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Sherchan JS, Fernandez JR, Njoku A, Brown TH, Forde AT. Perceptions of Racial-Ethnic Inequities in COVID-19 Healthcare and Willingness to Receive the COVID-19 Vaccine. Epidemiology 2024; 35:377-388. [PMID: 38567886 PMCID: PMC11022993 DOI: 10.1097/ede.0000000000001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/19/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine. METHODS This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs). RESULTS Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities. CONCLUSIONS Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults.
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Affiliation(s)
- Juliana S. Sherchan
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Jessica R. Fernandez
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Anuli Njoku
- Department of Public Health, Southern Connecticut State University, New Haven, CT
| | | | - Allana T. Forde
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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Cernega A, Nicolescu DN, Meleșcanu Imre M, Ripszky Totan A, Arsene AL, Șerban RS, Perpelea AC, Nedea MI(I, Pițuru SM. Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) in Healthcare. Healthcare (Basel) 2024; 12:773. [PMID: 38610195 PMCID: PMC11011466 DOI: 10.3390/healthcare12070773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Our professional activity is constantly under pressure from a multitude of elements and factors that can be classified into the four components of the VUCA phenomenon-volatility, uncertainty, complexity, and ambiguity-components that define the turbulence and challenges of the external environment. Considering the general elements of this phenomenon, we designed a new VUCA dimension specific to the healthcare field within which we have identified and analyzed all the factors that can influence the main actors of the doctor-patient relationship and the effects that can occur within the healthcare system in which this relationship is born. In this context, we generated the VUCA treatment in healthcare capable of mitigating the impact of this phenomenon; this treatment involves essential elements in overcoming possible crises and vulnerabilities of the medical profession. The VUCA treatment in healthcare requires combating volatility, uncertainty, complexity, and ambiguity through vision, understanding, clarity, and agility, which are grounded in the doctor's need to acquire cross-functional competencies (soft skills). These competencies are applicable by using functional mechanisms and techniques that support the doctor in developing adaptability and anticipation skills, understanding the patient's needs and addressing them, and ensuring the functionality and efficiency of the healthcare system by transferring these elements from micro-management to macro-management levels.
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Affiliation(s)
- Ana Cernega
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Dragoș Nicolae Nicolescu
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina Meleșcanu Imre
- Department of Prosthodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Calea Plevnei, 010221 Bucharest, Romania;
| | - Alexandra Ripszky Totan
- Department of Biochemistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania;
| | - Andreea Letiția Arsene
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Robert Sabiniu Șerban
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Anca-Cristina Perpelea
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina-Ionela (Ilie) Nedea
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Silviu-Mirel Pițuru
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
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Moujahid C, Turman JE, Houradi H, Amahdar L. Scoping Review to Identify Social Determinants of Maternal Health in Morocco. Int J Soc Determinants Health Health Serv 2024; 54:151-162. [PMID: 38037291 DOI: 10.1177/27551938231217589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
To understand the mechanism of health inequities and their influence on maternal health, the Commission on Social Determinants of Health (CSDH) provides a framework to identify structural and intermediate causes of health inequity. This review maps and describes the current socioeconomic determinants of maternal health in Morocco according to the CSDH framework. A scoping study was carried out from six databases (Springer, Web of Science, Pubmed, Science Direct, Jstor, and Cochrane library) based on quantitative and qualitative research done since 1990. Structural factors such as women's employment and economic status, education level, culture, and gender equity were influenced by intermediary factors such as place of residence, age at marriage, maternal age at childbirth, and parity (either alone or in conjunction with other variables). Together these factors worked to influence maternal health service usage or affected maternal health outcomes. Power dynamics were identified in a variety of social situations that impacted access to health care for women across socioeconomic categories. Studies reveal how social determinants impact maternal health in Morocco. Addressing these determinants is required for sustainably improving maternal and infant health in Morocco.
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Affiliation(s)
- Chaimae Moujahid
- Biomedical Technologies, Sciences and Technologies of Health, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Jack E Turman
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Hiba Houradi
- Biomedical Technologies, Sciences and Technologies of Health, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Loubna Amahdar
- Biomedical Technologies, Sciences and Technologies of Health, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
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Xiao Y, Chen TT, Zhu SY, Li CY, Zong L. Factors associated with workplace violence against Chinese healthcare workers: an online cross-sectional survey. Front Public Health 2024; 12:1295975. [PMID: 38550327 PMCID: PMC10977601 DOI: 10.3389/fpubh.2024.1295975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
Objectives Workplace violence (WPV) against healthcare workers (HCWs) has reached significant levels globally, impeding the quality and accessibility of healthcare systems. However, there is limited available knowledge regarding the determinants linked with WPV among HCWs and the discrepancies observed across various levels of hospitals in China. The objective of the present research was to investigate the factors linked to WPV and job satisfaction among HCWs in China. Methods A self-developed questionnaire based on WeChat was employed to collect data. The questionnaire consisted of demographic information as well as occupational factors. To measure WPV, the Chinese version of the Workplace Violence Scale was utilized. Career satisfaction was assessed through two questions regarding career choices. The collected data was analyzed using descriptive analyses, chi-square tests, and multivariate logistic regressions. Results A total of 3,781 valid questionnaires (1,029 doctors and 2,752 nurses) were collected. Among all participants, 2,201 (58.2%) reported experiencing at least one form of WPV in the past year, with emotional abuse being the most frequent occurrence (49.7%), followed by threats (27.9%). The multivariate logistic regression analysis revealed several risk factors associated with WPV, including male gender, shift work, senior professional title, bachelor's degree education, employment in secondary-level hospitals, and working over 50 h per week (p < 0.05). Career satisfaction among HCWs who experienced high levels of WPV was low, with only 11.2% remaining confident in their profession, and a mere 2.0% supporting their children pursuing careers in healthcare. Conclusion WPV poses a significant challenge within the Chinese healthcare system. Efforts should be made to address the identified risk factors and promote a safe and satisfying working environment for HCWs.
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Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting-ting Chen
- Nursing Department, West China Hospital of Sichuan University, Chengdu, China
| | - Shao-yi Zhu
- Department of Psychiatry, Shantou University Mental Health Center, Shantou, China
| | - Chun-ya Li
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Ling Zong
- Department of Judicial Expertise, Zhongshan Third People’s Hospital, Zhongshan, China
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Duliba Y, Streltsov Y, Kharchenko V, Korchak N, Antonova O. Corruption in healthcare: a view from the pandemic. Med Leg J 2024; 92:43-45. [PMID: 36510470 DOI: 10.1177/00258172221135751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Corruption in healthcare has become transnational and intersectoral in nature; leading countries around the world have become vulnerable and insufficiently prepared to address health crises. The article deals with topical issues of corruption in healthcare during the Covid-19 pandemic in public and private sectors. By comparing different ratings, we concluded that there is a correlation between the level of corruption and the average annual income of the respective state, the observance of human rights and democratic standards in the context of their response to the Covid-19 pandemic.
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Affiliation(s)
- Yevheniia Duliba
- Department of Constitutional Law and Field-Related Disciplines, Institute of Law, National University of Water and Environmental Engineering, Rivne, Ukraine
| | - Yevgen Streltsov
- Department of Criminal Law, National University "Odesa Law Academy", Ukraine
| | - Vadym Kharchenko
- Department of Criminal Law Subjects, Faculty No. 6, the Kharkiv National University of Internal Affairs, Ukraine
| | - Nataliia Korchak
- Department of Public Policy of the Educational and Scientific Institute of Public Administration and Civil Service, Taras Shevchenko National University of Kyiv, Ukraine
| | - Olena Antonova
- Department of Legal and Social and Humanitarian Disciplines, Flight Academy of the National Aviation University, Ukraine
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Al Zoubi F, Kashanian K, Beaule P, Fallavollita P. First deployment of artificial intelligence recommendations in orthopedic surgery. Front Artif Intell 2024; 7:1342234. [PMID: 38362139 PMCID: PMC10867959 DOI: 10.3389/frai.2024.1342234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Scant research has delved into the non-clinical facets of artificial intelligence (AI), concentrating on leveraging data to enhance the efficiency of healthcare systems and operating rooms. Notably, there is a gap in the literature regarding the implementation and outcomes of AI solutions. The absence of published results demonstrating the practical application and effectiveness of AI in domains beyond clinical settings, particularly in the field of surgery, served as the impetus for our undertaking in this area. Within the realm of non-clinical strategies aimed at enhancing operating room efficiency, we characterize OR efficiency as the capacity to successfully perform four uncomplicated arthroplasty surgeries within an 8-h timeframe. This Community Case Study addresses this gap by presenting the results of incorporating AI recommendations at our clinical institute on 228 patient arthroplasty surgeries. The implementation of a prescriptive analytics system (PAS), utilizing supervised machine learning techniques, led to a significant improvement in the overall efficiency of the operating room, increasing it from 39 to 93%. This noteworthy achievement highlights the impact of AI in optimizing surgery workflows.
