The application of process mining to care pathway analysis in the NHS

Background: Prostate cancer is the most common cancer in men in the UK and the sixth-fastest increasing cancer in males. Within England survival rates are improving, however, these are comparatively poorer than other countries. Currently, information available on outcomes of care is scant and there is an urgent need for techniques to improve healthcare systems and processes. Aims: To provide prostate cancer pathway analysis, by applying concepts of process mining and visualisation and comparing the performance metrics against the standard pathway laid out by national guidelines. Methods: A systematic review was conducted to see how process mining has been used in healthcare. Appropriate datasets for prostate cancer were identified within Imperial College Healthcare NHS Trust London. A process model was constructed by linking and transforming cohort data from six distinct database sources. The cohort dataset was filtered to include patients who had a PSA from 2010-2015, and validated by comparing the medical patient records against a Case-note audit. Process mining techniques were applied to the data to analyse performance and conformance of the prostate cancer pathway metrics to national guideline metrics. These techniques were evaluated with stakeholders to ascertain its impact on user experience. Results: Case note audit revealed 90% match against patients found in medical records. Application of process mining techniques showed massive heterogeneity as compared to the homogenous path laid out by national guidelines. This also gave insight into bottlenecks and deviations in the pathway. Evaluation with stakeholders showed that the visualisation and technology was well accepted, high quality and recommended to be used in healthcare decision making. Conclusion: Process mining is a promising technique used to give insight into complex and flexible healthcare processes. It can map the patient journey at a local level and audit it against explicit standards of good clinical practice, which will enable us to intervene at the individual and system level to improve care.Open Acces

Temporal Lobe Epilepsy with Hippocampus Sclerosis: Prevalence, Etiology, And Treatment Options with Herbal Medicines

ABSTRACT Background and objectives: Epilepsy is a neurological disorder in which the patient suffers with two or more unprovoked seizures. It is one of the most common neurological disorders worldwide, affecting more than 70 million people. Currently various modes of effective treatments are available, but still there are many cases that remain drug resistant. Hence, there is a need to explore herbal medications for the treatment of drug resistant epilepsy. Methods: Recent reviews and research articles (2000-2022) from PubMed and Google Scholar have been explored. Review: Based on etiology, there are six categories of epilepsy: Genetic, Structural, Metabolic, Immune, Infectious, and Unknown epilepsy. Temporal lobe epilepsy with hippocampus sclerosis (TLE-HS) is one of the most common forms of structural epilepsy. Even though several new anti-epileptic drugs (AEDs) have been discovered, but the treatment of some cases, especially TLE-HS remain resistant to them. Surgery is one of the most effective treatment options for TLE-HS; however, this usually results in memory deficits, and occasionally, intracranial hematoma, delayed hydrocephalus, subdural empyema, and visual field defects in patients. Conclusion: Hence, to overcome drug resistance, new pharmacological and herbal therapies are required. Animal trials are first step in the development of new drugs, to study toxicity and efficacy of proposed drugs. Many herbs have anticonvulsant activity but remain an under-explored treatment option for epilepsy. Further research on herbal extracts as a possible treatment for epilepsy needs to be conducted

Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol.

INTRODUCTION: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. METHODS: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. EXPECTED OUTCOMES: Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518)

4-(4-Nitro­phen­oxy)butanol

The crystal structure of the title compound, C10H13NO4, features inter­molecular O—H⋯O(nitro) hydrogen bonding, which links mol­ecules into supra­molecular chains running parallel to the bc diagonal. There is also π–π stacking between 4-nitro­phenyl groups, the inter­planar distance between the nitro­benzene rings being 3.472 (2) Å

