Prioritization of patients' access to health care services

L'accès aux services de santé et les longs délais d'attente sont l’un des principaux problèmes dans la plupart des pays du monde, dont le Canada et les États-Unis. Les organismes de soins de santé ne peuvent pas augmenter leurs ressources limitées, ni traiter tous les patients simultanément. C'est pourquoi une attention particulière doit être portée à la priorisation d'accès des patients aux services, afin d’optimiser l’utilisation de ces ressources limitées et d’assurer la sécurité des patients. En fait, la priorisation des patients est une pratique essentielle, mais oubliée dans les systèmes de soins de santé à l'échelle internationale. Les principales problématiques que l’on retrouve dans la priorisation des patients sont: la prise en considération de plusieurs critères conflictuels, les données incomplètes et imprécises, les risques associés qui peuvent menacer la vie des patients durant leur mise sur les listes d'attente, les incertitudes présentes dans les décisions des cliniciens et patients, impliquant l'opinion des groupes de décideurs, et le comportement dynamique du système. La priorisation inappropriée des patients en attente de traitement a une incidence directe sur l’inefficacité des prestations de soins de santé, la qualité des soins, et surtout sur la sécurité des patients et leur satisfaction. Inspirés par ces faits, dans cette thèse, nous proposons de nouveaux cadres hybrides pour prioriser les patients en abordant un certain nombre de principales lacunes aux méthodes proposées et utilisées dans la littérature et dans la pratique. Plus précisément, nous considérons tout d'abord la prise de décision collective incluant les multiples critères de priorité, le degré d'importance de chacun de ces critères et de leurs interdépendances dans la procédure d'établissement des priorités pour la priorisation des patients. Puis, nous travaillons sur l'implication des risques associés et des incertitudes présentes dans la procédure de priorisation, dans le but d'améliorer la sécurité des patients. Enfin, nous présentons un cadre global en se concentrant sur tous les aspects mentionnés précédemment, ainsi que l'implication des patients dans la priorisation, et la considération des aspects dynamiques du système dans la priorisation. À travers l'application du cadre global proposé dans le service de chirurgie orthopédique à l'hôpital universitaire de Shohada, et dans un programme clinique de communication augmentative et alternative appelé PACEC à l'Institut de réadaptation en déficience physique de Québec (IRDPQ), nous montrons l'efficacité de nos approches en les comparant avec celles actuellement utilisées. Les résultats prouvent que ce cadre peut être adopté facilement et efficacement dans différents organismes de santé. Notamment, les cliniciens qui ont participé à l'étude ont conclu que le cadre produit une priorisation précise et fiable qui est plus efficace que la méthode de priorisation actuellement utilisée. En résumé, les résultats de cette thèse pourraient être bénéfiques pour les professionnels de la santé afin de les aider à: i) évaluer la priorité des patients plus facilement et précisément, ii) déterminer les politiques et les lignes directrices pour la priorisation et planification des patients, iii) gérer les listes d'attente plus adéquatement, vi) diminuer le temps nécessaire pour la priorisation des patients, v) accroître l'équité et la justice entre les patients, vi) diminuer les risques associés à l’attente sur les listes pour les patients, vii) envisager l'opinion de groupe de décideurs dans la procédure de priorisation pour éviter les biais possibles dans la prise de décision, viii) impliquer les patients et leurs familles dans la procédure de priorisation, ix) gérer les incertitudes présentes dans la procédure de prise de décision, et finalement x) améliorer la qualité des soins.Access to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care

Facebook satisfaction, life satisfaction: Malaysian undergraduate experience

The central aim of this study was to investigate an approach whereby students’ online social networking produces positive psychological outcomes. Basically, Facebook is a social site that is open to all and closely integrated into the daily experience of most undergraduate students in Malaysia. This study conducted to analyse the association between the number of Facebook friends and the amount of time spent on Facebook with life satisfaction. The purpose of the current study was to investigate what gratifications Malaysian students obtain from Facebook uses. The present study also probed to find out whether gratification obtaining from Facebook uses predicts life satisfaction. In doing so, the theory of the uses and gratification and the theory of the life satisfaction were adopted as theoretical frame work. Our findings of 798 participants, conducting a factor analysis, explored respectively the following gratifications behind Facebook uses: entertainment, communication, social investigation social attention, shared identity and information seeking. Furthermore, using the regression equation, this study failed to find direct association between number of Facebook friends and amount of time using with life satisfaction. The number of Facebook friends while controlling by Facebook motivations could predict life satisfaction. So, it is propounded the view that general uses of social networking sites don’t meet the psychological effects, but the type of certain interaction is the matter. Finally, the findings of this study detected shared identity and social attention as two obtaining gratification that predicted students’ life satisfaction

