Search results for: long-term care services

Authors: Maria Ahmad, Alexandra Valetopoulou, Michael D. Christian

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Background: London’s Air Ambulance (LAA) provides advanced pre-hospital trauma care across London, bringing specialist resources and expert trauma teams to patients. Since its inception 32 years ago, LAA has treated over 40,000 pre-hospital patients and significantly contributed to pre-hospital patient care in London. To the authors’ best knowledge, this is the first analysis to quantify the magnitude of the publication impact of LAA on the international field of pre-hospital medicine. Method: We searched the Scopus, Web of Science, Google Scholar and PubMed databases to identify LAA focused articles. These were defined as articles on the topic of pre-hospital medicine which either utilised data from LAA, or focused on LAA patients, or were authored by LAA clinicians. A bibliometric analysis was conducted and the impact of each eligible article was classified as either: high (article directly influenced the change or creation of clinical guidelines); medium (the article was referenced in clinical guidelines or had >20 Google Scholar citations or >10 PubMed citations); or low impact (article had <20 Google Scholar citations or <10 PubMed citations). Results: The literature search yielded 1,120 articles in total. 198 articles met our inclusion criteria, and their full text was analysed to determine the level of impact. 19 articles were classified as high-impact, 76 as medium-impact, and 103 as low-impact. 20 of the 76 medium-impact articles were referenced in clinical guidelines but had not prompted changes to the guidelines. Conclusion: To our knowledge, this review is the first to quantify the significant publication impact of LAA within the field of pre-hospital medicine over the last 32 years. LAA publications have focused on and driven clinical innovations in trauma care, particularly in pre-hospital anaesthesia, haemorrhage control, and major incidents, with many impacting national and international guidelines. We recommend a greater emphasis on multidisciplinary pre-hospital collaboration in publications in future research and quality improvement projects across all pre-hospital services.

Keywords: air ambulance, pre-hospital medicine, London’s Air Ambulance, London HEMS

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Authors: Budsarin Padwang, Darunee Jongudomkarn, Thawan Nieamsup, Autchareeya Patumwan, Rutja Phuphaibul

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In Northern Thailand, a pilot study by the qualitative data, on caring for family members with chronic illness/bedridden based on in-depth interviews of the 12 elderly caregivers in family was carried out during November to December 2017. There are four families that living with three generations in the family. This report is part of a larger study of 'The intergenerational contract of the family in long-term care for older members' to understand the situation and context related to the research questions. Content analysis was obtained and the results revealed as followings. 1) No choice and no freedom: most caregivers were asked by their family members to do the care giving roles because of various appropriate reasons and they could not refuse and felt like having no freedom. 2) ‘Katanyu’ to the parents: The Thai ideology of making merit by taking care of parents was beliefs to do the best in their caregiver roles. 3) The family commitments: The issues of family caring and relationships were the key value of keeping family members to take care of older members with chronic illness/bedridden. The preliminary findings can be beneficial for other regions and will lead to in-depth explore to answer the research questions of the larger study in the future.

Keywords: intergenerational contract, long term care, older members, generational family

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Dusanee Suwankhong, Pranee Liamputtong

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Mothers living with HIV tend to experience stigma and discrimination which has an impact on their psychological and social well-being and their human rights. This paper explores the lived experience of Thai mothers with HIV in their family. In-depth interviewing and drawing methods were employed to gain a deep understanding on the experience of 30 HIV-positive mothers in the southern community of Thailand. The data was analyzed using thematic analysis method. We found that the majority of HIV-positive mothers learned about their HIV status through blood test services during their antenatal care, but some decided to visit a doctor when their partner became chronically frail and showed some signs indicating HIV/AIDS. Learning about their HIV gave them a great shock, and they could not believe that they were infected with HIV/AIDS. They feared that their illness would be disclosed and hence attempted to keep their HIV secret. This was due to the fact that people in their community would blame and labeled them as a ‘disgusting person’. Besides, they would be separated from social contacts and networks, their individual rights would be disregarded, and their potential roles would be restricted. Although participants suggested that people had more positive view on HIV-infected person nowadays, all still wanted to keep it secret because of fear of stigma and discrimination. Thai health care has provided various kinds of support programs, but many mothers chose not to participate due to the fear of disclosure. However, the women attempted to seek some strategies to live a life which would be more acceptable by the community. We conclude that HIV is still seen as a stigmatised disease in rural community of southern Thailand. Local health care providers and relevant sectors in the locality should create suitable programs to enhance self-worth among those HIV-positive mothers because this could increase a quality of life of this vulnerable mothers. Providing sufficient and appropriate supports for better emotional wellbeing is an essential role of health professionals so that the feeling of isolation among these women could be eliminated and positive social justice can be achieved.

Keywords: HIV-positive mothers, lived experience, southern Thailand, stigma and discrimination