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Affiliation(s)
- Farid Al Zoubi
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, ON, Canada
| | - Koorosh Kashanian
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul Beaule
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Pascal Fallavollita
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Fuster-Casanovas A, Miró Catalina Q, Vidal-Alaball J, Escalé-Besa A, Carrión C. eHealth in the Management of Depressive Episodes in Catalonia's Primary Care From 2017 to 2022: Retrospective Observational Study. JMIR Ment Health 2024; 11:e52816. [PMID: 38236631 PMCID: PMC10835588 DOI: 10.2196/52816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The reasons for mental health consultations are becoming increasingly relevant in primary care. The Catalan health care system is undergoing a process of digital transformation, where eHealth is becoming increasingly relevant in routine clinical practice. OBJECTIVE This study aimed to analyze the approach to depressive episodes and the role of eHealth in the Catalan health care system from 2017 to 2022. METHODS A retrospective observational study was conducted on diagnostic codes related to depressive episodes and mood disorders between 2017 and 2022 using data from the Catalan Institute of Health. The sociodemographic evolution and prevalence of depression and mood disorders in Catalonia were analyzed between 2017 and 2022. Sociodemographic variables were analyzed using absolute frequency and percentage. The prevalence of depressive episodes was calculated, highlighting the year-to-year changes. The use of eHealth for related consultations was assessed by comparing the percentages of eHealth and face-to-face consultations. A comparison of sociodemographic variables based on attendance type was conducted. Additionally, a logistic regression model was used to explore factors influencing face-to-face attendance. The analysis used R software (version 4.2.1), with all differences examined using 95% CIs. RESULTS From 2017 to 2022, there was an 86.6% increase in the prevalence of depression and mood disorders, with women consistently more affected (20,950/31,197, 67.2% in 2017 and 22,078/33,169, 66.6% in 2022). In 2022, a significant rise in depression diagnoses was observed in rural areas (difference 0.71%, 95% CI 0.04%-1.43%), contrasting with a significant decrease in urban settings (difference -0.7%, 95% CI -1.35% to -0.05%). There was a significant increase in antidepressant use in 2022 compared to 2017 (difference 2.4%, 95% CI 1.87%-3.06%) and the proportion of eHealth visits rose from 4.34% (1240/28,561) in 2017 to 26.3% (8501/32,267) in 2022. Logistic regression analysis indicated that men (odds ratio [OR] 1.06, 95% CI 1.04-1.09) and younger individuals had a higher likelihood of eHealth consultations in 2022. Furthermore, individuals using eHealth consultations were more likely to use antidepressants (OR 1.54, 95% CI 1.50-1.57) and anxiolytics (OR 1.06, 95% CI 1.03-1.09). CONCLUSIONS The prevalence of depression in Catalonia has significantly increased in the last 6 years, likely influenced by the COVID-19 pandemic. Despite ongoing digital transformation since 2011, eHealth usage remained limited as of 2017. During the lockdown period, eHealth accounted for nearly half of all health care consultations, representing a quarter of consultations by 2022. In the immediate aftermath of the COVID-19 pandemic, emerging evidence suggests a significant role of eHealth in managing depression-related consultations, along with an apparent likelihood of patients being prescribed antidepressants and anxiolytics. Further research is needed to understand the long-term impact of eHealth on diagnostic practices and medication use.
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Affiliation(s)
- Aïna Fuster-Casanovas
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central, University of Catalonia, Vic, Spain
| | - Anna Escalé-Besa
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central, University of Catalonia, Vic, Spain
| | - Carme Carrión
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
- School of Medicine, Universitat de Girona, Girona, Spain
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Sepetis A, Rizos F, Pierrakos G, Karanikas H, Schallmo D. A Sustainable Model for Healthcare Systems: The Innovative Approach of ESG and Digital Transformation. Healthcare (Basel) 2024; 12:156. [PMID: 38255044 PMCID: PMC10815686 DOI: 10.3390/healthcare12020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In recent years, the globe has faced a series of topics of growing concern, such as the COVID-19 pandemic, the international financial crisis, rising socio-economic inequalities, the negative outcomes of greenhouse gas emissions, which resulted in climate change, and many others. Organizations worldwide have confronted these new challenges of sustainable finance by incorporating environmental, social, and corporate governance (ESG) factors and digital transformation (DT) in their innovation business strategies. The healthcare sector represents a large share of the global economy (about 10% of global economic output), employs a large number of workers, and needs to rely more on an open innovation model where interested parties, especially patients, are going to have a say in their own well-being. Thus, it is imperative that healthcare providers be efficient, effective, resilient, and sustainable in the face of significant challenges and risks. At the same time, they must offer sustainable development goals and digital transformation to healthcare users through limited governmental resources. This study investigates the role, importance, and correlation of ESG factors and digital transformation to the sustainable finance of healthcare systems through an innovative model. The main purpose of the paper is to present the already implemented ESG and DT factors in the healthcare sector and to propose a mutual and combined implementation strategy based on common evaluation tools, methods, and actions. A set of proposed actions and strategies are presented for the sustainability and resilience of the healthcare sector.
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Affiliation(s)
- Anastasios Sepetis
- Postgraduate Health and Social Care Management Program, Department of Business Administration, University of West Attica, 12244 Athens, Greece;
| | - Fotios Rizos
- Department of Business Administration, University of West Attica, 12241 Athens, Greece;
| | - George Pierrakos
- Postgraduate Health and Social Care Management Program, Department of Business Administration, University of West Attica, 12244 Athens, Greece;
| | - Haralampos Karanikas
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece;
| | - Daniel Schallmo
- Institute for Entrepreneurship, University of Applied Sciences Neu-Ulm, 89231 Neu-Ulm, Germany;
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Singh G, Corlin L, Beninger PR, Neumann PJ, Boumil MM, Mehta S, Salem DN. Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System. Med Decis Making 2024; 44:18-27. [PMID: 37876181 DOI: 10.1177/0272989x231206750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Professional roles within a hospital system may influence attitudes behind clinical decisions. OBJECTIVE To determine participants' preferences about clinical decisions that either value equal health care access or efficiency. DESIGN Deidentified survey asking participants to choose between offering a low-cost screening test to a whole population ("equal access") or a more sensitive, expensive test that could be given to only half of the population but resulting in 10% more avoided deaths ("efficient"). Data collection took place from August 18, 2021, to January 24, 2022. Study 1644 was determined to be exempt by Tufts Health Sciences Institutional Review Board (IRB). SETTING Tufts Medicine Healthcare System. PARTICIPANTS Approximately 15,000 hospital employees received an e-mail from the Tufts Medicine Senior Vice President of Academic Integration. MEASUREMENTS Analysis of survey responses with chi-square and 1-sample t tests to determine the proportion who chose each option. Logistic regression models fit to examine relationships between professional role and test choice. RESULTS A total of 1,346 participants completed the survey (∼9.0% response rate). Overall, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%). However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice. For example, among those in nonclinical roles, women were more likely than men to choose equal health care access. In multivariable analyses, having clinical roles was significantly associated with 1.73 times the likelihood of choosing equal access (95% confidence interval = 1.33-2.25). LIMITATIONS Generalizability concerns and survey question wording limit the study results. CONCLUSION Clinicians were more likely than nonclinicians to choose the equal health care access option, and health care administrators were more likely to choose efficiency. These differing attitudes can affect patient care and health care quality. HIGHLIGHTS Divergent preferences of valuing equal health care access and efficiency may be in conflict during clinical decision making.In this cross-sectional study that included 1,346 participants, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%), a nonsignificant difference. However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choiceSince clinicians were more likely than nonclinicians to choose the equal health care access option and health care administrators were more likely to choose efficiency, these differing attitudes can affect patient care and health care quality.
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Affiliation(s)
- Ganeev Singh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
| | - Paul R Beninger
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Marcia M Boumil
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Shreya Mehta
- Tufts University School of Medicine, Boston, MA, USA
| | - Deeb N Salem
- Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
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Merino M, Maravilla-Herrera P, Lorenzo TM, Arance JA, Bobes J, Corrales M, Guzmán F, Morales M, Mur C. The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain. Glob Reg Health Technol Assess 2024; 11:82-93. [PMID: 38601072 PMCID: PMC11005448 DOI: 10.33393/grhta.2024.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults highly interfere with function in multiple dimensions, increasing the economic burden associated with ADHD. The aim of this study was to explore the impact of ADHD in Spanish adults and estimate the associated economic burden within the healthcare, social, economic, and legal domains. Methods An economic model was developed from a social perspective using a bottom-up approach, based on the scientific literature and a multidisciplinary expert group. Results The cost incurred per diagnosed adult patient with ADHD included an annual cost of €15,652 and a one-time cost of €7,893 (3,035 M€ and 1,531 M€ for Spain, respectively). Regarding the annual cost, 50% was attributed to costs within the economic domain, of which 53% were work-absenteeism-related. Moreover, 28% was attributed to costs within the social domain, of which 74% were substance-abuse-related. Regarding the one-time cost, 52% was attributed to costs within the healthcare domain, of which approximately 50% were hospitalization-related costs. Moreover, 42% was attributed to costs within the legal domain, of which 62% were imprisonment-related costs. Conclusions This is the first report on the socioeconomic burden of ADHD in Spanish adults, shedding light on the large burden that adult ADHD poses on the healthcare system and society at large, as symptoms have been shown to impact almost every aspect of life. This is particularly important for undiagnosed/untreated patients with ADHD in Spain, as appropriate treatments have shown positive results in these areas and may reduce its associated socioeconomic burden.
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Affiliation(s)
| | | | | | | | - Julio Bobes
- Department of Medicine, Oviedo University, Oviedo - Spain
- Network Biomedical Research Centre on Mental Health—CIBERSAM, Oviedo - Spain
| | - Montse Corrales
- Department of Psychiatry, Vall d’Hebron University Hospital, Barcelona - Spain
| | | | - María Morales
- Department of Psychiatry, Puerta de Hierro University Hospital, Majadahonda - Spain
| | - Carlos Mur
- Department of Psychiatry, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany - Andorra
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11
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Abu Assab M, Alhamad H, Albahar F, Abu Dayyih W, Echarif S, Abu Assab H. Pharmacovigilance Concept Knowledge, Perspectives and Attitudes: A Cross-Sectional Study Among Community Pharmacists. INQUIRY 2024; 61:469580241246464. [PMID: 38581250 PMCID: PMC10999125 DOI: 10.1177/00469580241246464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
The concept of pharmacovigilance (PV) is currently highlighted after emergency authorization and worldwide distribution of the urgently launched COVID-19 novel vaccinations. As they typically serve as the initial point of patient contact for medication-related issues, understanding the knowledge, perspectives, and attitudes of community pharmacists in PV and reporting adverse drug reactions (ADRs) is crucial to improving the healthcare system and public health policies. However, previous studies in Jordan have not focused entirely on community pharmacists. This study aimed to assess community pharmacists' knowledge, perspectives, and attitudes on PV and ADRs reporting in Jordan. The applied methodology in this study was based on a cross-sectional study design using a validated questionnaire distributed to a convenient sample of Jordanian community pharmacists. Seventeen questions were designed from different pieces of literature relating to knowledge, perspectives, and attitudes of PV among community pharmacists. Descriptive statistics (frequencies and percentages) were used to report the results data. The study questionnaire was completed by 180 of 325 community pharmacists willing to participate (a response rate of 55.4%). Of them (n = 132, 73%) were aware of the concept of PV. Additionally (n = 84, 47%) of the community pharmacists would use the concept and policy of PV in their everyday work. Nevertheless, only (n = 36, 20.0%) of the community pharmacists thought an ADR should be reported if seen, and approximately 120 pharmacists (67.0%) believed it was essential to report ADRs as patient health matters. Although community pharmacists in Jordan showed a considerable awareness level of PV, they demonstrated a low level of its application. Thus, ADR reporting is not considered a mainstay among them, and the implementation of PV is not yet addressed. The results from this study shed light on community pharmacists' perceptions and attitudes regarding ADR reporting and PV.