A COMPARATIVE STUDY ON THE CYTOTOXIC EFFECT OF DIFFERENT CONCENTRATIONS OF HYDROGEN PEROXIDE AND CARBAMIDE PEROXIDE ON THE SURVIVAL OF HUMAN DENTAL PULP STEM CELLS IN VITRO

Abstract. Background: Tooth discoloration due to different causes (systemic or acquired) is one of the major issues that has involved the dentists to itself. up to now, dental bleaching has been reported as the most conservative method of treating teeth discoloration. In most bleaching methods, hydrogen peroxide and carbamide peroxide derivatives are used at different concentrations. Considering that these materials are oxidative materials, in this study, we are trying to evaluate and compare the toxicity of different concentrations of these two materials on dental pulp stem cells. Materials andmethods: Human dental pulp stem cells (DPSCs) were extracted and cultured, and they were treated with 50, 100, 180, 250 and 300 μM concentrations of hydrogen peroxide and 1.9, 0.95, 0.71, 0.47 and 0.24 mg/ml concentrations of carbamide peroxide. Metabolic activity of the cells was evaluated by MTT test. Objective: The purpose of this study was to evaluate and compare the cytotoxic effects of various concentrations of hydrogen peroxide and carbamide peroxide on the survival of human dental pulp stem cells. Results: The results showed that viability of treated cells with hydrogen peroxide andcarbamide peroxide has decreased at high concentrations. IC50 was at 180 μM concentration from HP and 1.9 mg concentration of CP, which was statistically significant (P<0.05). Conclusion: The results of our studies showed that these two materials affect the growth of stem cells in a dose-dependent manner. These materials, at low concentrations, cause a esistance to oxidative stress, however, at high concentrations, they have toxic effects on cell growth. The fatal effect of hydrogen peroxide on cells is much more than the effect of carbamide peroxide on the same cell line. It can be concludedthat carbamide peroxide has less side effects than hydrogen peroxide and its use at a lower dose compared to hydrogen peroxide can be a good method for tooth bleaching.Keywords: Stem cells, Dental pulp, Apoptosis, Hydrogen peroxide, Carbamide peroxid

Effect of the Bone Graft on the Surface Microhardness of Endodontic Biomaterials

Introduction: During periapical surgery, using of bone products in large endodontic lesions, is a treatment option that could affect the properties of the retro-filling endodontic material. The aim of present study was to evaluate the effect of Osteon II bone powder on the surface microhardness of calcium-enriched mixture (CEM) and mineral trioxide aggregate (MTA). Methods and Materials: Each material was mixed and carried into 40 sterile custom-made plastic cylinders. Half of the samples in each group were exposed to Osteon II. All cylinders were submerged in simulated tissue fluid and incubated at 37°C and 100% relative humidity for 7 days. Surface microhardness values of each study group was attained using Vickers microhardness test. The data were analyzed statistically using two-way ANOVA and independent t-test at a significance level of 0.05. Results: The highest and lowest microhardness values were recorded in the MTA/without Osteon and MTA/with Osteon groups, respectively. Irrespective of the presence or absence of bone powder, the overall microhardness of CEM cement and MTA was not significantly different. In the MTA group, the presence of the powder resulted in a significant decrease (P<0.05) of the microhardness; however, its effect on CEM cement was not significant (P>0.05). Conclusion: Under the limitations of the present in vitro study, the presence of Osteon bone powder had no negative effect on the microhardness of CEM cement, contrary to its effect on MTA.Keywords: Bone Graft; Calcium-enriched Mixture; Hardness; Mineral Trioxide Aggregat

Prediction of adverse pregnancy outcomes by first‑trimester components of metabolic syndrome : a prospective longitudinal study

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Springer in Archives of Gynecology and Obstetrics on 3/3/2023.Available online: doi.org/10.1007/s00404-023-06967-0acceptedVersio