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Authors: Sami Alanazi

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Teamwork practices have been recognized as a significant strategy to improve patient safety, quality of care, and staff and patient satisfaction in healthcare settings, particularly within the emergency department (ED). The EDs depend heavily on teams of interdisciplinary healthcare staff to carry out their operational goals and core business of providing care to the serious illness and injured. The ED is also recognized as a high-risk area in relation to service demand and the potential for human error. Few studies have considered the perceptions and experiences of the ED staff (physicians, nurses, allied health professionals, and administration staff) about the practice of teamwork, especially in Saudi Arabia (SA), and no studies have been conducted to explore the practices of teamwork in the EDs. Aim: To explore the practices of teamwork from the perspectives and experiences of staff (physicians, nurses, allied health professionals, and administration staff) when interacting with each other in the admission areas in the ED of a public hospital in the Northern Border region of SA. Method: A qualitative case study design was utilized, drawing on two methods for the data collection, comprising of semi-structured interviews (n=22) with physicians (6), nurses (10), allied health professionals (3), and administrative members (3) working in the ED of a hospital in the Northern Border region of SA. The second method is non-participant direct observation. All data were analyzed using thematic analysis. Findings: The main themes that emerged from the analysis were as follows: the meaningful of teamwork, reasons of teamwork, the ED environmental factors, the organizational factors, the value of communication, leadership, teamwork skills in the ED, team members' behaviors, multicultural teamwork, and patients and families behaviors theme. Discussion: Working in the ED environment played a major role in affecting work performance as well as team dynamics. However, Communication, time management, fast-paced performance, multitasking, motivation, leadership, and stress management were highlighted by the participants as fundamental skills that have a major impact on team members and patients in the ED. It was found that the behaviors of the team members impacted the team dynamics as well as ED health services. Behaviors such as disputes among team members, conflict, cooperation, uncooperative members, neglect, and emotions of the members. Besides that, the behaviors of the patients and their accompanies had a direct impact on the team and the quality of the services. In addition, the differences in the cultures have separated the team members and created undesirable gaps such the gender segregation, national origin discrimination, and similarity and different in interests. Conclusion: Effective teamwork, in the context of the emergency department, was recognized as an essential element to obtain the quality of care as well as improve staff satisfaction.

Keywords: teamwork, barrier, facilitator, emergencydepartment

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Authors: Naomi Mutea, Jossete Jones

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The project aimed at exploring the views and perceptions of nurse leaders and educators regarding use of International Classification for Nursing Practice (ICNP) in an informal approach which involved face to face discussions, after which a decision would be made on whether to proceed and propose introduction of ICNP project in Kenya as a pilot project which would mean all nurses would use a standard approach to reporting and documenting nursing care. In addition the project was to determine the best approaches/methods that can be used to introduce ICNP in the Kenyan nursing education and practice environment using the findings of the pilot project. Further four cardex reports were reviewed to establish if nurses on the bedside used a standardized language in documenting and reporting care processes. The cardex reports showed that nurses do not use ICNP or any other standardized language. The results of the discussions revealed that this would be a challenge due to several challenges experienced in conducting nursing research in resource-limited environments. The following questions were asked during the informal discussions with the educators/leaders: •What is currently being taught in terms of standardized nursing language? •Are you familiar with ICNP? •Do you view it advantageous to have a standardized language? •What is the greatest need at the moment in terms of curriculum development for BSN regarding use of standardized nursing language? •If you had a wish to change something in your curriculum, what would that be?

Keywords: nursing, standardized language, ICNP, resource-limited care environments

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Authors: Itamir de Morais Barroca Filho, Cephas A. S. Barreto, Ramon Malaquias, Cezar Miranda Paula de Souza, Arthur Costa Gorgônio, João C. Xavier-Júnior, Mateus Firmino, Fellipe Matheus Costa Barbosa

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Information and Communication Technologies (ICT) in healthcare are crucial for efficiently delivering medical healthcare services to patients. These ICTs are also known as e-health and comprise technologies such as electronic record systems, telemedicine systems, and personalized devices for diagnosis. The focus of e-health is to improve the quality of health information, strengthen national health systems, and ensure accessible, high-quality health care for all. All the data gathered by these technologies make it possible to help clinical staff with automated decisions using machine learning. In this context, we collected patient data, such as heart rate, oxygen saturation (SpO2), blood pressure, respiration, and others. With this data, we were able to develop machine learning models for patients’ risk of death and estimate the length of stay in ICU beds. Thus, this paper presents the methodology for applying machine learning techniques to develop these models. As a result, although we implemented these models on an IoT healthcare platform, helping clinical staff in healthcare in an ICU, it is essential to create a robust clinical validation process and monitoring of the proposed models.

Keywords: ICT, e-health, machine learning, ICU, healthcare

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Freya Harding, Anne Gatuguta, Chi Eziefula

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Introduction Research shows the quality of experiences of pregnancy, birth, and postpartum impacts the health and well-being of the mother and baby. This is recognised by the WHO in their recommendations ‘Intrapartum care for a positive childbirth experience’. The COVID-19 pandemic saw the transformation of the NHS Maternity services to prevent the transmission of COVID-19. Physical and social isolation may have affected women’s experiences of pregnancy, birth and postpartum; especially those of healthcare. Examples of such changes made to the NHS include both the reduction in volume of face-to-face consultations and restrictions to visitor time in hospitals. One notable detriment due to these changes was the absence of a partner during certain stages of birth. The aim of this study was to explore women’s experiences of pregnancy, birth, and postnatal period during the COVID-19 pandemic in the UK. Methods We collected qualitative data from women who had given birth during the COVID-19 pandemic. In-depth, semi-structured interviews were conducted with twelve participants recruited from mother and baby groups in Southeast England. Data were audio-recorded, transcribed verbatim, and analysed thematically using both inductive and deductive approaches. Ethics permission was granted from Brighton and Sussex Medical School (ER/BSMS9A83/1). Results Interviews were conducted with 12 women who gave birth between May 2020 and February 2021. Ages of the participants ranged between 28 and 42 years, most of which were white British, with one being Asian British. All participants were heterosexual and either married or co-habiting with their partner. Five participants worked in the NHS, and all participants had professional occupations. Women felt inadequately supported both socially and medically. An appropriate sense of control over their own birthing experience was lacking. Safety mechanisms, such as in-person visits from the midwife, had no suitable alternatives in place. Serious health issues were able to “slip through the net.” Mental health conditions in some of those interviewed worsened or developed. Similarly, reduced support from partners during birth and during the immediate postpartum period at the hospital, coupled with reduced ward staffing, resulted in some traumatic experiences; particularly for women who had undergone caesarean section. However, some unexpected positive effects were reported; one example being that partners were able to spend more time with their baby due to furlough schemes and working from home. Similarly, emergency care was not felt to have been compromised. Overall, six themes emerged: (1) Self-reported traumatic experiences, (2) Challenges of caring for a baby with reduced medical and social support, (3) Unexpected benefits to the parenting experience, (4) The effects of a sudden change in medical management (5) Poor communication from healthcare professionals (6) Social change; with subthemes of support accessing medical care, the workplace, family and friends, and antenatal & baby groups. Conclusions The results indicate that the healthcare system was unable to adequately deliver maternity care to facilitate positive pregnancy, birth, and postnatal experiences during the heights of the pandemic. The poor quality of such experiences has been linked an increased risk of long-term health complications in both the mother and child.

