Search results for: healthcare care providers

Authors: Lilian Nantume Wampande

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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.

Keywords: adolescent, HIV, support groups, Uganda

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Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.

Keywords: care, ethics, expertise, NICU, paternalism

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Authors: E. M. Vieira, C. S. Vieira, L. P. Bonifácio, L. M. de Oliveira Ciabati, A. C. A. Franzon, F. S. Zaratini, J. A. C. Sanchez, M. S. Andrade, J. P. Dias de Souza

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The quality of prenatal care is key to reduce maternal morbidity and mortality. Communication between the health service and users can stimulate prevention and care. M-health has been an important and low cost strategy to health education. The PRENACEL programme (prenatal in the cell phone) was developed. It consists of a programme of information via SMS from the 20^th week of pregnancy up to 12^th week after delivery. Messages were about prenatal care, birth, contraception and breastfeeding. Communication of the pregnant woman asking questions about their health was possible. The objective of this study was to evaluate the implementation of PRENACEL as a useful complement to the standard prenatal care. Twenty health clinics were selected and randomized by cluster, 10 as the intervention group and 10 as the control group. In the intervention group, women and their partner were invited to participate. The control group received the standard prenatal care. All women were interviewed in the immediate post-partum and in the 12^th and 24^th week post-partum. Most women were married, had more than 8 years of schooling and visit the clinic more than 6 times during prenatal care. The intervention group presented lowest percentage of higher economic participants (5.6%), less single mothers and no drug user. It also presented more prenatal care visits than the control group and it was less likely to present Severe Acute Maternal Mortality when compared to control group as well as higher percentage of partners (75.4%) was present at the birth compared to control group. Although the study is still being carried out, preliminary data are showing positive results of the compliance of women to prenatal care.

Keywords: cellphone, health technology, prenatal care, prevention

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Authors: Prosper Tafadzwa Denhere, Ephias Ruhode, Munyaradzi Zhou

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Health Information Systems (HISs) interoperability is emerging to be the future of modern healthcare systems Enterprise Architecture (EA), where healthcare entities are seamlessly interconnected to share healthcare data. The reality that the healthcare industry has been characterised by an influx of fragmented stand-alone e-Health systems, which present challenges of healthcare information sharing across platforms, desires much attention for systems integration efforts. The lack of an EA conceptual framework resultantly crates the need for investigating an ideal solution to the objective of Health Information Systems interoperability development assessment. The study takes a qualitative exploratory approach through a design science research context. The research aims to study the various themes withdrawn from the literature that can help in the assessment of interoperable HISs development through a literature study. Themes derived from the study include HIS needs, HIS readiness, HIS constraints, and HIS technology integration elements and standards tied to the EA development architectural layers of The Open Group Architecture Framework (TOGAF) as an EA development methodology. Eventually, the themes were conceptualised into a framework reviewed by two experts. The essence of the study was to provide a framework within which interoperable EA of HISs should be developed.

Keywords: enterprise architecture, eHealth, health information systems, interoperability

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Authors: Anne Klimesch, Alejandra Martinez, Martin HäRter, Isabelle Scholl, Paulina Bravo

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Patient-centered care (PCC) is a key principle of high-quality healthcare. In Latin America, research on and promotion of PCC have taken place in the past. However, thorough implementation of PCC in practice is still missing. In Germany, an integrative model of patient-centeredness has been developed by synthesis of diverse concepts of PCC. The model could serve as a point of reference for further research on the implementation of PCC. However, it is predominantly based on research from Europe and North America. This scoping review, therefore, aims to accumulate research on PCC in Latin America in the past 15 years and analyse how PCC has been conceptualized. The resulting overview of PCC in Latin America will be a foundation for a subsequent study aiming at the adaptation of the integrative model of patient-centeredness to the Latin American health care context. Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, SCIELO, Redalyc.) will be searched, and reference and citation tracking will be performed. Studies will be included if they were carried out in Latin America, investigated PCC in any clinical and community setting (public and private), and were published in English, Spanish, French, or Portuguese since 2006. Furthermore, any theoretical framework or conceptual model to guide how PCC is conceptualized in Latin America will be included. Two reviewers will be responsible for the identification of articles, screening of records, and full-text assessment. The results of the scoping review will be used in the development of a mixed-methods study with the aim to understand the needs for PCC, as well as barriers and facilitators in Latin America. Based on the outcomes, the integrative model of PCC will be translated to Spanish and adapted to the Latin American context. The integrative model will enable the dissemination of the concept of PCC in Latin America and will provide a common ground for further research on the topic. The project will thereby make an important contribution to an evidence-based implementation of PCC in Latin America.