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12
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Bernales M, Cordón P, Gonzalez S, Pedrero V, Ferrer L. Interaction among health workers and trans men: Findings from a qualitative study in Chile. J Nurs Scholarsh 2024; 56:142-152. [PMID: 37140134 DOI: 10.1111/jnu.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To explore trans men's access and use of healthcare services in Chile, based on the experiences of the trans men themselves, as well as of healthcare professionals. METHODS A qualitative study with an ethnographic approach was carried out with 30 participants: 14 trans men and 16 healthcare professionals. Semi-structured one-on-one interviews with open-ended questions were used to collect the data. A thematic analysis was carried out with the NVivo Software. RESULTS Three main themes were identified: (1) failures in the recognition of trans identity, (2) challenges with patient-centered care, and (3) use of other ("non-trans") health services. CONCLUSIONS The results suggest that not all transition processes are the same, individuals seek different ways; therefore, it is necessary to consider different body types and identities when planning programs and care for men in transition. Moreover, the accompaniment provided during the gender transition process should contemplate emotional and mental support. CLINICAL RELEVANCE The study outlines the need for all healthcare professionals to have training and knowledge about the transgender population, regardless of whether they are part of the teams supporting gender transition processes. The role of nurses and the contributions that can be made from nursing discipline in this research field are fundamental.
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Affiliation(s)
- M Bernales
- School of Nursing, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Cordón
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Gonzalez
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Pedrero
- School of Nursing, Universidad Andres Bello, Santiago, Chile
| | - L Ferrer
- School of Nursing, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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13
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Khosravi M, Zare Z, Mojtabaeian SM, Izadi R. Artificial Intelligence and Decision-Making in Healthcare: A Thematic Analysis of a Systematic Review of Reviews. Health Serv Res Manag Epidemiol 2024; 11:23333928241234863. [PMID: 38449840 PMCID: PMC10916499 DOI: 10.1177/23333928241234863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction The use of artificial intelligence (AI), which can emulate human intelligence and enhance clinical results, has grown in healthcare decision-making due to the digitalization effects and the COVID-19 pandemic. The purpose of this study was to determine the scope of applications of AI tools in the decision-making process in healthcare service delivery networks. Materials and methods This study used a qualitative method to conduct a systematic review of the existing reviews. Review articles published between 2000 and 2024 in English-language were searched in PubMed, Scopus, ProQuest, and Cochrane databases. The CASP (Critical Appraisal Skills Programme) Checklist for Systematic Reviews was used to evaluate the quality of the articles. Based on the eligibility criteria, the final articles were selected and the data extraction was done independently by 2 authors. Finally, the thematic analysis approach was used to analyze the data extracted from the selected articles. Results Of the 14 219 identified records, 18 review articles were eligible and included in the analysis, which covered the findings of 669 other articles. The quality assessment score of all reviewed articles was high. And, the thematic analysis of the data identified 3 main themes including clinical decision-making, organizational decision-making, and shared decision-making; which originated from 8 subthemes. Conclusions This study revealed that AI tools have been applied in various aspects of healthcare decision-making. The use of AI can improve the quality, efficiency, and effectiveness of healthcare services by providing accurate, timely, and personalized information to support decision-making. Further research is needed to explore the best practices and standards for implementing AI in healthcare decision-making.
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Affiliation(s)
- Mohsen Khosravi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zare
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Morteza Mojtabaeian
- Department of Healthcare Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Lin SY, Chan PK, Hsu WH, Kao CH. Exploring the proficiency of ChatGPT-4: An evaluation of its performance in the Taiwan advanced medical licensing examination. Digit Health 2024; 10:20552076241237678. [PMID: 38449683 PMCID: PMC10916498 DOI: 10.1177/20552076241237678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Background Taiwan is well-known for its quality healthcare system. The country's medical licensing exams offer a way to evaluate ChatGPT's medical proficiency. Methods We analyzed exam data from February 2022, July 2022, February 2023, and July 2033. Each exam included four papers with 80 single-choice questions, grouped as descriptive or picture-based. We used ChatGPT-4 for evaluation. Incorrect answers prompted a "chain of thought" approach. Accuracy rates were calculated as percentages. Results ChatGPT-4's accuracy in medical exams ranged from 63.75% to 93.75% (February 2022-July 2023). The highest accuracy (93.75%) was in February 2022's Medicine Exam (3). Subjects with the highest misanswered rates were ophthalmology (28.95%), breast surgery (27.27%), plastic surgery (26.67%), orthopedics (25.00%), and general surgery (24.59%). While using "chain of thought," the "Accuracy of (CoT) prompting" ranged from 0.00% to 88.89%, and the final overall accuracy rate ranged from 90% to 98%. Conclusion ChatGPT-4 succeeded in Taiwan's medical licensing exams. With the "chain of thought" prompt, it improved accuracy to over 90%.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Pak Ki Chan
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Chest Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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15
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Mulaku MN, Nyagol B, Owino EJ, Ochodo E, Young T, Steingart KR. Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives. Glob Health Action 2023; 16:2148355. [PMID: 36548521 PMCID: PMC9788701 DOI: 10.1080/16549716.2022.2148355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates. OBJECTIVE To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB. METHODS We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients' change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings. CONCLUSION Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care.
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Affiliation(s)
- Mercy Namuma Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pharmacy, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bruce Nyagol
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Pahlavanyali S, Hetlevik Ø, Baste V, Blinkenberg J, Hunskaar S. Continuity of care and mortality for patients with chronic disease: an observational study using Norwegian registry data. Fam Pract 2023; 40:698-706. [PMID: 37074143 PMCID: PMC10745252 DOI: 10.1093/fampra/cmad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Research on continuity of care (CoC) is mainly conducted in primary care and has received little acknowledgment in other levels of care. This study sought to investigate CoC across care levels for patients with selected chronic diseases, along with its association with mortality. METHODS In a registry-based cohort study, patients with ≥1 consultation in primary or specialist healthcare or hospital admission with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or heart failure in 2012 were linked to disease-related consultation data in 2013-2016. CoC was measured by Usual Provider of Care index (UPC) and Bice-Boxermann continuity of care score (COCI). Values equal to one were categorized into one group and the rest into three equal groups (tertiles). The association with mortality was determined by Cox regression models. RESULTS The highest mean UPCtotal was measured for patients with diabetes mellitus (0.58) and the lowest for those with asthma (0.46). The population with heart failure had the highest death rate (26.5). In adjusted Cox regression analyses for COPD, mortality was 2.6 times higher (95% CI 2.25-3.04) for patients in the lowest tertile of continuity compared to those with UPCtotal = 1. Patients with diabetes mellitus and heart failure showed similar results. CONCLUSION CoC was moderate to high for disease-related contacts across care levels. A higher mortality associated with lower CoC was observed for patients with COPD, diabetes mellitus, and heart failure. A similar, but not statistically significant trend was found for patients with asthma. This study suggests that higher CoC across levels of care can decrease mortality.
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Affiliation(s)
- Sahar Pahlavanyali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jesper Blinkenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Rozanova J, Zaviryukha I, Deac AA, Zeziulin O, Kiriazova T, Earnshaw V, Rich KM, Shenoi SV, Skipper H, Yariy V, Strang SJ. Human costs of healthcare resilience during the war in Ukraine: Lessons from addiction and HIV treatment. Addiction 2023. [PMID: 38130082 DOI: 10.1111/add.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Julia Rozanova
- Department of Health Service and Population Research, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
- AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Alexandra A Deac
- Department of Health Service and Population Research, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States
| | | | | | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | | | - Sheela V Shenoi
- Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Harry Skipper
- Kyiv Addiction Treatment Clinic "Sociotherapy", Kyiv, Ukraine
| | - Volodymyr Yariy
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sir John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Salehi Shahraki A, Lauer H, Grobler M, Sakzad A, Rudolph C. Access Control, Key Management, and Trust for Emerging Wireless Body Area Networks. Sensors (Basel) 2023; 23:9856. [PMID: 38139702 PMCID: PMC10747010 DOI: 10.3390/s23249856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Wireless Body Area Networks (WBANs) are an emerging industrial technology for monitoring physiological data. These networks employ medical wearable and implanted biomedical sensors aimed at improving quality of life by providing body-oriented services through a variety of industrial sensing gadgets. The sensors collect vital data from the body and forward this information to other nodes for further services using short-range wireless communication technology. In this paper, we provide a multi-aspect review of recent advancements made in this field pertaining to cross-domain security, privacy, and trust issues. The aim is to present an overall review of WBAN research and projects based on applications, devices, and communication architecture. We examine current issues and challenges with WBAN communications and technologies, with the aim of providing insights for a future vision of remote healthcare systems. We specifically address the potential and shortcomings of various Wireless Body Area Network (WBAN) architectures and communication schemes that are proposed to maintain security, privacy, and trust within digital healthcare systems. Although current solutions and schemes aim to provide some level of security, several serious challenges remain that need to be understood and addressed. Our aim is to suggest future research directions for establishing best practices in protecting healthcare data. This includes monitoring, access control, key management, and trust management. The distinguishing feature of this survey is the combination of our review with a critical perspective on the future of WBANs.