Keywords: pregnancy, birth, postpartum, postnatal, COVID-19, maternity, social support, qualitative, pandemic

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Authors: Mona Almanasef, Dalia Almaghaslah, Geetha Kandasamy, Rajalakshimi Vasudevan, Sadia Batool

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Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide and their services are used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers to the provision of these services in Saudi Arabia. Materials and Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in the Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services and barriers to practicing public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counseling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunization. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in the Asir region have varying levels of involvement in public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Keywords: community pharmacist, public health, Asir region, Saudi Arabia

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Authors: Arezoo Fallahi, Siamak Derakhshan, Parvaneh Taymoori, Babak Nematshahrbabaki

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Background: Osteoporosis, the most common metabolic bone disease, is an important health care issue. Not only the cost of disease is high but also is one of the causes of disability and mortality and effect on quality of life. Although self-care is effective on disease, s control and treatment but still effective factors on self-care of patient, s viewpoint have not been survey. The aim of this study was to explore effective factors on self-care in women with osteoporosis. Materials and methods: This study was done by conventional content analysis approach in year 2014. Through purposeful sampling 15 women referred to bone mass densitometry centers participated in this study. Inclusion criteria were: Women older than 50 years old with osteoporosis, final diagnosis of osteoporosis for over six –month period, T-score index below -2.5 (lower back or hip), drug use by patients with a physician’s prescription, ability in speaking and attending to participate in the study. Data was collected by face to face and group semi-structure deep interviews and analyzed via content analysis method. To support of rigor of data, criteria credibility, confirmability and transferability were used. Results: during data analysis five categories developed: “hope and disability in the face of illness”, “mutual roles of physician”, “role of family” and “administrative centers and organizations”. To perform self-care behaviors, the participations of this study emphasized on pay attention to their own healthy, regarding patients' rights by physician, pay attention to women's health by men, and the role of media especially radio and television. Conclusion: the finding of the study showed that women’s responsibility with osteoporosis for their health is not a factor but it is multifactorial. Increasing life expectancy in patients, attention to patients needs by physician, increasing health promotion programs in the media and enhancing role of family may provide conditions and infrastructure to empowerment women in doing self-care behavior.

Keywords: women, osteoporosis, self-care, content analysis

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Authors: Soma Sarkar

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A number of authors have recently argued that there are strong links between ecosystem services and sustainable development, particularly development efforts that aim to reduce rural poverty. We see two distinct routes by which the science of ecosystem services can contribute to both nature conservation and sustainable development. First, a thorough accounting of ecosystem services and a better understanding of how and at what rates ecosystems produce these services can be used to motivate payment for nature conservation. At least part of the generated funds can be used to compensate people who suffer lost economic opportunities to protect these services. For example, if rural poor are asked to take actions that reduce farm productivity to protect and regulate water supply, those farmers could be compensated for the reduced productivity they experience. When the benefits of natural ecosystems are explicitly quantified, those benefits are more valued both by the people who directly interact with the ecosystems and the governmental and other agencies that would have to pay for substitute sources of these services if these ecosystems should become impaired. Appreciating the value of ecosystem services can motivate increased conservation investment to prevent having to pay for substitutes later. This approach could be characterized as a ‘‘government investment’’ approach because the payments will generally come from beneficiaries outside of the local area, and a governmental or other agency is typically responsible for collecting and redistributing the funds. Second, a focus on the conservation of ecosystem services could improve the success of projects that attempt to both conserve nature and improve the welfare of the rural poor by fostering markets for the goods and services that local people produce or extract from ecosystems. These projects could be characterized as more ‘‘community based’’ because the goal is to foster the more organic, or grassroots, development of cottage industries, such as ecotourism, or the production of non-timber forest products, that are enhanced by better protection of local ecosystems. Using this framework, we discuss the factors that may have contributed to failure or success for several projects in the district of Purulia, one of the most backward districts of India and inhabited by indigenous group of people. A large majority of people in this district are dependent on environment based incomes for their sustenance. The erosion of natural resource base owing to poor governance in the district has led to the reductions in the household incomes of these people. The scale of our analysis is local or project level. The plight of poor has little to do with the production functions of ecosystem services. But for rural poor, at the local level, the status of ecosystem services can make a big difference in their daily lives.