Keywords: conceptual framework, integrative model of PCC, Latin America, patient-centered care

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Authors: Kristine Joy Y. Sumanga, Clarissa Mae D. Derecho

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Telemedicine is providing health care services using electronic means at a distance, including the diagnosis, treatment, and prevention of diseases as well as the research and evaluation and education of health care providers. The role of telemedicine in this time of the COVID-19 pandemic is vital, especially in the practice of medicine. General Objective: To determine the extent of knowledge, preparedness and perception of telemedicine among Family Medicine Resident Physicians in different training institutions in Cebu City during the Coronavirus Disease 19 pandemic. Methods: A descriptive, cross-sectional survey research study was conducted in four hospital training institutions in Cebu City. A total of 41 respondents gave their consent and were given the online survey questionnaire pertaining to the extent of knowledge, preparedness and perceptions on telemedicine, including respondents’ demographic data and problems encountered in Telemedicine. Results: Out of the 41 respondents, 56.10% were young adults (26 to 30 years old), mostly females (70.73%), single (68.29%), first-year residents (43.90%), employed at a government hospital (70.73%) and are in the traditional residency pathway (82.93%). On relevant experience, 82.93% experienced telemedicine during residency, with 100% on follow-up consultations, and 95% were consulted due to infections. Respondents’ extent of knowledge was average, while the extent of preparedness and perception were great. Problems with low connectivity (80.48%) were noted by most of the respondents. Conclusion: Resident physicians moderately understood the information about telemedicine but with a great extent of preparedness and perception. They are always prepared for telemedicine modality because they are fully aware of its existence and need in the delivery of health care services among their patients at the time of the pandemic. Challenges to low connectivity and handling patients’ data privacy were the major concerns met by the resident physicians in the use of telemedicine.

Keywords: telemedicine, knowledge, preparedness, perception, family medicine, residents, COVID 19

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Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

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Authors: I. Brezeanu, J. Mackrill, A. Cajo, C. Mogollon

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Modern Slavery is a serious crime, where often the victims are unable to leave their situation of exploitation, being controlled by threats, punishment, violence, coercion, and deception. In the UK, this term encompasses both Slavery and Human Trafficking. The number of potential victims who were referred to the National Referral Mechanism (NRM) increased exponentially in the past decade, passing from fewer than 700 potential victims referred in 2010 to more than 12.000 in 2021. Our study aims to explore how the concept of Trauma-Informed Care (TIC) approach can be adopted by services working with survivors of Modern Slavery and Trafficking (MST). Notably, in this paper, we will elaborate on how the complex needs of survivors are related to their traumatic experiences and what are the necessary steps and resources for implementing a Modern Slavery Trauma-Informed model. While there are relatively few services in the UK that have a deep understanding of the survivors’ and practitioners’ views of how trauma impacts their daily life, there is a strong need for developing services that are organised and delivered in ways that prevent retraumatisation and enable trauma survivors to engage safely with the right professionals at the right time, promoting healing through positive relationships. Such models, known as Trauma-Informed Approaches (TIAs), are seen as crucial to the empowerment of survivors, yet they remain a marginal implementation model by governments, law enforcement, judiciary, or care providers, who are frequently survivors’ first point of contact in the recovery process. In order to understand better how to provide best practice and to adopt the concept, this study is based on a multi-disciplinary approach, encompassing both theoretical perspectives and co-production. By combining qualitative and quantitative research and comparing different analysis of applied examples of TIC in the US and the UK, we gained important insights about the prevention and impact of trauma on survivors’ life. The articulation between more general expertise on Trauma-Informed Care developed by other institutions operating in the field, and the SJOG delivery, based on the Salvation Army’s Modern Slavery Victim Care and Coordination Contract (MSVCC) and the Care Quality Commission regulations, allowed to identify on one side what are the complex needs of survivors derived from their traumatic experiences, and on the other side, how could MST services prevent retraumatisation. Additional, two in-depth interviews with survivors, who receive support from one of our services at Olallo House in London, and a survey shared among all colleagues working with MST services completed the findings of the research with their personal experience and knowledge. Ultimately, we developed an evidence-based Trauma-Informed Care Pathway that aims to improve the wellbeing of survivors and to support them to live a meaningful life. The establishedpathway delivers three main outcomes belonging to the social determinants of health criteria – health and wellbeing, purpose and relationship, and covers key themes of the context of trauma, needs of individuals, and service support.

