarise the results based on five themes that emerged: types of source data and process; geographical location; analysis methodology; medical domain; and challenges. Our paper concludes with a discussion on the issues and opportunities for process mining to improve the care pathways for frail elderly people