Search results for: quality care

Authors: Robyn L. Curran, Joanne R. Naidoo, Gugu Mchunu

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Along with the increasing awareness of human trafficking, is the acknowledgement that it is no longer just a social problem but also a significant public health problem that requires both increased knowledge and the specialist equipping of aftercare providers such as nurses who care for human trafficking survivors. Current discourse regarding aftercare of human trafficking survivors, is that approaches do not clearly explain the function or content of aftercare and what aftercare entails. Although psychological and medical aftercare are emphasized as important components, little practical attention is devoted to what these components actually involve and the effectiveness of current practice in aftercare. Review of the literature on the processes that take place from aftercare to empowerment, revealed the need for emphasis to be placed on the voices of survivors concerning their liberation from oppression. The aim of the study was to develop a theory for aftercare of human trafficking survivors, through analyzing the experiences of survivors and aftercare providers in shelters in three provinces in South Africa. Through using a Straussian grounded theory approach, the researcher developed a theory to inform care of human trafficking survivors in low resource settings using the voice of the survivors and those experienced in direct care of human trafficking survivors. Four human trafficking survivors and three aftercare providers from three shelters in three provinces in South Africa were individually interviewed in order for the theory to emerge. The findings of the study elicited a theoretical model of the renewed self, and the conditions that facilitate this process in care of human trafficking survivors. The process that human trafficking survivors navigate to empowerment require mutual collaboration of the aftercare provider and survivor as the survivor awakens vision, confronts reality, re-salvages autonomy and liberates self. Psychological resilience of the survivor facilitates the transition to renewed self. The recommendations of this study may improve the nursing care provided to human trafficking survivors and equip professionals with knowledge and skills to promote the process of renewing self for survivors.

Keywords: aftercare, aftercare providers, grounded theory, human trafficking survivors

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Authors: Ibrahim Auwalu

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The main thrust of this paper is the examination of Quality Education as opposed to low level knowledge acquisition in the promotion of quality of life, health, individual and national growth and development. The paper reviews the role education plays in developed, developing and third world economies. It further explores the real meaning of poverty in the context it exists. That is poverty in terms of its dimensions– shortened lives, illiteracy, social exclusion and lack of material means to improve family circumstances. The paper concludes that education not only helps individuals escape poverty by developing the skills needed to improve their livelihoods, but also generates productivity gains that fuel economic growth.

Keywords: quality, education, global, poverty alleviation

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Authors: Evelyn Marie Richmond, Andrew McBride, Chris Johnston, John Marley

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Background: Good quality patient information resources for orthognathic treatment help to reinforce information delivered during the initial consultation and help patients make informed decisions about their care. The Consultant Orthodontists and a Dental Core Trainee noted limited patient engagement with the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources and that the existing BOS patient information leaflet (PIL) could be customised and developed to meet local requirements. Aim: The quality improvement project (QIP) aimed to improve patients' understanding of orthognathic treatment by ensuring at least 90% of patients had read the new in-house patient information leaflet (PIL) and a minimum of 50% of patients had accessed the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources before attending the joint orthognathic multidisciplinary clinic by June 2023. Methods: The QIP was undertaken in the orthodontic department of the School of Dentistry, Belfast. Data was collected prospectively during a 6-month period from January 2023 to June 2023 over 3 Plan, Do, Study, Act (PDSA) cycles. Suitable patients were identified at consultant orthodontic new patient clinics. Following initial consultation for orthognathic treatment, patients were contacted to complete a patient questionnaire. Design: The change ideas were a poster with a QR code directing patients to the BOS 'Your Jaw Surgery' website in consultation areas and a new in-house PIL with a QR code directing patients to the BOS 'Your Jaw Surgery' website. Results: In PDSA cycle 1, 86.7% of patients were verbally directed to the BOS 'Your Jaw Surgery' website, and 53.3% accessed the online resources after their initial consultation. Although 100% of patients reported reading the existing PIL, only 64.3% felt it discussed the risks of orthognathic treatment in sufficient detail. By PDSA cycle 3, 100% of patients reported being directed to the BOS 'Your Jaw Surgery' website, however, only 58.3% engaged with the website. 100% of patients who read the new PIL felt that it discussed the risks of orthognathic treatment in sufficient detail. Conclusion: The slight improvement in access to the BOS 'Your Jaw Surgery' website shows that patients do not necessarily choose to access information online despite its availability. The uptake of the new PIL was greater than reported patient engagement with the BOS 'Your Jaw Surgery' website, which indicates patients still value written information despite the availability of online resources.