Keywords: trauma-informed care, modern slavery, human trafficking, trauma, retraumatisation

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Authors: Sandra So, Mohd Roslan Ismail, Safurah Jaafar

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With the rapid proliferation of data in healthcare has provided an opportune platform creation of Artificial Intelligence (AI). AI has brought a paradigm shift for healthcare professionals, promising improvement in delivery and quality. This study aims to determine the perception of healthcare personnel on perceived ease of use, perceived usefulness, and subjective norm toward attitude for artificial intelligence acceptance. A cross-sectional single institutional study of employees’ perception of adopting AI in the hospital was conducted. The survey was conducted using a questionnaire adapted from Technology Acceptance Model and a four-point Likert scale was used. There were 96 or 75.5% of the total population responded. This study has shown the significant relationship and the importance of ease of use, perceived usefulness, and subjective norm to the acceptance of AI. In the study results, it concluded that the determining factor to the strong acceptance of AI in their practices is mostly those respondents with the most interaction with the patients and clinical management.

Keywords: artificial intelligence, machine learning, perceived ease of use, perceived usefulness, subjective norm

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Authors: Francis Gyapong, Denis Yar

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The use of cell phones has become an indispensable tool in the hospital's settings. Cell phones are used in hospitals without restrictions regardless of their unknown microbial load. However, the indiscriminate use of mobile devices, especially at health facilities, can act as a vehicle for transmitting pathogenic bacteria and other microorganisms. These potential pathogens become exogenous sources of infection for the patients and are also a potential health hazard for self and as well as family members. These are a growing problem in many health care institutions. Innovations in mobile communication have led to better patient care in diabetes, asthma, and increased in vaccine uptake via SMS. Notwithstanding, the use of cell phones can be a great potential source for nosocomial infections. Many studies reported heavy microbial contamination of cell phones among healthcare workers and communities. However, limited studies have been reported in our region on bacterial contamination on cell phones among healthcare workers. This study assessed microbial contamination of cell phones of health care workers (HCWs) at the Mampong Municipal Government Hospital (MMGH), Ghana. A cross-sectional design was used to characterize bacterial microflora on cell phones of HCWs at the MMGH. A total of thirty-five (35) swab samples of cell phones of HCWs at the Laboratory, Dental Unit, Children’s Ward, Theater and Male ward were randomly collected for laboratory examinations. A suspension of the swab samples was each streak on blood and MacConkey agar and incubated at 37℃ for 48 hours. Bacterial isolates were identified using appropriate laboratory and biochemical tests. Kirby-Bauer disc diffusion method was used to determine the antimicrobial sensitivity tests of the isolates. Data analysis was performed using SPSS version 16. All mobile phones sampled were contaminated with one or more bacterial isolates. Cell phones from the Male ward, Dental Unit, Laboratory, Theatre and Children’s ward had at least three different bacterial isolates; 85.7%, 71.4%, 57.1% and 28.6% for both Theater and Children’s ward respectively. Bacterial contaminants identified were Staphylococcus epidermidis (37%), Staphylococcus aureus (26%), E. coli (20%), Bacillus spp. (11%) and Klebsiella spp. (6 %). Except for the Children ward, E. coli was isolated at all study sites and predominant (42.9%) at the Dental Unit while Klebsiella spp. (28.6%) was only isolated at the Children’s ward. Antibiotic sensitivity testing of Staphylococcus aureus indicated that they were highly sensitive to cephalexin (89%) tetracycline (80%), gentamycin (75%), lincomycin (70%), ciprofloxacin (67%) and highly resistant to ampicillin (75%). Some of these bacteria isolated are potential pathogens and their presence on cell phones of HCWs could be transmitted to patients and their families. Hence strict hand washing before and after every contact with patient and phone be enforced to reduce the risk of nosocomial infections.