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Affiliation(s)
- Ahmad Salehi Shahraki
- Department of Computer Science and Information Technology, La Trobe University, Melbourne 3086, Australia
| | - Hagen Lauer
- Department of Mathematics, Natural Sciences, and Computer Science, Technische Hochschule Mittelhessen, 35390 Gießen, Germany;
| | - Marthie Grobler
- Cybersecurity and Quantum Systems (CQS), CSIRO’s Data61, Melbourne 3168, Australia;
| | - Amin Sakzad
- Dep of Software Systems & Cybersecurity, Monash University, Melbourne 3800, Australia; (A.S.); (C.R.)
| | - Carsten Rudolph
- Dep of Software Systems & Cybersecurity, Monash University, Melbourne 3800, Australia; (A.S.); (C.R.)
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Lavoie JG, Clark W, McDonnell L, Nickel N, Dutton R, Kanayok J, Fowler-Woods M, Anawak J, Brown N, Voisey Clark G, Evaluardjuk-Palmer T, Wong ST, Sanguins J, Mudryj A, Mullins N, Ford M, Clark J. Cross-jurisdictional pandemic management: providers speaking on the experience of Nunavut Inuit accessing services in Manitoba during the COVID-19 pandemic. Int J Circumpolar Health 2023; 82:2259122. [PMID: 37731361 PMCID: PMC10515685 DOI: 10.1080/22423982.2023.2259122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Abstract
Across Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created challenges related to the need to keep Nunavut residents safe while accessing care, and to manage the risk of outbreaks in Nunavut resultant from patients returning home. A number of strategies were adopted to mitigate risk, including the expansion of virtual care, self-isolation requirements before returning from Winnipeg, and a level of cross-jurisdictional coordination previously unprecedented. Structural limitations in Nunavut however limited opportunities to expand virtual care, and to allow providers from Manitoba to access the Nunavut's electronic medical records of patients requiring follow up. Thus, known and long-standing issues exacerbated vulnerabilities within the Nunavut healthcare system. We conclude that addressing cross-jurisdictional issues would be well served by the development of a more formal Nunavut-Manitoba agreement (with similar agreements with Ontario and Alberta), outlining mutual obligations and accountabilities.
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Affiliation(s)
- Josée G. Lavoie
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, MB, Canada
| | - wayne Clark
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - leah McDonnell
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, MB, Canada
| | - nathan Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - rachel Dutton
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - janet Kanayok
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - melinda Fowler-Woods
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Inuit Association, Winnipeg, MB, Canada
| | - jac Anawak
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - nuqaalaq Brown
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - grace Voisey Clark
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - julianne Sanguins
- National Institute of Nursing Research, Division of Intramural Research, Bethesda, MD, USA
- Manitoba Métis Federation, Winnipeg, MB, Canada
| | - adriana Mudryj
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, MB, Canada
| | - nastania Mullins
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - marti Ford
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - judy Clark
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
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Dybowski B. Local solutions to shorten treatment delays in bladder cancer. Results of a survey among CEJU authors. Cent European J Urol 2023; 76:280-282. [PMID: 38230314 PMCID: PMC10789278 DOI: 10.5173/ceju.2023.004e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Bartosz Dybowski
- Faculty of Medicine, Lazarski University, Warsaw, Poland
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
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21
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Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med 2023; 10:1201414. [PMID: 38075954 PMCID: PMC10704904 DOI: 10.3389/fcvm.2023.1201414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
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22
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Ibrahim M. Cancer care in Lebanon and the climate-proofing of a burning phoenix. Ecancermedicalscience 2023; 17:ed130. [PMID: 38414949 PMCID: PMC10898891 DOI: 10.3332/ecancer.2023.ed130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Indexed: 02/29/2024] Open
Abstract
Beirut, the capital of Lebanon, has been burnt and rebuilt seven times, earning the title of an urban phoenix. Its strategic geolocation in the heart of the Mediterranean gave the country leverage for the economy, by becoming a hotspot for trade through its different ports. Its cultural and religious diversity provided a fertile ground for businesses to grow, most importantly the banking and healthcare sector. The strategic location also put the country in the eye of the storm of different major crises, leaving the small country a crippling state, swamped with political corruption, nepotism, fragile infrastructure, and an overall dysfunctional system. In October 2019, the collapse of the banking system led to a state of hyperinflation in the country, with the financial and economic crisis in Lebanon now ranked in the top 10 most severe crises episodes globally since the mid-nineteenth century. This crisis exposed the extent of corruption and dysfunctionality: a fragmented healthcare sector struggling to protect the vulnerable populations especially cancer patients, a workforce seeking exodus due to challenging work conditions amid a state of hyperinflation, and a fragile infrastructure unable to withstand climate changes in one of the hottest and driest areas on the planet, the Middle East. Despite being caught in this turmoil, Lebanon still managed to update its national climate pledge under the Paris Agreement. However, the financial recovery plan that is aiming to revive the economy and overcome short-term financial challenges, has a risk of affecting long-term climate-proofing efforts. In a multilevel crisis-torn country, it might be difficult to look on the impact of climate change in particular on cancer care, without accounting for the other ongoing troubles. In such circumstances, protecting public health becomes a major challenge yet a priority. The resilience of the system is currently being tested as the crisis evolves, and should be continuously monitored.
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Millarch AS, Bonde A, Bonde M, Klein KV, Folke F, Rudolph SS, Sillesen M. Assessing optimal methods for transferring machine learning models to low-volume and imbalanced clinical datasets: experiences from predicting outcomes of Danish trauma patients. Front Digit Health 2023; 5:1249258. [PMID: 38026835 PMCID: PMC10656776 DOI: 10.3389/fdgth.2023.1249258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Accurately predicting patient outcomes is crucial for improving healthcare delivery, but large-scale risk prediction models are often developed and tested on specific datasets where clinical parameters and outcomes may not fully reflect local clinical settings. Where this is the case, whether to opt for de-novo training of prediction models on local datasets, direct porting of externally trained models, or a transfer learning approach is not well studied, and constitutes the focus of this study. Using the clinical challenge of predicting mortality and hospital length of stay on a Danish trauma dataset, we hypothesized that a transfer learning approach of models trained on large external datasets would provide optimal prediction results compared to de-novo training on sparse but local datasets or directly porting externally trained models. Methods Using an external dataset of trauma patients from the US Trauma Quality Improvement Program (TQIP) and a local dataset aggregated from the Danish Trauma Database (DTD) enriched with Electronic Health Record data, we tested a range of model-level approaches focused on predicting trauma mortality and hospital length of stay on DTD data. Modeling approaches included de-novo training of models on DTD data, direct porting of models trained on TQIP data to the DTD, and a transfer learning approach by training a model on TQIP data with subsequent transfer and retraining on DTD data. Furthermore, data-level approaches, including mixed dataset training and methods countering imbalanced outcomes (e.g., low mortality rates), were also tested. Results Using a neural network trained on a mixed dataset consisting of a subset of TQIP and DTD, with class weighting and transfer learning (retraining on DTD), we achieved excellent results in predicting mortality, with a ROC-AUC of 0.988 and an F2-score of 0.866. The best-performing models for predicting long-term hospitalization were trained only on local data, achieving an ROC-AUC of 0.890 and an F1-score of 0.897, although only marginally better than alternative approaches. Conclusion Our results suggest that when assessing the optimal modeling approach, it is important to have domain knowledge of how incidence rates and workflows compare between hospital systems and datasets where models are trained. Including data from other health-care systems is particularly beneficial when outcomes are suffering from class imbalance and low incidence. Scenarios where outcomes are not directly comparable are best addressed through either de-novo local training or a transfer learning approach.
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Affiliation(s)
- Andreas Skov Millarch
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alexander Bonde
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bonde
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Ballerup, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Hellerup, Denmark
| | - Søren Steemann Rudolph
- Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Michelson KA, Bachur RG, Cruz AT, Grubenhoff JA, Reeves SD, Chaudhari PP, Monuteaux MC, Dart AH, Finkelstein JA. Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data. Diagnosis (Berl) 2023; 10:383-389. [PMID: 37340621 PMCID: PMC10679849 DOI: 10.1515/dx-2023-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES To derive a method of automated identification of delayed diagnosis of two serious pediatric conditions seen in the emergency department (ED): new-onset diabetic ketoacidosis (DKA) and sepsis. METHODS Patients under 21 years old from five pediatric EDs were included if they had two encounters within 7 days, the second resulting in a diagnosis of DKA or sepsis. The main outcome was delayed diagnosis based on detailed health record review using a validated rubric. Using logistic regression, we derived a decision rule evaluating the likelihood of delayed diagnosis using only characteristics available in administrative data. Test characteristics at a maximal accuracy threshold were determined. RESULTS Delayed diagnosis was present in 41/46 (89 %) of DKA patients seen twice within 7 days. Because of the high rate of delayed diagnosis, no characteristic we tested added predictive power beyond the presence of a revisit. For sepsis, 109/646 (17 %) of patients were deemed to have a delay in diagnosis. Fewer days between ED encounters was the most important characteristic associated with delayed diagnosis. In sepsis, our final model had a sensitivity for delayed diagnosis of 83.5 % (95 % confidence interval 75.2-89.9) and specificity of 61.3 % (95 % confidence interval 56.0-65.4). CONCLUSIONS Children with delayed diagnosis of DKA can be identified by having a revisit within 7 days. Many children with delayed diagnosis of sepsis may be identified using this approach with low specificity, indicating the need for manual case review.