Keywords: orthognathic surgery, patient information resources, quality improvement project, risks

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Authors: Kingsley Agyapong

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Research conducted in recent years has delved into the concept of patient-perceived value within the context of co-creation, particularly in the realm of doctor-patient interactions within healthcare settings. However, existing scholarly discourse lacks exploration regarding the emergence of patient-derived value in the co-creation process, specifically within encounters involving patients and stakeholders such as doctors, nurses, pharmacists, and other healthcare professionals. This study aims to fill this gap by elucidating the perspectives of patients regarding the value they derive from their interactions with multiple stakeholders in the delivery of healthcare services. The fieldwork was conducted at a university clinic located in Ghana. Data collection procedures involved conducting 20 individual interviews with key informants on distinct value accrued from co-creation practices and interactions with stakeholders. The key informants consisted of patients receiving care at the university clinic during the Malaria Treatment Process. Three themes emerged from both the existing literature and the empirical data collected. The first theme, labeled as "patient value needs in co-creation," encapsulates elements such as communication effectiveness, interpersonal interaction quality, treatment efficacy, and enhancements to the overall quality of life experienced by patients during their interactions with healthcare professionals. The second theme, designated as "services that enhance patients' experience in value co-creation," pertains to patients' perceptions of services that contribute favourably to co-creation experiences, including initiatives related to health promotion and the provision of various in-house services that patients deem pertinent for augmenting their overall experiences. The third theme, titled "Challenges in the co-creation of patients' value," delineates obstacles encountered within the co-creation process, including health professionals' challenges in effectively following up with patients scheduled for review and prolonged waiting times for healthcare delivery. This study contributes to the patients' perceptions of value within the co-creation process during their interactions with service providers, particularly healthcare professionals. By gaining a deeper insight into this process, healthcare providers can enhance the delivery of patient-centered care, thereby leading to improved healthcare outcomes. The study further offers managerial implications derived from its findings, providing actionable insights for healthcare managers and policymakers aiming to optimize patient value creation in healthcare services. Furthermore, it suggests avenues for future research endeavors within healthcare settings.

Keywords: patient, healthcare, co-creation, malaria

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Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

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Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

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Authors: Josephine Aikpitanyi, Friday Okonofua, Lorrettantoimo, Sandy Tubeuf

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Every day, 800 women die from conditions related to pregnancy and childbirth, resulting in an estimated 300,000 maternal deaths worldwide per year. Over 99 percent of all maternal deaths occur in developing countries, with more than half of them occurring in sub-Saharan Africa. Nigeria being the most populous nation in sub-Saharan Africa bears a significant burden of worsening maternal and child health outcomes with a maternal mortality rate of 917 per 100,000 live births and child mortality rate of 117 per 1,000 live births. While several studies have documented that financial barriers disproportionately discourage poor women from seeking needed maternal and child healthcare, other studies have indicated otherwise. Evidence shows that there are instances where health facilities with skilled healthcare providers exist, and yet maternal, and child health outcomes remain abysmally low, indicating the presence of non-cognitive and behavioural factors that may affect the utilization of healthcare services. This study investigated the influence of locus of control and self-esteem on utilization of maternal and child healthcare services in Nigeria. Specifically, it explored the differences in utilization of antenatal care, skilled birth care, postnatal care, and child vaccination by women having an internal and external locus of control and women having high and low self-esteem. We collected information on non-cognitive traits of 1411 randomly selected women, along with information on utilization of the various indicators of maternal and child healthcare. Estimating logistic regression models for various components of healthcare services utilization, we found that women’s internal locus of control was a significant predictor of utilization of antenatal care, skilled birth care, and completion of child vaccination. We also found that having high self-esteem was a significant predictor of utilization of antenatal care, postnatal care, and completion of child vaccination after adjusting for other control variables. By improving our understanding of non-cognitive traits as possible barriers to maternal and child healthcare utilization, our findings offer important insights for enhancing participant engagement in intervention programs that are initiated to improve maternal and child health outcomes in low-and-middle-income countries.