Keywords: mobile phones, bacterial contamination, patients, MMGH

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Authors: A. Aguezzoul

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The Logistics Services Providers (LSPs) selection and performance is a strategic decision that affects the overall performance of any company as well as its supply chain. It is a complex process, which takes into account various conflicting quantitative and qualitative factors, as well as outsourced logistics activities. This article focuses on the evolution of the weights associated to these factors over the last years in order to better understand the change in the importance that logistics professionals place on them criteria when choosing their LSPs. For that, an analysis of 17 main studies published during 2014-2017 period was carried out and the results are compared to those of a previous literature review on this subject. Our analysis allowed us to deduce the following observations: 1) the LSPs selection is a multi-criteria process; 2) the empirical character of the majority of studies, conducted particularly in Asian countries; 3) the criteria importance has undergone significant changes following the emergence of information technologies that have favored the work in close collaboration and in partnership between the LSPs and their customers, even on a worldwide scale; 4) the cost criterion is relatively less important than in the past; and finally 5) with the development of sustainable supply chains, the factors associated with the logistic activities of return and waste processing (reverse logistics) are becoming increasingly important in this multi-criteria process of selection and evaluation of LSPs performance.

Keywords: logistics outsourcing, logistics providers, multi-criteria decision making, performance

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Authors: Michael Joseph Passmore

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Euthanasia, or assisted suicide (EAS), refers to the provision of medical assistance to individuals seeking to end their own lives. In Canada, the issue of EAS has been the subject of debate and legislative action for many years. In 2016, the Canadian government passed the Medical Assistance in Dying (MAID) Act. This legalized EAS in Canada is subject to certain eligibility criteria. In 2023, debate in Canada continues regarding the scope of MAID practice and associated legislation. Dementia is an illness that causes suffering at the end of life. Persons suffering due to dementia deserve timely and effective palliative care.

Keywords: palliative care, neurocognitive disorder, dementia, Alzheimer’s disease, euthanasia, assisted suicide, medical ethics, bioethics

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Authors: Umedov Mekhroz, Griaznova Svetlana

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In connection with the growth of oncological diseases, the design of centers for diagnostics and the production of radiopharmaceuticals is the most relevant area of healthcare facilities. The design of new nuclear medicine centers should be carried out from the standpoint of solving the following tasks: the availability of medical care, functionality, environmental friendliness, sustainable development, improving the safety of drugs, the use of which requires special care, reducing the rate of environmental pollution, ensuring comfortable conditions for the internal microclimate, adaptability. The purpose of this article is to substantiate architectural and planning solutions, formulate recommendations and principles for the design of nuclear medicine centers and determine the connections between the production and medical functions of a building. The advantages of combining the production of radiopharmaceuticals and the department of medical care: less radiation activity is accumulated, the cost of the final product is lower, and there is no need to hire a transport company with a special license for transportation. A medical imaging department is a structural unit of a medical institution in which diagnostic procedures are carried out in order to gain an idea of the internal structure of various organs of the body for clinical analysis. Depending on the needs of a particular institution, the department may include various rooms that provide medical imaging using radiography, ultrasound diagnostics, and the phenomenon of nuclear magnetic resonance. The production of radiopharmaceuticals is an object intended for the production of a pharmaceutical substance containing a radionuclide and intended for introduction into the human body or laboratory animal for the purpose of diagnosis, evaluation of the effectiveness of treatment, or for biomedical research. The research methodology includes the following subjects: study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research; An integrated approach to the study of existing international experience of PET / CT scan centers and the production of radiopharmaceuticals; Elaboration of graphical analysis and diagrams based on the system analysis of the processed information; Identification of methods and principles of functional zoning of nuclear medicine centers. The result of the research is the identification of the design principles of nuclear medicine centers with the functions of the production of radiopharmaceuticals and the department of medical imaging. This research will be applied to the design and construction of healthcare facilities in the field of nuclear medicine.