Biallelic variants in four genes underlying recessive osteogenesis imperfecta

Peer reviewe

Anti-apoptotic effect of HCV core gene of genotype 3a in Huh-7 cell line

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus (HCV) Core protein regulates multiple signaling pathways and alters cellular genes expression responsible for HCV induced pathogenesis leading to hepatocellular carcinoma (HCC). Prevalence of HCV genotype 3a associated HCC is higher in Pakistan as compare to the rest of world; however the molecular mechanism behind this is still unclear. This study has been designed to evaluate the effect of HCV core 3a on apoptosis and cell proliferation which are involved in HCC</p> <p>Methodology</p> <p>We examined the in vitro effect of HCV Core protein of genotype 3a and 1a on cellular genes involved in apoptosis by Real time PCR in liver cell line (Huh-7). We analyzed the effect of HCV core of genotype 1a and 3a on cell proliferation by MTT assay and on phosphrylation of Akt by western blotting in Huh-7 cells.</p> <p>Results</p> <p>The HCV 3a Core down regulates the gene expression of Caspases (3, 8, 9 and 10), Cyto C and p53 which are involved in apoptosis. Moreover, HCV 3a Core gene showed stronger effect in regulating protein level of p-Akt as compared to HCV 1a Core accompanied by enhanced cell proliferation in Huh-7 cell line.</p> <p>Conclusion</p> <p>From the current study it has been concluded that reduced expression of cellular genes involved in apoptosis, increased p-Akt (cell survival gene) and enhanced cell proliferation in response to HCV 3a core confirms anti apoptotic effect of HCV 3a Core gene in Huh-7 that may lead to HCC.</p

Latent Class Model on Socio-Religious Data

We believe that in last two decades perception regarding socio-religious values had been changed in our society. Survey has been carried out on “changes in social values and their acceptance” in year 2011. Respondents have asked 74 questions (marked on Likert-scale) regarding educational system, political and religious affiliations and their impact on social values. Among these we have selected only those questions related to socio-religious issues (based on of individual and collective perceptions about the prevailing standard of the society in comparison with Islamic standards). Similar surveys using the same questionnaire had had conducted in year 1994 and 2001. Respondents, at each time of survey, were young students (youth acquiring education) from different colleges (Karachi region) and Karachi University. Perception can be explained more appropriately through latent class model (LCM). Through LCM we can explore structures in the data in term of different opinion groups. The modeling is done on the selected set of similar questions from each year. Conditional probabilities for year 2011, 2001 and 1994 are then compared in search of presence of any difference of opinion between the respondents. It is observed that by the passage of time, due to the influence of the electronic media there is a change in the opinion about the values of the society among the youth. Although, there is a reduction in the proportion of “Dissatisfied group” within the society but negative perception is penetrating among our young generation specifically about Ulmah and Imam’s role and women’s due rights toward society

Exploration of Groups Through Latent Structural Model

In this paper Latent Class Analysis is applied on two different data sets. One of which is of elections of Karachi University Teacher Society (KUTS) in year 1993-1994. Members of two (Rightist and Mix) groups were competing for the post of President, Vice president, Secretary and Treasurer. The second data is about the study of parenting style on rearing children along with the factors self esteem and thoughts of suicide. From both the data set we will be able to come across the groups prevailing in our society and be able to assign conditional probability to individual, to which group they belong

Promoting supportive and respectful maternity care in public health facilities in sindh, Pakistan: A theory-informed health system intervention

Background: Disrespect, abuse, discrimination, and lack of emotional support characterize intrapartum care in the health systems of many low- and middle-income countries. Although the World Health Organization (WHO) provides frameworks and guidelines to address this issue, no operational model exists that effectively incorporates WHO intrapartum care guidelines into routine public health services. We aimed to develop and pilot-test a theory-driven, service-delivery intervention package linking dignified care with perinatal mental health to promote psychosocially supportive and respectful maternity care (S-RMC) in public health facilities in Sindh, Pakistan.Methods: Using a mixed-method, pre-post design, the study was implemented in 6 secondary-level public health facilities in 2 rural districts of Southern Sindh, Pakistan. Its development was guided by the COM-B framework and informed by a literature review, formative research, and consultative sessions with implementers. The intervention was implemented in March-September 2021 and compared women\u27s experiences of S-RMC during childbirth at baseline (n=313) and endline (n=314). We used descriptive statistics and linear regression techniques for analysis.Results: A substantial reduction was observed in the cumulative level of overall mistreatment from baseline to endline, yielding a relative change of 50% (P\u3c.001). Similar change was evident across different types of mistreatment: physical abuse (75%), verbal abuse (72%), ineffective communication (60%), nonconfidential care (78%), health system conditions and constraints (25%), noninclusive care (28%), lack of supportive care (52%), and stigma and discrimination (82%). Furthermore, we observed a significant reduction in the proportion of women experiencing symptoms of anxiety and depression before and after the intervention.Conclusion: This intervention built the capacity of maternity teams while improving accountability, health information systems, and governance measures. Given its promise to promote supportive and respectful childbirth in public health facilities, a large-scale effectiveness evaluation across diverse settings is warranted