Keywords: ecosystem services, governance, rural poor, community based natural resource management

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Authors: Laila Yasir Al-Harthy, Ali H. Al-Badi

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As an emerging business model, cloud computing has been initiated to satisfy the need of organizations and to push Information Technology as a utility. The shift to the cloud has changed the way Information Technology departments are managed traditionally and has raised many concerns for both, public and private sectors. The purpose of this study is to investigate the possibility of cloud computing services replacing services provided traditionally by IT departments. Therefore, it aims to 1) explore whether organizations in Oman are ready to move to the cloud; 2) identify the deciding factors leading to the adoption or rejection of cloud computing services in Oman; and 3) provide two case studies, one for a successful Cloud provider and another for a successful adopter. This paper is based on multiple research methods including conducting a set of interviews with cloud service providers and current cloud users in Oman; and collecting data using questionnaires from experts in the field and potential users of cloud services. Despite the limitation of bandwidth capacity and Internet coverage offered in Oman that create a challenge in adopting the cloud, it was found that many information technology professionals are encouraged to move to the cloud while few are resistant to change. The recent launch of a new Omani cloud service provider and the entrance of other international cloud service providers in the Omani market make this research extremely valuable as it aims to provide real-life experience as well as two case studies on the successful provision of cloud services and the successful adoption of these services.

Keywords: cloud computing, cloud deployment models, cloud service models, deciding factors

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Authors: Isabell Koinig, Sandra Diehl

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In recent years, the health-care context has not been left unaffected by technological developments. In recent years, the Internet of Medical Things (IoMT)has not only led to a collaboration between disease management and advanced care coordination but also to more personalized health care and patient empowerment. With more than 40 % of all health technology being IoMT-related by 2020, questions regarding privacy become more prevalent, even more so during COVID-19when apps allowing for an intensive tracking of people’s whereabouts and their personal contacts cause privacy advocates to protest and revolt. There is a widespread tendency that even though users may express concerns and fears about their privacy, they behave in a manner that appears to contradict their statements by disclosing personal data. In literature, this phenomenon is discussed as a privacy paradox. While there are some studies investigating the privacy paradox in general, there is only scarce research related to the privacy paradox in the health sector and, to the authors’ knowledge, no empirical study investigating young people’s attitudes toward data security when using wearables and health apps. The empirical study presented in this paper tries to reduce this research gap by focusing on the area of digital and mobile health. It sets out to investigate the degree of importance individuals attribute to protecting their privacy and individual privacy protection strategies. Moreover, the question to which degree individuals between the ages of 20 and 30 years are willing to grant commercial parties access to their private data to use digital health services and apps are put to the test. To answer this research question, results from 6 focus groups with 40 participants will be presented. The focus was put on this age segment that has grown up in a digitally immersed environment. Moreover, it is particularly the young generation who is not only interested in health and fitness but also already uses health-supporting apps or gadgets. Approximately one-third of the study participants were students. Subjects were recruited in August and September 2019 by two trained researchers via email and were offered an incentive for their participation. Overall, results indicate that the young generation is well informed about the growing data collection and is quite critical of it; moreover, they possess knowledge of the potential side effects associated with this data collection. Most respondents indicated to cautiously handle their data and consider privacy as highly relevant, utilizing a number of protective strategies to ensure the confidentiality of their information. Their willingness to share information in exchange for services was only moderately pronounced, particularly in the health context, since health data was seen as valuable and sensitive. The majority of respondents indicated to rather miss out on using digital and mobile health offerings in order to maintain their privacy. While this behavior might be an unintended consequence, it is an important piece of information for app developers and medical providers, who have to find a way to find a user base for their products against the background of rising user privacy concerns.

Keywords: digital health, privacy, privacy paradox, IoMT

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Authors: Hacer Kobya Bulut, Ilknur Kahriman, Birsel C. Demirbag

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Introduction and Purpose: The lives of children with cancer are affected by long term hospitalizations in a negative way due to complications arising from diagnosis or treatment. However, the children's parents are known to have difficulties in meeting their children’s needs and providing home care after cancer treatment or during remission process. Supporting these children and their parents by giving a planned discharge training starting from the hospital and home care leads to reducing hospital applications, hospitalizations, hospital costs, shortening the length of hospital stay and increasing the satisfaction of the children with cancer and their families. This study was conducted to investigate the status of children and their parents' unplanned application to hospital and re-hospitalization. Methods: The study was carried out with 65 children with hematological malignancy in 0-17 age group and their families in a hematology clinic and polyclinic of a university hospital in Trabzon. Data were collected with survey methodology between August-November, 2015 through face to face interview using numbers, percentage and chi-square test in the evaluation. Findings: Most of the children were leukemia (90.8%) and 49.2% had been ill over 13 months. Few of the parents (32.3%) stated that they had received discharge and home care training (24.6%) but most of them (69.2%) found themselves enough in providing home care. Very few parents (6.2%) received home care training after their children being discharged and the majority of parents (61.5%) faced difficulties in home care and had no one to call around them. The parents expressed that in providing care to their children with hematological malignance, they faced difficulty in feeding them (74.6%), explaining their disease (50.0%), giving their oral medication (47.5%), providing hygiene (43.5%) and providing oral care (39.3%). The question ‘What are the emergency situations in which you have to bring your children to a doctor immediately?' was replied as fever (89.2%), severe nausea and vomiting (87.7%), hemorrhage (86.2%) and pain (81.5%). The study showed that 50.8% of the children had unplanned applications to hospitals and 33.8% of them identified as unplanned hospitalization and the first causes of this were fever and pain. The study showed that the frequency of applications (%78.8) and hospitalizations (%81.8) was higher for boys and a statistically significant difference was found between gender and unplanned applications (X=4.779; p=0.02). Applications (48.5%) and hospitalizations (40.9%) were found lower for the parents who had received hospital discharge training, and a significant difference was determined between receiving training and unplanned hospitalizations (X=8.021; p=0.00). Similarly, applications (30.3%) and hospitalizations (40.9%) was found lower for the ones who had received home care training, and a significant difference was determined between receiving home care training and unplanned hospitalizations (X=4.758; p=0.02). Conclusion: It was found out that caregivers of children with cancer did not receive training related to home care and complications about treatment after discharging from hospital, so they faced difficulties in providing home care and this led to an increase in unplanned hospital applications and hospitalizations.