Keywords: architectural planning solutions, functional zoning, nuclear medicine, PET/CT scan, production of radiopharmaceuticals, radiotherapy

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Authors: Osuagwu Justine Ugochukwu

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Investigating the effects of transformational and transactional leadership styles on the performance of healthcare employees at the University Teaching Hospital (UNTH) in Enugu, Nigeria, was the goal of the research. The respondents were asked to fill out a structured questionnaire. The respondents were chosen using a straightforward random sampling technique and consisted of 370 health workers at the hospital. The result of the analysis revealed that transactional and transformational leadership style has a positive while ambidextrous leadership has a negative effect on healthcare workers' performance in UNTH, Enugu. Therefore, the management of public hospitals that have the capacity to change their top management approach to leadership styles will gain substantial support from their employees’ thereby increasing organizational commitment and performance among health workers. This will have remarkable social implications, one of which is a change in the work culture and attitude of medical personnel from the seemingly anti-community of patients to friendly engagement and treatment of patients leading to a harmonious coexistence among these individuals in society. Investigating ambidextrous leadership and the use of nonparametric analysis is unique and has brought brand-new knowledge to leadership literature.

Keywords: workers performance, transformational leadership, transactional leadership, governance quality, ambidextrous leadership

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Authors: Hong Wu, Naiji Lu, Chenguang Wang, Xinming Tu

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This article analyzes the causal effects of informal care, mental health, and physical health on falls and other accidents (e.g. traffic accidents) among elderly people. To purge potential reversal causal effects, e.g., past accidents induce more future informal care, we use two-stage least squares to identify the impacts. By using longitudinal data from a representative national China Health and retirement longitudinal study of people aged 45 and older in China, our findings indicate that informal care decreases while poor health conditions increase the occurrence of accidents. We also find heterogeneous impacts on the occurrence of accidents, varying by gender, urban status, and past accident history. Our findings suggest the following three policy implications. First, policy makers who aim to decrease accidents should take informal care to elders into account. Second, ease of birth policy and postponed retirement policy are urgent to meet the demand of informal care. Third, medical policies should attach great importance to not only physical health but also mental health of elderly parents especially for older people with accident history.

Keywords: accident, China, fall, informal care, mental health, physical health

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Data integration of health through connected services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. Such integration will support all wind of change in healthcare by being predictive, pre-emptive, personalized, problem-oriented and participatory. Prototyping a healthcare system that enables data integration has been a big challenge for healthcare for a long time. However, an innovative solution started to emerge by focusing on problem lists where everything can connect the problem list forming a growing graph. This notion was introduced by Dr. Lawrence Weed in early 70’s, but the enabling technologies weren’t mature enough to provide a successful implementation prototype. In this article, we are describing our efforts in prototyping Dr. Lawrence Weed's problem-oriented medical record (POMR) and his patient case schema (SOAP) to shape a prototype for connected health. For this, we are using the TypeGraphQL API and our enterprise-based QL4POMR to describe a Web-Based gateway for healthcare services connectivity. Our prototype has reported success in connecting to the HL7 FHIR medical record and the OpenTarget biomedical repositories.

Keywords: connected health, problem-oriented healthcare record, SOAP, QL4POMR, typegraphQL

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Lucile Richard

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Contemporary thinkers studying biopolitics and its lethal logic find little interest in Foucault's "vague sketch of the pastorate.” Despite pastoral power being depicted as the matrix of governmentality in the genealogy of biopower, most post-Foucauldian theorists disregard its study. Sovereign power takes precedence in the examination of the governmental connection between care, violence, and death. Questioning this recurring motif, this article advocates for a feminist exploration of pastoral power. It argues that giving attention to the genealogy of the pastorate is essential to account for the carelessness that runs today's politics. Examining Foucault's understanding of this "power to care" uncovers the link between care work and politics, a facet of governmentality often overlooked in sovereignty-centered perspectives. His description of “pastoral insurrections”, in so far as it highlights that caring, far from being excluded from politics, is the object of competing problematizations, also calls for a more nuanced and complex comprehension of the politicization of care and care work than the ones developed by feminist theorists. As such, it provides an opportunity to delve into under-theorized dimensions of the "care crisis" in feminist accounts. On one hand, it reveals how populations are disciplined and controlled, not only through caregiving obligations, but also through being assigned or excluded from receiving care. On the other, it stresses that the organization of the public sphere is just as important as the organization of the private sphere, which is the main focus for most feminists, in preventing marginalized perspectives on caring from gaining political momentum.