Original Article

Objectives: Balance disorder is one of the most common problems after stroke causes falling and fear of falling in some patients. The balance based video games are newly used in people with motor problems. It is very important to use different interventions for balance issues. The aim of this study is to determine the effectiveness of videogame on balance and fear of falling in one participant. Methods: This experimental study was done in a single subject system, A-B design for one patient with chronic stroke. This method including repetitive measures conducted in two phases, baseline and then twelve intervention sessions. Berg Balance Scale, Timed up and go, Functional Reach, the maximum weight bearing in different directions and the deviation from center were conducted for balance assessing. Fear of falling questionnaire was used to assess fear of falling. Analysis of results was done by C-statistic, Bayesian factor, Mann Whitney U, and visual analysis graphs. Results: The results showed significant improvement for balance skills, the maximum force produced by lower extremities and reducing fear of falling parameters. But the deviation from center graphs did not showed distinct pattern. Discussion: All analysis confirmed the efficacy of videogames on balance skills and fear of falling improvement. However, the deviation from center did not show improvement and it seems to need more studies

Corneal topography and higher-order aberrations in patients with type 2 diabetes mellitus

Background: Changes in blood sugar levels cause alterations in the anterior segment and retina of the eye. This study was aimed at evaluating corneal topography, aberrometry, and corneal asphericity in patients with treatment-naive type 2 diabetes mellitus (T2DM). Methods: Participants with treatment-naive T2DM were enrolled in this cross-sectional study. The inclusion criteria were glycated hemoglobin A1c (Hb A1c) greater than or equal to 7.5% and absence of other ocular or systemic diseases. Patients who refused to participate or had a history of topical or systemic steroid use, hyperlipidemia, hypertension, anemia, prior ocular disorder or surgery, diabetic retinopathy, glaucoma, cataract, active ocular inflammatory or infectious disease, or contact lens use were excluded. All participants underwent a comprehensive ophthalmic examination. The Pentacam HR Scheimpflug tomography system (Pentacam High Resolution; Oculus, Wetzlar, Germany) was used to measure the anterior-segment parameters. Results: Sixty eyes of 30 patients with a male-to-female ratio of 1:1 were included; the mean (standard deviation [SD]) age and Hb A1c were 51.63 (6.73) years and 8.82% (1.31%), respectively. The mean (SD) values of central corneal thickness, root mean square (RMS) of total aberration, RMS of lower-order aberrations, RMS of higher-order aberrations, spherical aberration, 0° coma, 90° coma, flat anterior keratometry (K), steep anterior K, mean anterior K, anterior topographic astigmatism, flat posterior K, steep posterior K, mean posterior K, posterior topographic astigmatism, anterior corneal asphericity, and posterior corneal asphericity were 540.22 (24.47) µm, 1.72 (0.73) µm, 1.63 (0.73) µm, 0.51 (0.17) µm, + 0.31 (0.09) µm, - 0.06 (0.15) diopters (D), 0.003 (0.21) D, 43.87 (1.49) D, 44.69 (1.50) D, 44.28 (1.44) D, + 0.82 (0.83) D, - 6.25 (0.27) D, - 6.55 (0.31) D, - 6.40 (0.28) D, - 0.30 (0.15) D, - 0.32 (0.12) Q-value, and - 0.47 (0.17) Q-value, respectively. Conclusions: We presented the mean values of Pentacam parameters for aberrometry, keratometry, and corneal asphericity in patients with treatment-naive T2DM. These values could serve as a baseline for prospective monitoring of the ocular health status of this cohort and for comparison with future cohorts of patients with well-controlled T2DM. Further studies are required to assess the presence and applicability of ocular changes following intensive blood glucose control in T2DM and further understand the related pathophysiology

Symptomatic reinfection with COVID-19: A case-report study in Iran

Coronavirus disease 2019 (COVID-19) resulted in a worldwide concern. The role of the immunity system and memory cells in this disease and their ability in preventing a secondary infection is a controversial issue. Here we presented a case of reinfection with this virus eight months after the first episode. A twenty-one-year-old man was referred to our local hospital on 19 February 2020 with symptoms of viral infection. COVID-19 infection was confirmed by RT-PCR. He got hospitalized for 5 days. Eight months later on 4 October 2020, he was again referred with symptoms of viral infection and para-clinical tests confirmed COVID-19 infection. He got hospitalized for 6 days in the second episode. Although the immunity system plays important role in COVID-19 infection through the presence of memory cells it doesn’t guarantee permanent immunity to this virus. Reinfection with COVID-19 is possible and has been reported in some other studies.

Patient Engagement and its Evaluation Tools – Current Challenges and Future Directions; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”

Considering the growing recognition of the importance of patient engagement in healthcare decisions, research and delivery systems, it is important to ensure high quality and efficient patient engagement evaluation tools. In this commentary, we will first highlight the definition and importance of patient engagement. Then we discuss the psychometric properties of the patient engagement evaluation tools identified in a recent review on patient engagement in healthcare organization- and system-level decision-making. Lastly, we suggest future directions for patient engagement and its evaluation tools