Keywords: cancer, children, unplanned application, unplanned hospitalization

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Authors: Joselyne Rugema, Innocent Twagirayezu, Aimable Nkurunziza, Alice Nyirazigama, Vedaste Bagweneza, Belancilla Nikuze

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Introduction: Burn injuries among children are associated with major complications. Early health care seeking and appropriate management are crucial in saving lives and preventing complications. Objective: To assess home-based management practices and health seeking behaviors among caregivers of children admitted with burn injuries at selected hospitals in Rwanda. Methods: A cross-sectional descriptive study was conducted among caregivers of children admitted with burn injuries at three hospitals in Kigali. A semi-structured questionnaire was used to collect the data that were analyzed using SPSS version 25. Statistical software Results: Most of the children with burn injuries had median age of 36 months, and 89.9% had second-degree burns. 92.4% of burns happened at home and 63.3% were scalds. Only 18% of the caregivers seek care immediately after children’s burn injuries. About 2.5% reported not seeking any care after burn injuries and 3.8% sought care from traditional healers. 65.9% of the participants used wrong practices before seeking care such as applying honey, cooking oil and urine to the burn injuries. Transportation difficulties before consulting health facilities were the main reported faced barriers to success health care (86.1%). Conclusion: Immediate health seeking behavior was low. Wrong practices including application of harmful products to burn injuries are common in the community. There is a need for community based interventions to prevent burn injuries at home and to empower the community with appropriate actions to take after injuries.

Keywords: adolescent pregnancy, qualitative design, childbearing, teenage mothers

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Authors: Bing Li, Zhi Li, Yilong Yang

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Web classification can promote the quality of service discovery and management in the service repository. It is widely used to locate developers desired services. Although traditional classification methods based on supervised learning models can achieve classification tasks, developers need to manually mark web services, and the quality of these tags may not be enough to establish an accurate classifier for service classification. With the doubling of the number of web services, the manual tagging method has become unrealistic. In recent years, the attention mechanism has made remarkable progress in the field of deep learning, and its huge potential has been fully demonstrated in various fields. This paper designs a multi-head attention graph convolutional network (MHAGCN) service classification method, which can assign different weights to the neighborhood nodes without complicated matrix operations or relying on understanding the entire graph structure. The framework combines the advantages of the attention mechanism and graph convolutional neural network. It can classify web services through automatic feature extraction. The comprehensive experimental results on a real dataset not only show the superior performance of the proposed model over the existing models but also demonstrate its potentially good interpretability for graph analysis.

Keywords: attention mechanism, graph convolutional network, interpretability, service classification, service discovery

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Authors: Ademola Ibukunolu Atanda, Gbenga Nathaniel Adeola

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The study examined awareness of child rights as a determinant of effective student personnel services in public secondary schools in Southwestern Nigeria. It was survey research. The sample comprised 433 teachers, 137 school administrators, and 968 students who were drawn by simple random sampling techniques. The respondents were given copies of questionnaires tagged “school administrator/teacher’s awareness of child’s rights and student personnel services elements inventory.” Key Informant Interview (KII) was also employed. The data were analysed using frequency count, percentages, weighted average, grand mean, standard deviation, and Pearson Product Moment Correlation, while KII was qualitatively analysed. The findings of the study revealed that public secondary school administrator awareness of child rights was at a moderate level, but the awareness of child rights was low among the teachers. The study equally revealed that student personnel services are moderately provided in public secondary schools in Southwestern Nigeria, but security remains a major challenge. It was also found that there was a significant relationship between awareness of child rights and effective student personnel services. It was therefore recommended, based on the findings, that attention should be given to heightening awareness of child rights among public secondary school administrators and teachers for effective student personnel services. Copies of the Child Right Act 2003 should also be made available in all public secondary schools in Southwestern Nigeria, as the study revealed that the documents were not available.

Keywords: student personnel, child right, administrator awareness, practice of child right

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Authors: Lo Kar Yin

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In view of the increasing speed and quantity of the housing supply, building, and civil engineering infrastructure works triggered by the pandemic across the globe, contractors, professional services providers (PSP), including consultants (e.g., architect, project manager, civil/geotechnical/structural engineer, building services engineer, quantity surveyor/cost manager, etc.) and suppliers have faced tremendous challenges of the fierce market, limited manpower, and resources under contract prices fluctuation and competitive fee and price. With qualitative analysis, this paper is to review the available information from the industry stakeholders with a view to finding solutions for enhancing efficiency, safety, and quality of construction value chain services for public and private organizations/companies’ sustainable growth, not limited to checking the deliverables and data transfer from multi-disciplinary parties. Technology, contracts, and people are the key requirements for shaping the construction industry. With the integration of a modern engineering contract (e.g., NEC) collaborative approach, practical workflows are designed to address loopholes together with different levels of people employment/retention and technology adoption to achieve the best value for money.