Keywords: Foucault, feminist theory, resistance, pastoral power, crisis of care, biopolitics

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Authors: Hong Wu, Naiji Lu

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Improvement of health behavior among people with chronic diseases is vital for increasing longevity and enhancing quality of life. This paper researched the causal effects of informal care on the compliance with doctor’s health advices – smoking control, dietetic regulation, weight control and keep exercising – among older people with chronic diseases in China, which is facing the challenge of aging. We addressed the selection bias by using propensity score matching in the estimation process. We used the 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study. Our results showed informal care can help improve health behavior of older people. First, informal care improved the compliance of smoking controls: whether smoke, frequency of smoking, and the time lag between wake up and the first cigarette was all lower for these older people with informal care; Second, for dietetic regulation, older people with informal care had more meals every day than older people without informal care; Third, three variables: BMI, whether gain weight and whether lose weight were used to measure the outcome of weight control. There were no significant difference between group with informal care and that without for BMI and the possibility of losing weight. Older people with informal care had lower possibility of gain weight than that without; Last, for the advice of keeping exercising, informal care increased the probability of walking exercise, however, the difference between groups for moderate and vigorous exercise were not significant. Our results indicate policy makers who aim to decrease accidents should take informal care to elders into account and provide an appropriate policy to meet the demand of informal care. Our birth policy and postponed retirement policy may decrease the informal caregiving hours, so adjustments of these policies are important and urgent to meet the current situation of aged tendency of population. In addition, government could give more support to develop organizations to provide formal care, such as nursing home. We infer that formal care is also useful for health behavior improvements.

Keywords: chronic diseases, compliance, CHARLS, health advice, informal care, older people, propensity score matching

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Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Paulo Sergio Altman Ferreira

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Relationship development plays an essential role in every logistics company. Logistics companies are service-based businesses essentially performing the flow of materials, housing, and inventory management for a wide range of customers. The service encounter between the logistics provider’s personnel and the customers may form a connection that will demonstrate a strong impact, not only to the customers' overall satisfaction but may also provide the perception of individualized services. Logistics services must drive value. It also shows a close influence on the quality and costs of client-centered services. If we describe logistics value creation as the function of quality perception of the client divided by service costs, there is a requirement to better outline and explain the measures and analytics for logistics costs and relationship performance. This critical shift to understand logistics services is a relevant contribution to capture how relationship value can be quantified. This might involve changing our current perspective on logistics providers beyond uniquely measuring the services in terms of activities, personnel levels, and financial/costs ratios. This paper argues that measuring value creation accomplishments of logistics services needs to consider the relational improvements for the wider range of logistics companies. Accurate logistics value requires a description of the financial impact of the relational perspective of the service.

Keywords: logistics services providers, financial metrics, relationship management, value creation

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Authors: W. L. Tsang, H. Y. Li, S. L. Wong, T. Y. Kwok, S. C. Yuen, S. S. Kwok, P. S. Ko, S. Y. Lau

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Introduction: Palliative care is no doubt necessary in surgery. When one looks at studies of what patients with life-threatening illness want and compares to what they experience in surgical units, the gap is huge. Surgical nurses, being patient advocates, should engage with patients and families sooner rather than later in their illness trajectories to consider how to manage the illness, not just their capacity to survive. Objective: This clinical practice guide aims to fill the service gap of palliative care in surgery by producing a quality-driven, evidence-based yet straightforward clinical practice guide based on a focus strategy. Methodology: In line with Guide to Good Nursing Practice: End-of-Life Care recommended by Nursing Council of Hong Kong and the strategic goal of improving quality of palliative care proposed in HA Strategic Plan 2017-2022, multiple phases of work were undertaken from July 2015 to December 2017. A pragmatic clinical practice guide for surgical patients facing life-threatening conditions was developed based on assessments on knowledge of and attitudes towards end-of-life care of surgical nurses. Key domains, including preparation for bereavement, nursing care for imminently dying patients and at the dying scene were crystallized according to the results of the assessments and the palliative care checklist formulated by UCH Palliative Care Team. After a year of rollout, its content was refined through analyses of implementation in routine practice and consensus opinions from frontline nurses. Results and Outcomes: This clinical practice guide inspires surgical nurses with the art of care to provide for patients’ comfort, function, and longevity. It provides practical directions and assists nurses to master the skills on advance care planning and learn how to be clear with patients, families and themselves about the realities of the disease pictures. Through the implementation, patients and families are included in the decision process, and their wishes are honored. The delivery of explicit and high-quality palliative care maintains good nurse-to-patient relations and enhances satisfaction of hospital care of patients and families. Conclusion: Surgical nursing has always been up to the unique challenges of the era. This clinical practice guide has become an island of credibility for our nurses as they traverse the often stormy waters of life-limiting illness.