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Affiliation(s)
| | - Richard G. Bachur
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Andrea T. Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joseph A. Grubenhoff
- Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Scott D. Reeves
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Arianna H. Dart
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
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Elyes M, Heesen P, Schelling G, Bode-Lesniewska B, Studer G, Fuchs B. Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis. Cancers (Basel) 2023; 15:4892. [PMID: 37835586 PMCID: PMC10571532 DOI: 10.3390/cancers15194892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).
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Affiliation(s)
- Maria Elyes
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Philip Heesen
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
| | - Georg Schelling
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | | | - Gabriela Studer
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Bruno Fuchs
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
- Kantonsspital Winterthur, Sarcoma Service, 8400 Winterthur, Switzerland
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Almodhen F, Moneir WM. Toward a Financially Sustainable Healthcare System in Saudi Arabia. Cureus 2023; 15:e46781. [PMID: 37954697 PMCID: PMC10632744 DOI: 10.7759/cureus.46781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to find out the application of a sustainability model framework to test the financial sustainability of the healthcare system in Saudi Arabia and to suggest some reforms required to maintain a sustainable healthcare system in the country. METHODS To test the financial sustainability of the publicly funded healthcare system in Saudi Arabia, we applied analytical techniques using a sustainability model framework based on the framework indicators proposed previously by the Office of Sustainable Development, Bureau for Africa, U.S. Agency for International Development. An empirical time-trend analysis was also used to judge the financial sustainability of the healthcare system of Saudi Arabia in the future. RESULTS The results showed significant threats to the financial sustainability of the healthcare system. Saudi Arabia's revenues, gross domestic product (GDP), government budget, and Ministry of Health (MOH) budget were all directly influenced by the oil prices. CONCLUSION The healthcare system in Saudi Arabia seems to be financially unsustainable, and the need for change is inevitable. Saudi's ambitious program of development "Vision 2030" will surmount the challenges faced by the country and will lead to substantial enhancements in the health sector in Saudi Arabia, and other opportunities for improvement do exist.
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Affiliation(s)
- Fayez Almodhen
- Pediatric Urology, Surgery Department, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Wael M Moneir
- Pediatric Urology, King Abdulaziz Medical City, Riyadh, SAU
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27
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Snegireva YY, Ananchenkova PI, Gurtskoy LD, Shkrumyak AR, Metelskaya AV. [HUMAN RESOURCES MANAGEMENT OF A PRIVATE MEDICAL ORGANIZATION]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1257-1262. [PMID: 38069895 DOI: 10.32687/0869-866x-2023-31-s2-1257-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Abstract
The article deals with the issues of human resources management of a private medical organization. The author investigates the current state of the staffing of Russian healthcare: the provision of specialists in the healthcare system, professional motivation and prospects for the development of private medicine. In recent years, a system of private medical organizations has been formed in the Russian market of medical services, which provide medical care in parallel with state medical structures. Research in the field of human resource management in healthcare of a theoretical and practical nature shows that the problem of personnel shortage in the field of medicine is urgent and needs to be solved. One of the factors of insufficient staffing of medical organizations is the underinvestment of the healthcare industry over a long period and low preparedness for emergency situations and response to them, which has worsened under the influence of the rapid spread of the coronavirus pandemic. In conclusion, it is concluded that the main task of the effective functioning of a medical organization and the provision of high-quality medical services is the management of human resources. The purpose of this study is to consider the issues of human resources management of a private medical organization.
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Affiliation(s)
- Yu Yu Snegireva
- Scientific Research Institute of Health Organization and Medical Management of the Department of Health of the City of Moscow, 115184, Moscow, Russia,
| | - P I Ananchenkova
- Scientific Research Institute of Health Organization and Medical Management of the Department of Health of the City of Moscow, 115184, Moscow, Russia
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia
| | - L D Gurtskoy
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia
| | - A R Shkrumyak
- Scientific Research Institute of Health Organization and Medical Management of the Department of Health of the City of Moscow, 115184, Moscow, Russia
| | - A V Metelskaya
- Scientific Research Institute of Health Organization and Medical Management of the Department of Health of the City of Moscow, 115184, Moscow, Russia
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28
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Costa N, Blyth FM, Parambath S, Huckel Schneider C. What's the low back pain problem represented to be? An analysis of discourse of the Australian policy directives. Disabil Rehabil 2023; 45:3312-3322. [PMID: 36150033 DOI: 10.1080/09638288.2022.2125085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Low back pain (LBP) directives provide information about how LBP should be managed, communicated and navigated in complex health systems, making them an important form of policy. This study aimed to examine how LBP is problematised (represented) in Australian directives. MATERIALS AND METHODS We employed an analysis of discourse of LBP directives drawing on Bacchi's "What's the problem represented to be?" policy problematisation approach. RESULTS Our analysis suggests that LBP is problematised as a symptom that tends to improve when individuals take responsibility for themselves, but may require care at times. The way in which LBP is represented in the directives excludes important aspects, such as the uncertainties of scientific knowledge, paradigms other than (post)positivist, multimorbidity, social and structural determinants of health. CONCLUSION LBP directives may benefit from problematisations of LBP that consider the ongoing nature of LBP and broader contextual factors that impact on both LBP outcomes and care, beyond individual responsibility. Consideration of a wider range of paradigms and expanded evidence base may also be beneficial, as these are likely to enable individuals, clinicians and the Australian healthcare system to address LBP while dealing with its complexities, enabling real-world changes to lessen the LBP burden.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who work with people who experience low back pain (LBP) may benefit from critically reflecting about discourses embedded in policy directives.Healthcare professionals may consider engaging in policy changes processes to expand the discourses on which LBP policy directives rely.Healthcare professionals' ability to enact policy recommendations may be enhanced by consideration of the fluctuating nature of LBP, uncertainties, multimorbidity and determinants of health.
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Affiliation(s)
- Nathalia Costa
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona M Blyth
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Sarika Parambath
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ragozin AV, Safonov AL, Grishin VV, Stochik AA. [WORLD EXPERIENCE: HOW THE DEVELOPMENT OF THE PRINCIPLES OF ACADEMICIAN OF THE ACADEMY OF MEDICAL SCIENCES OF THE USSR N. A. SEMASHKO HELPED ICELAND TO CREATE ONE OF THE MOST EFFECTIVE HEALTHCARE SYSTEMS IN THE WORLD. PART 2. PRINCIPLES FUNCTIONING OF THE ICELANDIC HEALTH SYSTEM]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1290-1296. [PMID: 38069900 DOI: 10.32687/0869-866x-2023-31-s2-1290-1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Abstract
Annotation. The review article is devoted to the healthcare system of Iceland, which demonstrates some of the best indicators of public health in the world at relatively low costs for a developed European country. The successful experience of Icelandic healthcare is important for Russia, on the one hand, due to the proximity of this country to many Russian regions in terms of climatic and geographical location, demography and territorial development. On the other hand, the success of Iceland's healthcare is closely linked to the development of a model, in many ways similar to the Soviet model of Nikolai Semashko, which Russia has abandoned. The authors believe that Iceland's experience can be used in the modernization of regional healthcare systems in Eastern Siberia, the Far East and the Arctic, as well as Russian healthcare in general.
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Affiliation(s)
- A V Ragozin
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation
| | - A L Safonov
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation,
| | - V V Grishin
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation
| | - A A Stochik
- Scientific Research Institute of Healthcare Organization and Medical Management at the Department of Healthcare of Moscow, Moscow, Russian Federation
- FGBNU "N. A. Semashko National Research Institute of Public Health" of the Ministry of Education and Science of Russia, Moscow, Russian Federation
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30
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Ragozin AV, Safonov AL, Grishin VV, Stochik AA. [WORLD EXPERIENCE: HOW THE DEVELOPMENT OF THE PRINCIPLES OF ACADEMICIAN OF THE ACADEMY OF MEDICAL SCIENCES OF THE USSR N. A. SEMASHKO HELPED ICELAND TO CREATE ONE OF THE MOST EFFECTIVE HEALTHCARE SYSTEMS IN THE WORLD. PART 1. HISTORICAL OVERVIEW]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1282-1289. [PMID: 38069899 DOI: 10.32687/0869-866x-2023-31-s2-1282-1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Abstract
Annotation. The review article is devoted to the healthcare system of Iceland, which demonstrates some of the best indicators of public health in the world at relatively low costs for a developed European country. The successful experience of Icelandic healthcare is important for Russia, on the one hand, due to the proximity of this country to many Russian regions in terms of climatic and geographical location, demography and territorial development. On the other hand, the success of Iceland's healthcare is closely linked to the development of a model, in many ways similar to the Soviet model of Nikolai Semashko, which Russia has abandoned. The authors believe that Iceland's experience can be used in the modernization of regional healthcare systems in Eastern Siberia, the Far East and the Arctic, as well as Russian healthcare in general.
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Affiliation(s)
- A V Ragozin
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation
| | - A L Safonov
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation,
| | - V V Grishin
- Financial University under the Government of the Russian Federation, Moscow, Russian Federation
| | - A A Stochik
- Scientific Research Institute of Healthcare Organization and Medical Management at the Department of Healthcare of Moscow, Moscow, Russian Federation
- FGBNU "N. A. Semashko National Research Institute of Public Health" of the Ministry of Education and Science of Russia, Moscow, Russian Federation
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Fals AM, Brennan AM. Teaching Kitchens and Culinary Gardens as Integral Components of Healthcare Facilities Providing Whole Person Care: A Commentary. Nutrients 2023; 15:4162. [PMID: 37836446 PMCID: PMC10574558 DOI: 10.3390/nu15194162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Child and adult obesity continue to be major health concerns in the United States and can contribute to the development of chronic diseases. Culinary medicine, which incorporates teaching kitchens and gardens, may be a useful strategy for preventing and/or treating obesity-related disease by providing the knowledge and skills that encourage consumption of whole plant-based foods prepared at home. Though emerging research describes the benefits of culinary medicine-based programming, examples of teaching kitchens and culinary gardens being integrated into current clinical practice is minimal. Here, we describe the development of innovative, community-centered culinary medicine programming borne from interdisciplinary collaboration at a leading healthcare system. Preliminary outcomes suggest improvements in anthropometrics, cardiometabolic risk factors, and participation in healthy lifestyle behaviors in pediatric weight management patients, as well as improved confidence, knowledge, and likelihood to prepare whole food, plant-based meals in healthcare employees following participation in culinary medicine workshops. Hospitals and culinary medicine partners can support each other through shared knowledge, vision, and resources to provide value-based care to patients in the community. Collaboration among gardeners, chefs, architects, educators, and healthcare professionals can transfer traditional physician-driven care to patients, empowering them with the tools, resources, and confidence to improve health and wellbeing.