Keywords: efficiency, safety, quality, technology, contract, people, sustainable solutions, construction, services, integration

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Authors: Meltem Kürtüncü, Işın Alkan

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Objective: This study was carried out with an experimental design in order to determine whether the lullaby, which was listened from mother’s voice and a stranger’s voice to the babies born at term and hospitalized in neonatal intensive care unit, had an effect on stress and relaxation symptoms of the infants. Method: Data from the study were obtained from 90 newborn babies who were hospitalized in Neonatal Intensive Care Unit of Zonguldak Maternity And Children Hospital between September 2015-January 2016 and who met the eligibility criteria. Lullaby concert was performed by choosing one of the suitable care hours. Stress and relaxation symptoms were recorded by the researcher on “Newborn response follow-up form” at pre-care and post-care. Results: After lullaby concert when stress symptoms compared to infants in the experimental and control groups before the care was not detected statistically significant difference between crying, contraction, facial grimacing, flushing, cyanosis and the rates of increase in temperature. After care, crying, contractions, facial grimacing, flushing, and restlessness revealed a statistically significant difference between the groups, but as the cyanosis and temperature increased stress responses did not result in a significant difference between the groups. In the control group babies the crying, contraction, facial grimacing, flushing, and restlessness behaviors rates were found to be significantly higher than experimental group babies. After lullaby concert when relaxation symptoms compared to infants in the experimental and control groups before the care, eye contact rates who listen to lullaby from mother’s voice was found to be significantly higher than infants who listen to lullaby from stranger’s voice and infants in the control group. After care as eye contact, smiling, sucking/searching, yawning, non-crying and sleep behaviors relaxation symptoms revealed statistically significant results. In the control group, these behaviors were found statistically lower degree than the experimental groups. Conclusion: Lullaby concerts as masking the ambient noise, reducing the stress symptoms and increasing the relaxation symptoms, and also for soothing and stimulant affects, due to ease the transition to the sleep state should be preferred in the neonatal intensive care units.

Keywords: lullaby, mother voice, relaxation, stress

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Authors: Roongtiwa Chobchuen, Siriporn Mongkholthawornchai, Boonsong Hatawaikarn, Uriwan Chaichangreet, Kobkaew Thongtid, Pusda Pukdeekumjorn, Panita Limpawattana

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Background: Age-friendly nursing service system in Srinagarind Hospital has been developed continuously based on the value and cultural background of Thailand which corporates with the modified WHO’s Age friendly Primary Care Service System. It consists of 3 issues; 1) development of staff training, 2) age-friendly service and 3) appropriate physical environment. Objective: To evaluate the efficacy of Age-friendly Nursing Service System: KKU (AFNS:KKU) model and to evaluate factors associated with nursing perception with AFN:KKU. Study design: Descriptive study Setting: 31 wards that served older patients in Srinagarind Hospital Populations: Nursing staff from 11 departments (31 wards) Instrument: Age-friendly nursing care scale as perceived by hospitalized older person Procedure and statistical analysis: All participants were asked questions using age-friendly nursing care scale as perceived by hospitalized older person questionnaires. Descriptive statistics and multiple logistic regression analyses were used to analyse the outcomes. Results: There were 337 participants recruited in this study. The majority of them were women (92%) with the mean ages of 29 years and 77.45% were nurse practitioners. They had average nursing experiences of 5 years. The average scores of age-friendly nursing care scale were high and highest in the area of attitude and communication. Age, sex, educational level, duration of work among, and having experience in aging training were not associated with nursing perception where type of department was an independent factor. Nurses from department of Surgery and Orthopedic, Eye and ENT, special ward and Obstetrics and Gynecological had significant greater perception than nurses from Internal Medicine Department (p < 0.05). Conclusion: Nurses had high scores in all dimensions of age-friendly concept. The result indicates that nurses have good attitude to aging care which can lead to improve quality of care. Organization should support other domains of ageing care to achieve greater effectiveness in geriatric care.

Keywords: age-friendly, nursing service system, excellence model, geriatric care

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Authors: Aidan Jacobsen, Morgan Motia, David Sam, Jonathan Mudge

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Background: The Centers for Disease Control (CDC) lists vaccine requirements for children under two years old to correlate with development markers. CDC lists the coverage by age 24 months to be at least 90% nationally and 84% for Rhode Island Blackstone Valley Community Health Center (BVCHC) in Central Falls, Rhode Island, currently has a completed vaccination rate of 51% for children by the age of 24 months. Current barriers to care for up to date well child vaccinations include lack of transportation, parental work, childcare, and other social stressors. Objective: Increase the vaccination rate of children under the age of 24 months at BVCHC. Conduct a literature review to identify the common barriers preventing children under 24 months from receiving vaccinations. Reduce the barriers to expand access to vaccination care for infants Methods: Setting: Blackstone Valley Community Health Center, Pawtucket, RI Participants: (n=41), Patients between the age of 20-24 months, not up to date with the CDC vaccination recommendations and without a future appointment. QI Intervention: Patients were contacted via phone and offered an appointment during extra Saturday clinic hours in order to receive up to date vaccine care. A Saturday vaccine clinic was established specifically for patients in need of vaccines and having identified barriers to care. Conclusions: Expanding clinic hours and targeting non vaccine up –to-date patients can increase the current standard of childhood immunizations at BVCHC. Overcoming barriers preventing childhood immunization can improve access to providing up to date vaccinations. Other barriers still deter from reaching the national standard of immunizations rates.