Keywords: behavioural economics, health-seeking behaviour, locus of control and self-esteem, maternal and child healthcare, non-cognitive traits, and healthcare utilization

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Authors: S. Silva

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Some professions had an increased risk for occupational stress and less quality of working life. Among several professions this risk is particularly preoccupant in teachers, namely high school teachers. This study aims to characterize the work stress in teachers and understand how the work stress influences their quality of working life. One hundred teachers, 60 women and 40 men with mean age of 43,2 years (SD=7,8), from North Portugal teaching in several high schools filled in the following questionnaires: Social-Demographic Questionnaire, Teacher Stress Questionnaire and the Survey of Professional Life, during January to March 2015. The results of our study show that high school teachers have several occupational stressors (M=5) and poor perceived quality of working life. They are unsatisfied with their current job and they refer to a considerable job frustration. 33% referred to no expectations about a better future in these profession and 40% have no career development. There is a strong negative correlation between stress and teacher quality of working life (r=-.775). Moderate levels of stress are related to more favorable quality of working life (r=.632). Stress, frequent in teachers, is a significant predictor of poor quality of working life. There are several stressors affecting the teachers’ performance. Career development is not considered among this professional class and it seems related to current job frustration. Considering the role of high school teacher in the development and learning of students, these results should be taken in consideration when planning the graduation and interventions with teachers.

Keywords: career, quality of working life, stress, teachers

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Authors: Erin Lynne Plettenberg, Jeremy Vickery

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In an access-control situation, the role of a user determines whether a data request is appropriate. This paper combines vetted web mining and logic modeling to build a lightweight system for determining the role of a health care provider based only on their prior authorized requests. The model identifies provider roles with 100% recall from very little data. This shows the value of vetted web mining in AI systems, and suggests the impact of the ICD classification on medical practice.

Keywords: electronic medical records, information extraction, logic modeling, ontology, vetted web mining

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Authors: Kaliammah Kumaran, Thilaagheswary Thangadurai

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This study examined the relationship between anxious attachment and avoidant attachment among young adult romantic relationship quality. Our survey was administered to 300 young adult participants (126 males and 174 females) aged 18-24 years old (M= 20.85, SD=1.89), accomplished the English version of the Revised Adult Attachment Scale (RAAS) used to measure adult attachment and Revised Dyadic Adjustment Scale (RDAS). All the participants were tertiary level students. Findings of our study indicated that young adults experienced anxious attachment style is negatively correlated with romantic relationship quality as well as young adult from avoidant attachment also negatively correlated with romantic relationship quality among young adults. The results showed that insecure adult attachment styles which are anxious and avoidance adult attachment styles links with reduced quality of romantic relationship.

Keywords: adult attachment style, anxious attachment style, avoidant attachment style, romantic relationship quality

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Authors: Natnicha Hasoontree

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The purpose of this paper was to study the relationship between brand value and perceived brand quality of television viewers in Bangkok towards the television business in Thailand. The population included television viewers in Bangkok, Thailand. A probability sampling technique was performed to get a sample group that included 500 respondents. Taro Yamane technique was utilized to get a proper sample size. A five Likert scale questionnaire was designed specifically to investigate brand value and perceived brand quality from the perspectives of television viewers in Bangkok. The findings implied that consumers in Bangkok attached a high importance towards the brand equity of television companies that comprised brand ability, brand reputation, brand credibility, and business ethics. Perceived brand quality received high rank in all aspects.

Keywords: brand value, perceived brand quality, television business, television viewers

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Authors: Kwok W. Mui, Ling T. Wong, Nai K. K. Fong

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Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in Hong Kong. Investigators are eager to explore the environmental risk factors for COPD such as air pollution and occupational exposure. Through a cross-sectional survey, this study investigates the impact of air quality to the quality of life of patients with the COPD in terms of the scores of the (Chinese) chronic respiratory questionnaire (CCRQ) and the measurements of indoor air quality (IAQ) and Moser’s activities of daily living (ADL). Strong relationships between a number of indoor/outdoor environmental parameters were found and CRQ sub-scores for patients of COPD and thus indoor air pollutants must be monitored for future studies related to QOL for patients with COPD.