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Affiliation(s)
- Angela M Fals
- AdventHealth for Children, 601 E. Rollins St., Orlando, FL 32803, USA
| | - Andrea M Brennan
- AdventHealth Research Institute, 800 N. Magnolia Ave., Orlando, FL 32803, USA
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Döbrőssy L, Lapis K. [Oral cancer screening: what can the healthcare system do to reduce the burden of disease?]. Orv Hetil 2023; 164:1497-1505. [PMID: 37742222 DOI: 10.1556/650.2023.32871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023]
Abstract
Due to its high incidence and mortality, oral cancer makes a group of diseases of public health importance. Oral screening is a simple three-step procedure: the first step is questioning the patient about his/her smoking/drinking habits, secondly, visual inspection of the oral cavity, and finally, palpation of regional lymph nodes. If precancerous conditions or any form of oral cancer are suspected, the task is to send the examined person to oral clinical care. The examination can routinly be performed by dentists, but also by general practitioners and occupational health personnel. The difficulty of oral screening arises from the fact that most of the patients are of low socio-economic status. The organization of oral screening is the responsibility of the healthcare system personnel: their task is to identify the high-risk persons and to direct them to the scene of the screening. Orv Hetil. 2023; 164(38): 1497-1505.
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Affiliation(s)
| | - Károly Lapis
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Kórbonctani és Kísérletes Rákkutató Intézet Budapest Magyarország
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Mulaku MN, Corrie OM, Odero I, Young T, Steingart KR, Ochodo E. Health worker views on pre-treatment loss to follow-up in adults with pulmonary TB in Western Kenya. Public Health Action 2023; 13:77-82. [PMID: 37736575 PMCID: PMC10446661 DOI: 10.5588/pha.23.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 09/23/2023] Open
Abstract
SETTING County referral hospital in Western Kenya. OBJECTIVES To explore factors contributing to pre-treatment loss to follow-up (PTLFU) in adults with pulmonary TB and propose solutions to address PTLFU from healthcare worker (HCW) perspectives. DESIGN This was an exploratory qualitative study using thematic analysis. RESULTS We conducted 19 key informant interviews with HCWs representing laboratory, clinical care, management and the community. Participant age ranged from 26 to 62 years; 14 (74%) were females; and most (74%) had worked in TB care for ⩽5 years. They reported that patients experienced stigma and had misconceptions about TB that contributed to PTLFU. HCWs were hesitant to work in the TB clinic, which contributed to suboptimal patient care, leading to PTLFU. Unclear linkage between laboratory and clinician, and limited financial resources to track patients were among the healthcare system factors that led to PTLFU. HCWs suggested having proper patient preparation, assigning resources to track patients and holding regular interdisciplinary meetings as practical solutions to address PTLFU. CONCLUSION HCWs reported multiple factors that may influence PTLFU and recommended various solutions to address these. Knowledge of TB management, patient preparation, resources to track patients and multidisciplinary meetings will be central to addressing PTLFU.
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Affiliation(s)
- M N Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - O M Corrie
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - I Odero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - T Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - E Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Kotani K. The framework for modern community medicine in Japan. Biosci Trends 2023; 17:322-324. [PMID: 37612128 DOI: 10.5582/bst.2023.01199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Along with the transition to depopulation and an aging society in Japan, the modification of community medicine and its related systems is required. With this in mind, the Japanese government has recently advocated two major plans: 'Community Healthcare Vision' and 'Community-based Integrated Care System'. This paper proposes a theoretical framework to understand modern community medicine based on the ongoing government plans. The key viewpoints consisting of the framework are 'community and/or region', 'care systematization,' and 'coworking with residents (citizens)'. This is expected to be useful for capturing and monitoring the whole picture of modern community medicine in Japan. Such modeling might aid in the future development of medicine and medical science, as in other developed countries.
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Affiliation(s)
- Kazuhiko Kotani
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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Alshehri A, Balkhi B, Gleeson G, Atassi E. Efficiency and Resource Allocation in Government Hospitals in Saudi Arabi: A Casemix Index Approach. Healthcare (Basel) 2023; 11:2513. [PMID: 37761709 PMCID: PMC10531133 DOI: 10.3390/healthcare11182513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
In Saudi Arabia, the evaluation of healthcare institutions' performance and efficiency is gaining prominence to ensure effective resource utilization. This study aims to assess the efficiency of government hospitals in Saudi Arabia using the case mix index (CMI) approach. Comprehensive data from 67 MoH hospitals were collected and analyzed. The CMI was calculated by assigning weights to different patient groups based on case complexity and resource requirements, facilitating comparisons of hospital performance in terms of resource utilization and patient outcomes. The findings reveal variations in the CMI across hospitals in relation to size and type. The average CMI was 1.26, with the highest recorded at 1.67 and the lowest at 1.02. Medical cities demonstrated the highest CMI (1.47), followed by specialized hospitals (1.32), and general hospitals (1.21). The study highlights opportunities for enhancing productivity and efficiency, particularly in hospitals with lower CMI, by benchmarking against peer institutions with similar capacities and patient case mix. These findings have significant implications for hospital operations and resource allocation policies, supporting ongoing efforts to improve the efficiency of government hospitals in Saudi Arabia. By incorporating these insights into healthcare strategies, policymakers can work towards enhancing the overall performance and effectiveness of the healthcare system.
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Affiliation(s)
- Abdulrahman Alshehri
- National Casemix Center of Excellence, Riyadh 13315, Saudi Arabia; (A.A.); (G.G.); (E.A.)
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ghada Gleeson
- National Casemix Center of Excellence, Riyadh 13315, Saudi Arabia; (A.A.); (G.G.); (E.A.)
| | - Ehab Atassi
- National Casemix Center of Excellence, Riyadh 13315, Saudi Arabia; (A.A.); (G.G.); (E.A.)
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Vlassi A, Tzikos G, Dardavesis T, Zioga O, Papadimitriou K, Papavramidis T. The Impact of Change Management in the Greek National Health System: A Quantitative Study. Cureus 2023; 15:e45574. [PMID: 37868399 PMCID: PMC10586886 DOI: 10.7759/cureus.45574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Serious changes took place in Greece due to the economic crisis of 2008, which led to significant changes in Greece's health sector. The reforms and changes that were made to the National Health System (NHS) aimed to improve it, provide quality services to its users, and adapt it to Greece's new external environment. The aim of this study was to assess the management of these changes by the leadership of the NHS and to examine their effectiveness. MATERIAL AND METHODS The survey was based on quantitative research methods, using a questionnaire as a research tool. The sample population comprised employees of a tertiary-care public hospital in northern Greece. RESULTS We recruited a sample size of 100 participants for the survey. The questionnaire's Cronbach's alpha was equal to 0.724. The overall change management was moderate, and Greece's NHS did not follow a specific change-management model that provided principles facilitating the success of the effort. The most serious problems identified by using the questionnaire were the following: the changes were not structured and clear, the management set unrealistic goals and objectives, the changes to the NHS were made without the appropriate financial support, and there is uncertainty about the future of health care in Greece. CONCLUSION The present study showed that changes cannot be made randomly; rather, they require careful planning and organization. Further changes, continuous feedback, and development are required to improve the status of Greece's healthcare system.
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Affiliation(s)
- Alexandra Vlassi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Thessaloniki, GRC
| | - Theodoros Dardavesis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Olga Zioga
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Papadimitriou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Theodosios Papavramidis
- Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Apostolidi DM, Pantelaki N, Sarantaki A, Dragioti E, Metallinou D. Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act. Cureus 2023; 15:e45498. [PMID: 37859910 PMCID: PMC10584402 DOI: 10.7759/cureus.45498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Neonatal palliative care aims to provide multidisciplinary support to families and neonates suffering from life-threatening or life-limiting diseases. Many countries worldwide have recognized the importance of enhancing the quality of life in critically ill neonates and thus have created and systematically implemented palliative care protocols in neonatal intensive care units (NICUs). Europe has a very low neonatal mortality rate, which has been steadily decreasing over the last 30 years. Greece in particular, a country located in Southeast Europe, reported a neonatal mortality rate of 2.29/1,000 live births in 2020. Nevertheless, neonatal palliative care facilities are scarce on a national level. In this paper, several reasons are presented to support the integration of neonatal palliative care in the Greek national healthcare system with the vision to ensure that all neonates and their families will receive in the near future the care, support, and dignity they deserve when facing life-threatening or life-limiting illnesses.