Keywords: vaccinations, well child care, barriers to care, social determinants of health

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Authors: Emmanuel A. David, Rebecca O. Soremekun, Roseline I. Aderemi-Williams

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Background: The complexities involved in the management of diabetes mellitus require a multi-dimensional, multi-professional collaborative and continuous care by health care providers and a substantial self-care by the patients in order to achieve desired treatment outcomes. The effect of pharmacists’ care in the management of diabetes in resource-endowed nations is well documented in literature, but randomised-controlled assessment of the impact of pharmacist-led care among patients with diabetes in resource-limited settings like Nigeria and sub-Saharan Africa countries is scarce. Objective: To evaluate the impact of Pharmacist-led care on glycaemic control in patients with uncontrolled type 2 diabetes, using a randomised-controlled study design Methods: This study employed a prospective randomised controlled design, to assess the impact of pharmacist-led care on glycaemic control of 108 poorly controlled type 2 diabetic patients. A total of 200 clinically diagnosed type 2 diabetes patients were purposively selected using fasting blood glucose ≥ 7mmol/L and tested for long term glucose control using Glycated haemoglobin measure. One hundred and eight (108) patients with ≥ 7% Glycated haemoglobin were recruited for the study and assigned unique identification numbers. They were further randomly allocated to intervention and usual care groups using computer generated random numbers, with each group containing 54 subjects. Patients in the intervention group received pharmacist-structured intervention, including education, periodic phone calls, adherence counselling, referral and 6 months follow-up, while patients in usual care group only kept clinic appointments with their physicians. Data collected at baseline and six months included socio-demographic characteristics, fasting blood glucose, Glycated haemoglobin, blood pressure, lipid profile. With an intention to treat analysis, Mann-Whitney U test was used to compared median change from baseline in the primary outcome (Glycated haemoglobin) and secondary outcomes measure, effect size was computed and proportion of patients that reached target laboratory parameter were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each study. Mean age was 51±11.75 and majority were female (68.5%). Intervention patients had significant reduction in Glycated haemoglobin (-0.75%; P<0.001; η2 = 0.144), with greater proportion attaining target laboratory parameter after 6 months of care compared to usual care group (Glycated haemoglobin: 42.6% vs 20.8%; P=0.02). Furthermore, patients who received pharmacist-led care were about 3 times more likely to have better glucose control (AOR 2.718, 95%CI: 1.143-6.461) compared to usual care group. Conclusion: Pharmacist-led care significantly improved glucose control in patients with uncontrolled type 2 diabetes mellitus and should be integrated in the routine management of diabetes patients, especially in resource-limited settings.

Keywords: glycaemic control , pharmacist-led care, randomised-controlled trial , type 2 diabetes mellitus

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Authors: Waraporn Boonchieng, Ekkarat Boonchieng, Wilawan Senaratana, Jaras Singkaew

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Geographical information system (GIS) is a designated system widely used for collecting and analyzing geographical data. Since the introduction of ultra-mobile, 'smart' devices, investigators, clinicians, and even the general public have had powerful new tools for collecting, uploading and accessing information in the field. Epidemiology paired with GIS will increase the efficacy of preventive health care services. The objective of this study is to apply GPS location services that are available on the common mobile device with district health systems, storing data on our private cloud system. The mobile application has been developed for use on iOS, Android, and web-based platforms. The system consists of two parts of district health information, including recorded resident data forms and individual health recorded data forms, which were developed and approved by opinion sharing and public hearing. The application's graphical user interface was developed using HTML5 and PHP with MySQL as a database management system (DBMS). The reporting module of the developed software displays data in a variety of views, from traditional tables to various types of high-resolution, layered graphics, incorporating map location information with street views from Google Maps. Multi-extension exporting is also supported, utilizing standard platforms such as PDF, PNG, JPG, and XLS. The data were collected in the database beginning in March 2013, by district health volunteers and district youth volunteers who had completed the application training program. District health information consisted of patients’ household coordinates, individual health data, social and economic information. This was combined with Google Street View data, collected in March 2014. Studied groups consisted of 16,085 (67.87%) and 47,811 (59.87%) of the total 23,701 households and 79,855 people were collected by the system respectively, in Saraphi district, Chiang Mai Province. The report generated from the system has had a major benefit directly to the Saraphi District Hospital. Healthcare providers are able to use the basic health data to provide a specific home health care service and also to create health promotion activities according to medical needs of the people in the community.

Keywords: health, public health, GIS, geographic information system

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Authors: M. Shahadat Hossain

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People experiencing economic disadvantages have limited access to justice system. Employment status is a key indicator of economic disadvantage. There is a link between employment status and vulnerability to legal problems. This paper addresses the obstacles unemployed people experience to secure justice in Australia. This paper further explores exiting services for economically disadvantaged people to secure justice where these unemployment people can get access. It reveals that unemployed people are vulnerable to multifaced crime and violence. Due to high cost of legal services, these unemployed people are unable to afford legal services to access justice. They are often found higher levels of nonactions in terms of access to justice also due to lack of their initiatives. This paper further reveals that legal aid commissions are state and territory statutory agencies in Australia which provide free legal information, advice, duty lawyers, and legal representation services. Community legal centres are independent, non-profit government organizations with a focus of early advice, problem solving, and working with other agencies to address connected, financial, and health problems. Moreover, the private profession helps people who cannot afford to pay for a lawyer in several ways. But there are problems of shortage of funding for these legal services and making available to economically disadvantaged people. However, this paper argues that people experiencing long-term unemployment face barriers to secure justice due to their economic disadvantages. It further argues that services available for them to access to justice is inadequate.