Keywords: palliative care delivery, palliative care in surgery, hospice care, end-of-life care

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Authors: Tonya P. Bowers

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Background: The community/patient-focused quality improvement (QI) project has resolved a clinical problem using a quantitative design evaluating behavior change practices in a convenience sample from a multi-cultural congregation in a faith-based setting. AD is a legal document that speaks for the patient when they are unable to speak for themselves. The AD provides detailed information regarding critical medical decisions on behalf of the patient if they’re unable to make decisions themselves. The goal of an AD is to improve EOL care renderings that align with the patient’s desires. The AD diminishes anxiety and stress associated with making difficult EOL care decisions for patients and their families. Method: The project has two intervention strategies: pre-intervention and post-intervention formative surveys and a final summative survey. Most of the data collection takes place during implementation. The Let’s Talk About It Program utilized an online meeting platform for presentation. Participants were asked to complete informed consent and surveys via an online portal. Education included slide presentation, Advance Directive demonstration, video clips, discussions and 1:1 assistance with AD completion with a project manager. Results: Considering the overwhelming likelihood responses where 87.5% identified they “definitely would” hold an End-Of-Life conversation with their healthcare provider or family, and 81.25% indicated their likelihood that they “definitely would” complete an advance directive. In addition, the final summative post-intervention survey (n-14) also demonstrated an overwhelming 93% positive response. Which undoubtedly demonstrates favorable outcomes for the project. Conclusion: the Let’s Talk About It Program demonstrated effectiveness in improving participants' attitudes and acceptance towards Advance Directives and expanding End-of-Life care discussions. Emphasis on program sustainment within the church is imperative in fostering continued awareness and improved health outcomes for the local community with low health literacy.

Keywords: advance directive, end of life, advance care planning, palliative care, low health literacy, faith-based

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Authors: Engida Yisma, Berhanu Dessalegn, Ayalew Astatkie, Nebreed Fesseha

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Background: The use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. Methods: A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. Results: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) [Adjusted OR = 3.63(95%CI: 1.81, 7.28)]. Conclusions: A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.

Keywords: partograph, knowledge, utilization, obstetric care givers, public health institutions

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Authors: Narong Anurak

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This study aimed to find out the hair-care purchasing behavior at hypermarkets and to investigate two factors, package design and advertising channels, that influenced hair-care purchasing behavior. The subjects of the study consisted of 100 housewives aged between 20-60 who usually shopped at Big C Tiwanon. They were selected by accidental sampling, and were asked to complete a questionnaire. The main findings of the survey were that the majority of respondents regarding their brand selection of hair-care products, they gave priority to the product quality followed by a reasonable price, and fragrance, respectively. Besides, more than half of the respondents had brand loyalty while the rest were attracted by an attractive package design and advertising promotion campaigns. The respondents who were attracted by the package design said that the information on the labels influenced their purchasing decision the most, and television was a medium that best reached them as well.

Keywords: advertising channels, consumer purchasing decisions, hair-care market, package design

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Authors: Rajapaksha J. S. R. L., Rajapaksha R. G. D. T., Ranawaka A. U. R., Rangalla R. D. M. P., Ranwala R. D. E. B., Chandratilake M. N.