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Affiliation(s)
- Dimitra Maria Apostolidi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Nikoletta Pantelaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Antigoni Sarantaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
- Department of Medicine and Health Sciences, Linköping University, Linkoping, SWE
| | - Dimitra Metallinou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
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Thepna A, Cochrane BB, Salmon ME. Advancing nursing entrepreneurship in the 21st century. J Adv Nurs 2023; 79:3183-3185. [PMID: 36645175 DOI: 10.1111/jan.15563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/04/2023] [Indexed: 01/17/2023]
Affiliation(s)
- Arunrat Thepna
- School of Nursing, University of Washington, Washington, Seattle, USA
- Princess Agrarajakumari College of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Barbara B Cochrane
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Washington, Seattle, USA
| | - Marla E Salmon
- Department of Child, Family, and Population Health Nursing and Department of Global Health, School of Nursing, University of Washington, Washington, Seattle, USA
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Pearl R. Lifestyle Medicine: Overcoming Systemic and Cultural Barriers to Better, More Affordable Care. Am J Lifestyle Med 2023; 17:626-631. [PMID: 37711346 PMCID: PMC10498984 DOI: 10.1177/15598276231166321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
The 6 pillars of lifestyle medicine have strong scientific backing and plenty of supportive evidence to validate their integration into routine clinical practice. However, two barriers stand in the way of their widespread adoption: the system of healthcare and the culture of medicine. This article describes changes necessary to overcome these systemic and cultural obstacles and outlines steps necessary to achieve what traditional healthcare has so-far failed to deliver: higher quality, lower costs, and greater access to care.
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Fredriksson M, Gustafsson IB, Winblad U. A New Way of Thinking and Talking About Economy: Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden. Health Serv Insights 2023; 16:11786329231189402. [PMID: 37533504 PMCID: PMC10392155 DOI: 10.1177/11786329231189402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Healthcare systems may run into economic problems that may require 'active' decommissioning by policy-makers and managers. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the Swedish regions. Interviews were performed with 26 clinic managers 3 years after initial implementation. Those were analysed inductively, and then discussed based on a model of potential influences on sustainability. Although the programme was only 'partly sustained', the result point to a sustained attention to the health system's poor economy, visible in a great effort by the clinics to maintain their budgets. The most important influences were intervention fit and modifications made at the clinic level (i. innovation characteristics), clinic and health system leadership (ii. context), champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). When implementing decommissioning, it is particularly important to engage managers responsible for the care of patients and clinic budgets from an early stage and to allow them to design approaches based on the staff's and managers' detailed knowledge of the situation at their clinics and of the disease area, that is, to achieve fit at the clinics. In this way, the decommissioning approaches can more likely get the character of quality improvement efforts, which increases sustainability and may lead to positive quality outcomes. Despite being unpopular, the study suggests that decommissioning can have positive effects as well, such as creating opportunities to make difficult but necessary changes and fostering increased collegial support during the centralisation of services.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inga-Britt Gustafsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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lashkarbolouk N, Mazandarani M, Mohajeri Tehrani MR, Aalaa M, Sanjari M, Mehrdad N, Reza Amini M. Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231189048. [PMID: 37529303 PMCID: PMC10388609 DOI: 10.1177/11795514231189048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients' knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway's main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.
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Affiliation(s)
- Narges lashkarbolouk
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Bajgain BB, Chowdhury MZI, Dahal R, Bajgain KT, Adhikari K, Chowdhury N, Turin TC. Unmet Primary Health Care Needs among Nepalese Immigrant Population in Canada. Healthcare (Basel) 2023; 11:2120. [PMID: 37570361 PMCID: PMC10419120 DOI: 10.3390/healthcare11152120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. METHODS A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. RESULTS Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26-45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). CONCLUSIONS UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively.
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Affiliation(s)
- Bishnu Bahadur Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Mohammad Z. I. Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Rudra Dahal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 1M4, Canada
| | - Kalpana Thapa Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Kamala Adhikari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Population and Public Health, Alberta Health Services, Calgary, AB T2W 1S7, Canada
| | - Nashit Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tanvir C. Turin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Petre I, Barna F, Gurgus D, Tomescu LC, Apostol A, Petre I, Furau C, Năchescu ML, Bordianu A. Analysis of the Healthcare System in Romania: A Brief Review. Healthcare (Basel) 2023; 11:2069. [PMID: 37510510 PMCID: PMC10379121 DOI: 10.3390/healthcare11142069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
This manuscript provides a brief review and analysis of the healthcare system in Romania. This study aims to comprehensively analyse the healthcare system in Romania, evaluating its strengths, weaknesses, and impact on the population's access to quality healthcare services. Within the framework of the Romanian healthcare system, a multitude of pressing challenges endure. These encompass insufficient funding, shortages of medical personnel, and ineffectiveness in the provisioning of services. These impediments substantially hinder the accessibility of healthcare services, particularly in outlying and pastoral regions, thereby rendering the system susceptible and underserving certain demographics. Our investigation presents three hypotheses. The opening conjecture proposes that inadequate funding has a negative impact on the availability and standard of healthcare facilities in Romania. In addition, another hypothesis assumes that insufficient medical staff plays a considerable role in inequalities in access to and delivery of healthcare. Moreover, the existence of inadequacies in service provision serves as a significant barrier, obstructing the timely and efficient delivery of healthcare to those who need it. Our research encompasses a comprehensive analysis of key aspects of the Romanian healthcare system, ranging from healthcare infrastructure and financing mechanisms to service delivery and healthcare outcomes. Through a blend of qualitative and quantitative data sources, including government reports, academic studies, and statistical data, we have endeavoured to provide an in-depth evaluation. The analysis encompasses various aspects, including healthcare infrastructure, financing mechanisms, service delivery, and healthcare outcomes. Romania has a mixed healthcare system with both public and private providers. The primary level of care is delivered by family doctors, while hospitals and specialised medical centres provide secondary and tertiary care services. This research underlines the criticality of significant alterations being implemented in the healthcare system of Romania to address the issues arising from insufficient funding, a shortage of medical personnel, and shortcomings in service delivery. It is vital to tackle the obstacles presented by insufficient funding, the dearth of healthcare staff, and inadequacies in service delivery to attain impartial and reachable healthcare. By implementing these essential transformations, Romania can pave the way towards a healthcare system that efficaciously caters to the diverse requirements of its populace and guarantees the provision of prompt and superior healthcare services.
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Affiliation(s)
- Ion Petre
- Department of Functional Sciences, Medical Informatics and Biostatistics Discipline, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School, Faculty of Economics and Business Administration, West University of Timisoara, 16 J.H. Pestalozzi Street, 300115 Timisoara, Romania
| | - Flavia Barna
- Department of Finance, Faculty of Economics and Business Administration, West University of Timișoara, 16 Pestalozzi Street, 300115 Timisoara, Romania
| | - Daniela Gurgus
- Department of Balneology, Medical Recovery and Rheumatology, Centre for Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr. 2, 300041 Timisoara, Romania
| | | | - Adrian Apostol
- Department VII of Internal Medicine, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Izabella Petre
- Department XII, Discipline of Obstetrics and Gynecology III, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristian Furau
- Department of Obstetrics and Gynecology, "Vasile Goldiş" Western University of Arad, 310025 Arad, Romania
| | - Miruna Lucia Năchescu
- Finance Department, Faculty of Economics and Business Administration, West University of Timisoara, 300223 Timisoara, Romania
| | - Anca Bordianu
- Department of Plastic Surgery and Reconstructive Microsurgery Bagdasar-Arseni, Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", 010825 Bucharest, Romania
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Popa O, Barna RA, Borlea A, Cornianu M, Dema A, Stoian D. The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania. Front Endocrinol (Lausanne) 2023; 14:1221795. [PMID: 37497351 PMCID: PMC10368367 DOI: 10.3389/fendo.2023.1221795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction The COVID-19 pandemic had a significant impact on the healthcare system, leading to a prioritization of hospital admissions in many countries. Romania was no exception, and it had to restrict patient access to medical services in hospitals with chronic diseases and oncological pathology, including thyroid cancer. This study aimed to compare the clinical and pathological factors of patients with nodular thyroid disease diagnosed and surgically treated during the two years before and after the COVID-19 pandemic, in a single medical institution. Methods The retrospective study included 1505 patients who were diagnosed and operated on for nodular thyroid disease between January 2018 and December 2021. The patients were divided into two groups: the "PRECOVID" group (January 2018 to February 2020), and the "POSTCOVID" group (March 2020 to December 2021). The analyzed parameters included patients' gender, age, preoperative diagnosis, type of surgical intervention, and pathological diagnosis. Results A significant decrease was observed in the number of surgeries performed for thyroid nodular disease during the COVID-19 pandemic period (450 versus 1055 cases, p<0.00001). There was a significant decrease in the number of surgical reinterventions (0.9% in the POSTCOVID group versus 2.9% in the PRECOVID group, p=0.01) and a significant increase in the number of total thyroidectomies (84.9% in the POSTCOVID group versus 80.1% in the PRECOVID group, p=0.02). We also observed a higher incidence of malignant/borderline tumors in the POSTCOVID group compared to the PRECOVID group (p=0.04) and a significantly higher frequency of aggressive forms of thyroid cancer in the POSTCOVID group (p=0.0006). Discussion The COVID-19 pandemic had a significant impact on the surgical management of nodular thyroid disease, resulting in a decrease in surgeries and a change in the type of surgical interventions performed. The higher incidence of malignant/borderline tumors diagnosed during the pandemic highlights the importance of timely diagnosis and treatment of thyroid nodules to prevent cancer progression.
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Affiliation(s)
- Oana Popa
- Endocrinology Department, Centre of Molecular Research in Nephrology and Vascular Disease, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Robert Alexandru Barna
- Discipline of Morphopathology, Department of Microscopic Morphology, ANAPATMOL Research Centre, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Andreea Borlea
- Endocrinology Department, Centre of Molecular Research in Nephrology and Vascular Disease, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Marioara Cornianu
- Discipline of Morphopathology, Department of Microscopic Morphology, ANAPATMOL Research Centre, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Alis Dema
- Discipline of Morphopathology, Department of Microscopic Morphology, ANAPATMOL Research Centre, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Dana Stoian
- Endocrinology Department, Centre of Molecular Research in Nephrology and Vascular Disease, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
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Monahan AC, Feldman SS. The Utility of Predictive Modeling and a Systems Process Approach to Reduce Emergency Department Crowding: A Position Paper. Interact J Med Res 2023; 12:e42016. [PMID: 37428536 PMCID: PMC10366955 DOI: 10.2196/42016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/12/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Emergency department (ED) crowding and its main causes, exit block and boarding, continue to threaten the quality and safety of ED care. Most interventions to reduce crowding have not been comprehensive or system solutions, only focusing on part of the care procession and not directly affecting boarding reduction. This position paper proposes that the ED crowding problem can be optimally addressed by applying a systems approach using predictive modeling to identify patients at risk of being admitted to the hospital and uses that information to initiate the time-consuming bed management process earlier in the care continuum, shortening the time during which patients wait in the ED for an inpatient bed assignment, thus removing the exit block that causes boarding and subsequently reducing crowding.