Keywords: economic disadvantages, unemployment, access to justice, Australia

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Authors: Salwa Obeisat

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Obesity had become a global issue and a major public health concern, because of its impact on the public health. Obstetric and midwifery evidences reported that maternal obesity an important issue, because of its associated complications like obstructed labors, infections, and hemorrhage. People who are obese are often stigmatized and blamed for their weight. Health care providers are not immune to obesity-related prejudice, and the literature features several examples of their negative attitudes towards obese patients. In Jordan, few studies were conducted to investigate obesity prevalence rate and its associated factors. The purposes of this study were to assess the health care providers' attitudes toward overweight and obese women during the childbirth in the North of Jordan and to investigate the relationships between health care providers' socio-demographic characteristics and their attitudes. A descriptive, cross-sectional design was utilized. A convenient sample was consisted of 95 midwives, 30 nurses and 62 obstetricians, who were working in the labor rooms. A self-administered questionnaire consisted of three sections: demographical data, Arabic version of Fat Phobia Scale (FPS), and Arabic version of Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS). Results: The study findings revealed that the majority of Jordanian health care providers held negative attitudes toward overweight and obese women during childbirth. Midwives held less negative attitudes than did obstetricians and nurses. The majority of participants were perceived the overweight and obese pregnant women during childbirth as overate people, shapeless, slow and unattractive. Age, specialty, education and years of experience were found to be associated with health care providers’ attitudes. The Conclusion: Health care providers negative attitudes toward overweight and obese pregnant women are a cause for concern. Therefore, maternal obesity was needed to be more adequately addressed in basic education courses, and in the continuing professional education classes of practicing health care providers.

Keywords: attitudes, obesity, prevalence rate, nurses, midwives, obstetrician, childbirth

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Authors: Eda Kocakaya, Sebahat Seker, Dogan Argun

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The aim of this study is to determine the process of information technologies and the connections between concepts in accounting management services in Turkey. The objective of this study is to determine the adaptation and evaluation process of information technologies and the connections between concepts and differences in accounting management services in Turkey. The situation and determination of the IT applications of Accounting Management were studied. The applications of • Billing • Order Processing • Accounts Receivable/Payable Management • Contract Management • Bank Account Management Were discussed in this study. The IT applications were demonstrated and realized in actual accounting services. The sectoral representative's companies were selected, and the IT application was searched by bibliometric analysis.

Keywords: management, accounting, information technologies, adaptation

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Authors: Hussein Moselhy, Islam Salam

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There have been some challenges and problems which hinder the implementation of the e-marketing systems such as the high cost of information systems infrastructure and maintenance as well as their unavailability within the institution. Also, there is no system which supports all programming languages and different platforms. Another problem is the lack of integration between these systems on one hand and the operating systems and different web browsers on the other hand. No system for customer relationship management is established which recognizes their desires and puts them in consideration while performing e-marketing functions is available. Therefore, the service-oriented architecture emerged as one of the most important techniques and methodologies to build systems that integrate with various operating systems and different platforms and other technologies. This technology allows realizing the data exchange among different applications. The service-oriented architecture represents distributed computing concepts to demonstrate its success in achieving the requirements of systems through web services. It also reflects the appropriate design for the services to use different web services in supporting the requirements of business processes and software users. In a service-oriented environment, web services are deployed on the web in the form of independent services to be accessed without knowledge of the nature of the programs and systems with in. This Paper presents a proposal for a new model which contributes to the application of methods and means of e-marketing with the integration of marketing mix elements to improve marketing efficiency (E-MSOA). And apply it in the educational city of one of the Egyptian sector.

Keywords: service-oriented architecture, electronic commerce, virtual retailing, unified modeling language

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Authors: Liu Yi Hui, Chun-Liang Lai, Jhang Yu Cih, He You Jing, Chiu Fan-Yun, Lin Yu Fang

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For universities offering long-term care education, the inclusion of adulting learning and practices in professional courses as appropriate based on holistic design and evaluation could improve talent empowerment by leveraging social capital. Moreover, it could make the courses and materials used in long-term care education responsive to real-life needs. A mixed research method was used in the research design. A quantitative study was also conducted using a questionnaire survey, and the data were analyzed by SPSS 22.0 Chinese version. The qualitative data included students’ learning files (learning reflection notes, course reports, and experience records).

Keywords: adult learning, community empowerment, social capital, mixed research

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Authors: Anjali Sharma, R. R. K. Sharma

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The purpose of this study is to examine relationships between personality factors and customer switching for services. Earlier research was directed towards establishing relationship between individual personality traits and customer switching variables considering five-factors model comprised of five personality dimensions (OCEAN), in which personality was not the only influencing factor. Moreover, these works were found to be focused on products and not services. In contrast, the current study is aimed at investigating role of personality using Myer Briggs Type indicator (MBTI) as well as Five-Big Factors, on customer switching and building the conceptual framework on services rather than products. MBTI also known as four opposite pairs or dichotomies of personality dimensions are studied using different levels Involvement (High, Low) of consumer and Value of service-offering (Value for money and Premium) as moderators associated with Consumer Switching. The study is unique in sense that consequences of these indicators of personality on switching behavior has never been studied using considering moderating effect of involvement and value of services. According to our prepositions for a more Extrovert, Intuitive Personality the switching is going to be high whereas the switching is going to be less for an Introvert, Judgmental kind of personality. Similarly, for a consumer with high Neuroticism and Agreeableness the switching would be less as compared to an Open and Conscious Personality type. These level differs with level of a consumer’s involvement and type of a service being offered based on its value.

Keywords: consumer switching, involvement, Myer Briggs personality type indicators, personality, value of service

Procedia PDF Downloads 274