Research/Technical Note
Development of a Resource-Adaptive Acute Care Architecture for Low-Resource Hospitals:
A Yemen-Informed Clinical and Operational Framework
Khalil Gamil Hasan Mohammed Al-Sarem*
Issue:
Volume 15, Issue 3, September 2026
Pages:
27-42
Received:
29 September 2026
Accepted:
15 October 2026
Published:
29 October 2026
Abstract: Background: Acute-care delivery in resource-constrained hospitals requires two distinct judgments: what the patient clinically requires and what the facility can safely deliver at the present time. Existing triage, severity, early-warning, and syndrome-specific tools address important components of this problem but do not constitute a single operational architecture for capability matching, escalation, referral, and reassessment. Objective: To develop a testable Resource-Adaptive Acute Care Architecture (RAACA) that integrates established clinical assessment functions with a time-stamped representation of facility capability while preserving the independence of clinical risk assessment. Methods: This conceptual framework was developed through targeted evidence mapping of WHO emergency-care resources and peer-reviewed literature on emergency care, triage, deterioration assessment, and prehospital systems in low- and middle-income countries. Requirements were extracted, mapped to a seven-layer patient journey, and synthesized into explicit constructs, decision rules, operational states, and a prospective validation pathway. RAACA does not introduce a composite clinical score. Instead, it proposes a four-state operational capability taxonomy (R0–R3) and a structured capability-mismatch process. Results: RAACA comprises seven linked layers: (1) acuity/triage, (2) immediate physiologic threat, (3) severity and deterioration, (4) syndrome-specific risk, (5) required and available capability, (6) operational disposition and referral, and (7) reassessment and quality feedback. The architecture separates patient state, system state, and operational decision, and treats referral/transfer as a clinical risk-control process. R0–R3 is explicitly defined as an unvalidated operational construct rather than a severity or mortality score. Conclusions: RAACA provides a testable architecture for coordinating validated clinical tools with changing facility capability. Its principal research question is whether resource-state classification can be assigned reproducibly, represent actual capability, and improve predefined process measures without altering clinical risk classification. Prospective multicentre validation is required before clinical effectiveness can be inferred.
Abstract: Background: Acute-care delivery in resource-constrained hospitals requires two distinct judgments: what the patient clinically requires and what the facility can safely deliver at the present time. Existing triage, severity, early-warning, and syndrome-specific tools address important components of this problem but do not constitute a single operat...
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Research Article
A Narrative Review of Efficacy, Safety, and Prognostic Role of Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction
Issue:
Volume 15, Issue 3, September 2026
Pages:
43-57
Received:
18 September 2026
Accepted:
29 September 2026
Published:
31 October 2026
DOI:
10.11648/j.sjcm.20261503.12
Downloads:
Views:
Abstract: Background: Medical management of Heart failure with preserved ejection fraction (HFpEF) remains uncertain, especially beta blockers (BBs) had various outcomes in studies. The objective of the present study is to review the efficacy and prognostic role of BBs in patients with HFpEF. Methods: A total of 58 articles were chosen for this narrative review from sources including web of science, PUBMED and Google Scholar. Results: Patients with HFpEF are more prevalent in female. The average age of patients is usually 70-80 years. The most important risk factors for this condition include advanced age, female gender, hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and atrial fibrillation (AF). Despite a lack of evidence or indication, BBs are still extensively prescribed in HFpEF. In patients with HFpEF, BBs reduce blood pressure, left ventricular hypertrophy, and diastolic dysfunction by slowing heart rate and myocardial oxygen demand. BBs reduce blood pressure, but despite this, they do not improve the quality of life, cardiovascular events, and all-cause mortality. BBs may even be associated with an increased risk of HF hospitalization. In some studies, Carvedilol and Nebivolol were associated with improvement of functional capacity, NT Pro-BNP levels, and survival. Overally, using the BBs, recommended for patients of HFPEF with atrial fibrillation, hypertension, and coronary artery disease. Conclusion: BBs does not have a beneficial effect on quality of life and survival, and is also linked to a higher risk of HF-related hospitalizations. The use of BBs is not recommended for the treatment of HFpEF.
Abstract: Background: Medical management of Heart failure with preserved ejection fraction (HFpEF) remains uncertain, especially beta blockers (BBs) had various outcomes in studies. The objective of the present study is to review the efficacy and prognostic role of BBs in patients with HFpEF. Methods: A total of 58 articles were chosen for this narrative rev...
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