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Affiliation(s)
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Issa M. The Pathway to Achieving Universal Health Coverage in the Democratic Republic of Congo: Obstacles and Prospects. Cureus 2023; 15:e41935. [PMID: 37583749 PMCID: PMC10425163 DOI: 10.7759/cureus.41935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
This paper explores the complexities surrounding achieving universal health coverage (UHC) in the Democratic Republic of Congo (DRC) and proposes viable strategies to overcome the obstacles. The study's findings contribute to the global discourse on UHC in resource-limited settings and hold significant implications for policy formulation and implementation in both DRC and similar contexts. The introduction emphasises the importance of UHC in promoting equitable access to quality healthcare services for all individuals. Nevertheless, the DRC faces numerous challenges on its path to UHC. This paper identifies four key challenges: Firstly, the fragile healthcare infrastructure in the DRC necessitates the establishment of better-equipped facilities, an adequate healthcare workforce, and improved access to essential medical supplies. These factors hinder the provision of comprehensive health services and impede progress towards UHC. Secondly, socio-economic barriers such as persistent poverty, income disparities, and regional variations pose significant obstacles to achieving UHC in the DRC. Limited financial resources and widespread poverty prevent individuals from accessing healthcare services, exacerbating health inequities. Thirdly, weak health governance, inadequate policy implementation, and limited coordination among stakeholders impede the effective delivery of healthcare services in the DRC. Thus, strengthening governance structures and enhancing policy implementation are essential for UHC. Lastly, the absence of comprehensive health information systems and poor data management hinder evidence-based decision-making and resource allocation. Addressing these deficiencies is vital for monitoring progress and guiding policy formulation towards UHC. Given these challenges, this paper proposes potential solutions and future perspectives for achieving UHC in the DRC. These include strengthening health systems, implementing social protection mechanisms, enacting policy reforms, enhancing governance structures, and strengthening health information systems. Investments in robust health information systems, data collection and management improvements and the enhancement of capacity for health research and surveillance facilitate evidence-based decision-making and progress towards UHC. In conclusion, the DRC faces obstacles related to healthcare infrastructure, socio-economic factors, governance issues, and deficiencies in health information systems in its pursuit of UHC. However, by addressing these challenges through targeted interventions, policy reforms, and improved governance, the DRC can make strides towards ensuring equitable access to high-quality healthcare for all its citizens. Collaboration between national and international stakeholders is crucial for sustaining progress towards UHC and promoting health equity within the country.
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Affiliation(s)
- Moussa Issa
- Department of Emergency Medicine, Calderdale & Huddersfield National Health Service (NHS) Foundation Trust, Huddersfield, GBR
- Department of Health Research, Lancaster University, Lancaster, GBR
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Lee J, Tong K, Stroedecke N, Monestime S, Eom E, Stutsky M, Boothe K, Luon S, Sawant V, Renauer M. Implementation of an integrated ambulatory care pharmacist collaborative care workflow model in specialty clinics in a large academic health system. Am J Health Syst Pharm 2023; 80:842-851. [PMID: 37144568 DOI: 10.1093/ajhp/zxad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Ambulatory care and specialty pharmacy practices are rapidly growing in tandem with the accelerated development of advanced therapies for complex disease states. A coordinated and standardized interprofessional team-based approach is critical to providing high-quality care to specialty patients on complex, expensive, and high-risk therapies. Yale New Haven Health System dedicated resources to the creation of a medication management clinic under a unique care model that integrates ambulatory care pharmacists within specialty clinics who coordinate with centralized specialty pharmacists. The new care model workflow encompasses ambulatory care pharmacists, specialty pharmacists, ambulatory care pharmacy technicians, specialty pharmacy liaisons, clinicians, and clinic support staff. The strategies employed to design, implement, and optimize this workflow to meet the increasing demand for pharmacy support in specialty care is discussed. SUMMARY The workflow incorporated key activities from highly diverse existing specialty pharmacy, ambulatory care pharmacy, and specialty clinic practices. Standard processes were developed for patient identification, referral placement, visit scheduling, encounter documentation, medication fulfillment, and clinical follow-up. Resources were created or optimized to support successful implementation, including an electronic pharmacy referral, specialty collaborative practice agreements to facilitate pharmacist-led comprehensive medication management, and a standardized note template. Communication strategies were developed to facilitate feedback and process updates. Enhancements focused on eliminating documentation redundancies and delegating nonclinical tasks to a dedicated ambulatory care pharmacy technician. The workflow was implemented in 5 ambulatory rheumatology, digestive health, and infectious diseases clinics. Pharmacists utilized this workflow to complete 1,237 patient visits, serving 550 individual patients over 11 months. CONCLUSION This initiative created a standard workflow to support an interdisciplinary standard of specialty patient care that is robust to accommodate planned expansion. This workflow implementation approach can serve as a road map for other healthcare systems with integrated specialty and ambulatory pharmacy departments undertaking similar models for specialty patient management.
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Affiliation(s)
- Jenna Lee
- Yale New Haven Health System, New Haven, CT, USA
| | - Kimhouy Tong
- Yale New Haven Health System, New Haven, CT, USA
| | | | | | - Esther Eom
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | | | - Steph Luon
- Yale New Haven Health System, New Haven, CT, USA
| | - Vinay Sawant
- Yale New Haven Health System, New Haven, CT, USA
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Das S, Hussey P. HL7-FHIR-Based ContSys Formal Ontology for Enabling Continuity of Care Data Interoperability. J Pers Med 2023; 13:1024. [PMID: 37511637 PMCID: PMC10381488 DOI: 10.3390/jpm13071024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
The rapid advancement of digital technologies and recent global pandemic-like scenarios have pressed our society to reform and adapt health and social care toward personalizing the home care setting. This transformation assists in avoiding treatment in crowded secondary health care facilities and improves the experience and impact on both healthcare professionals and service users alike. The interoperability challenge through standards-based roadmaps is the lynchpin toward enabling the efficient interconnection between health and social care services. Hence, facilitating safe and trustworthy data workflow from one healthcare system to another is a crucial aspect of the communication process. In this paper, we showcase a methodology as to how we can extract, transform and load data in a semi-automated process using a common semantic standardized data model (CSSDM) to generate a personalized healthcare knowledge graph (KG). CSSDM is based on a formal ontology of ISO 13940:2015 ContSys for conceptual grounding and FHIR-based specification to accommodate structural attributes to generate KG. The goal of CSSDM is to offer an alternative pathway to discuss interoperability by supporting a unique collaboration between a company creating a health information system and a cloud-enabled health service. The resulting pathway of communication provides access to multiple stakeholders for sharing high-quality data and information.
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Affiliation(s)
- Subhashis Das
- ADAPT Centre & CeIC, Dublin City University (DCU), D09FW22 Dublin, Ireland
| | - Pamela Hussey
- ADAPT Centre & CeIC, Dublin City University (DCU), D09FW22 Dublin, Ireland
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El Tantawi M, Lam WYH, Giraudeau N, Virtanen JI, Matanhire C, Chifamba T, Sabbah W, Gomaa N, Al-Maweri SA, Uribe SE, Mohebbi SZ, Hasmun N, Guan G, Polonowita A, Khan SB, Pisano M, Ellakany P, Baraka MM, Ali AA, Orellana Centeno JE, Pavlic V, Folayan MO. Teledentistry from research to practice: a tale of nineteen countries. Front Oral Health 2023; 4:1188557. [PMID: 37397348 PMCID: PMC10311964 DOI: 10.3389/froh.2023.1188557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Aim The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.
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Affiliation(s)
- Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Walter Yu Hang Lam
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | | | - Jorma I. Virtanen
- Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Cleopatra Matanhire
- Department of Oral Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Timothy Chifamba
- Department of Oral Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Wael Sabbah
- Centre for Host Microbiome Interactions, King’s College London, London, United Kingdom
| | - Noha Gomaa
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sadeq Ali Al-Maweri
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sergio E. Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
- School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
| | - Simin Z. Mohebbi
- Research Center for Caries Prevention, Dentistry Research Institute, and Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Noren Hasmun
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Guangzhao Guan
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Ajith Polonowita
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sadika Begum Khan
- Department of Prosthetic Dentistry, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Mohamed Baraka
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | | | - Verica Pavlic
- Department of Periodontology and Oral Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Kobelski G, Naylor K, Ślusarz R, Wysokiński M. Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic. J Clin Med 2023; 12:4072. [PMID: 37373764 DOI: 10.3390/jcm12124072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/04/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences. AIM The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland. MATERIAL AND METHOD The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire. RESULTS The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score). CONCLUSIONS The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic.
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Affiliation(s)
- Grzegorz Kobelski
- Institute of Medical Sciences, University College of Applied Sciences in Chelm, Pocztowa 54, 22-100 Chełm, Poland
| | - Katarzyna Naylor
- Chair and Department of Didactics and Medical Simulation, Faculty of Medical Sciences, Medical University of Lublin Poland, Chodźki 7, 20-093 Lublin, Poland
| | - Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-821 Bydgoszcz, Poland
| | - Mariusz Wysokiński
- Department of Fundamentals of Nursing, Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin Poland, 20-093 Lublin, Poland
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