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Introduction: Lesbian, gay, bisexual, and transgender (LGBT) patients experience discrimination, insensitivity, and ignorance about LGBT-specific health needs among healthcare providers. Developing the correct attitudes among medical students towards LGBT may help provide them with optimal healthcare. Objectives: This study aimed at assessing the attitudes of medical students towards the LBGT community. Methodology: A cross-sectional descriptive study was among all the medical students in the Faculty of Medicine, University of Kelaniya, Sri Lanka, using a validated online questionnaire. The questionnaire focused on eight areas. The data were descriptively analyzed, and the demographic groups were compared. Results: 358 students completed the survey. The response rate was 34.26%. Their attitudes on traditional gender roles and comfortability in interacting with LGBT people were moderate, and they disagreed with negative LGBT social beliefs. They knew less about the origin of sexuality/gender of LGBT. Although they accepted LGBT as a part of diversity, they discouraged normalizing the social practices of LGBT people. Their acceptance and association of LGBT were moderately positive. A minority has encountered LGBT in close social circles, and the majority of them were batch-mates. Although males’ knowledge about the origin of LGBT was higher, they favoured traditional gender roles more. The religious groups showed no differences. The favourability of attitudes towards LGBT reflected respondents’ political ideology. Conclusion: Although medical students’ knowledge on the sexuality/gender basis of LGBT is poor, they have moderately favourable attitudes towards them. They accept LGBT as a part of social diversity but not their social practices. Poor knowledge, lack of encounters, cultural influences, and political ideology may have influenced their attitudes.

Keywords: medical students, attitude, LGBT, diversity

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Authors: Foroozan Sadri, Mohammadmehdi Moulaii, Farkhondeh Vahdati

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Smart materials can create a great revolution in our built environment, as living systems do. In this research, the optimal structure of healthcare building envelopes is analyzed in terms of thickness according to the utility of the smart-nano materials as nontoxic substances in the region. The research method in this paper is based on library studies and simulation. Grasshopper program is employed to simulate thermal characteristics to achieve the optimum U-value in Semnan desert climate, according to Iranian national standards. The potential of healthcare envelope layouts in thermal properties development (primarily U-value) of these buildings is discussed due to the high thermal loads of healthcare buildings and also toxicity effects of conventional materials. As a result, envelope thicknesses are calculated, and the performance of the nano-PCM and gypsum wallboards are compared. A solution with comparable performance using smart-nano materials instead of conventional materials would determine a decrease in wall thickness.

Keywords: energy saving, exterior envelope, smart-nano materials, thermal performance, U-value

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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Authors: Ilyas Khan. Liliane Pintelon, Harry Martin, Michael Shömig

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The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.

Keywords: home hemodialysis, home hemodialysis practices, patients’ related risks in the current home hemodialysis practices, patient safety in home hemodialysis

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Authors: Judith Partouche-Sebban, Saeedeh Rezaee Vessal

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Because of the rising number of new cases of cancer, especially among women, it is more than essential to better understand how women experience cancer in order to bring them adapted to support and care and enhance their well-being and patient experience. Cancer stands for a traumatic experience in which the diagnosis, its medical treatments, and the related side effects lead to deep physical and psychological changes that may arouse considerable stress and anxiety. In order to reduce these negative emotions, women tend to use various defense mechanisms, among which denial has been defined as the most frequent mechanism used by breast cancer patients. This study aims to better understand the consequences of the experience of cancer and their link with the adoption of a denial strategy. The empirical research was done among female cancer survivors in France. Since the topic of this study is relatively unexplored, a qualitative methodology and open-ended interviews were employed. In total, 25 semi-directive interviews were conducted with a female with different cancers, different stages of treatment, and different ages. A systematic inductive method was performed to analyze data. The content analysis enabled to highlight three different denial-related behaviors among women with cancer, which serve a self-protective function. First, women who expressed high levels of anxiety confessed they tended to completely deny the existence of their cancer immediately after the diagnosis of their illness. These women mainly exhibit many fears and a deep distrust toward the medical context and professionals. This coping mechanism is defined by the patient as being unconscious. Second, other women deliberately decided to deny partial information about their cancer, whether this information is related to the stages of the illness, the emotional consequences, or the behavioral consequences of the illness. These women use this strategy as a way to avoid the reality of the illness and its impact on the different aspects of their life as if cancer does not exist. Third, some women tend to reinterpret and give meaning to their cancer as a way to reduce its impact on their life. To this end, they may use magical thinking or positive reframing, or reinterpretation. Because denial may lead to delays in medical treatments, this topic deserves a deep investigation, especially in the context of oncology. As denial is defined as a specific defense mechanism, this study contributes to the existing literature in service marketing which focuses on emotions and emotional regulation in healthcare services which is a crucial issue. Moreover, this study has several managerial implications for healthcare professionals who interact with patients in order to implement better care and support for the patients.

Keywords: cancer, coping mechanisms, denial, healthcare services

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