Keywords: chronic obstructive pulmonary disease (COPD), indoor air pollutants, quality of life, chronic respiratory questionnaire (CRQ)

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Authors: Igor A. Podgorny

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TurboTax AnswerXchange is a social Q/A system supporting users working on federal and state tax returns. Content quality and popularity in the AnswerXchange can be predicted with propensity models using attributes of the question and answer. Using uplift modeling, we identify features of questions and answers that can be modified during the question-asking and question-answering experience in order to optimize the AnswerXchange content quality. We demonstrate that adding details to the questions always results in increased question popularity that can be used to promote good quality content. Responding to close-ended questions assertively improve content quality in the AnswerXchange in 90% of cases. Answering knowledge questions with web links increases the likelihood of receiving a negative vote from 60% of the askers. Our findings provide a rationale for employing the uplift modeling approach for AnswerXchange operations.

Keywords: customer relationship management, human-machine interaction, text mining, uplift modeling

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Authors: Júlia Alarcon Pinto, Carlos João Schaffhausser, Gustavo Alarcon Pinto

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Introduction: The deaf people in Brazil communicate through the Brazilian Sign Language (LIBRAS), which is restricted to this minority and people that received training. However, there is a lack of prepared professionals in the health system to deal with these patients. Therefore, effective communication, health education, quality of support and assistance are compromised. It is of utmost importance to develop measures that ensure the inclusion of deaf parents and children since there are frequent doubts about sphincter training and an absence of tools to promote effective communication between doctors and their patients. Objective: Use of an efficient, rapid and cheap communication method to promote social inclusion and patient education of deaf parents and children during pediatrics appointments. Results; The application demonstrates how to express phrases and symptoms within seconds and this allows patients to fully understand the information provided during the appointment and are capable to evaluate the signs of readiness, learn the correct approaches with the child, what are the adequate instruments, possible obstacles and the importance to execute medical orientations in order to achieve success in the process. Consequently, patients feel more satisfied, secured and embraced by professionals in the health system care. Conclusion: It is of utmost importance to use efficient and cheap methods that support patient care and education in order to promote health and social inclusion.

Keywords: application, deaf patients, social inclusion, sphincter training

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Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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Authors: V. Karuppaiah, J. C. Padaria, C. Srivastava

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The tobacco caterpillar, Spodoptera litura Fab (Lepidoptera: Noctuidae) is a polyphagous pest various field and horticulture crops in India. Pest had virtually developed resistance to all commonly used insecticides. Enhanced detoxification is the prime mechanism that is dictated by detoxification different enzymes and carboxylesterase is one of the major enzyme responsible development of resistance. In India, insecticide resistance studies on S. litura are mainly deployed on detoxification enzymes activity and investigation at gene level alteration i.e. at nucleotide level is very merger. In the present study, we collected the S. litura larvae from three different cauliflower growing belt viz., IARI, New Delhi (Delhi), Palari, Sonepat (Haryana) and Varanasi (Uttar Pradesh) to study the role of carboxylesterase activity and its gene level variation The CarE activity was measured using UV-VIS spectrophotometer with 3rd instar larvae of S. litura. The elevated activity of CarE was observed in Sonepat strain (28.09 ± 0.09 µmol/min/mg of protein) followed by Delhi (26.72 ± 0.04 µmol/min/mg of protein) and Varanasi strain (10.00 ± 0.44 µmol/min/mg of protein) of S. litura. The genomic DNA was isolated from 3rd instar larvae and CarE gene was amplified using a primer sequence, F:5’tccagagttccttgtcaggcac3’; R:5’ctgcatcaagcatgtctc3. CarE gene, about 500bp was partially amplified, sequenced and submitted to NCBI (Accession No. KF835886, KF835887 and KF835888). The sequence data revealed polymorphism at nucleotide level in all the three strains and gene found to have 88 to 97% similarity with previous available nucleotide sequences of S. litura, S. littoralis and S. exiqua. The polymorphism at the nucleotide level could be a reason for differential activity of carboxylesterase enzymes among the strains. However, investigation at gene expression level would be useful to analyze the overproduction of carboxylesterase enzyme.

Keywords: carboxylesterase, CarE gene, nucleotide polymorphism, insecticide resistance, spodoptera litura

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Authors: Omar Mayyas

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Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.

Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education

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Authors: Li Donghong, Peng Fuyang, Yang Guanghua, Su Xiaoyan

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Using open source code is a popular method of software development. How to evaluate the quality of software becomes more important. This paper introduces an evaluation model. The model evaluates the quality from four dimensions: technology, production, management, and development. Each dimension includes many indicators. The weight of indicator can be modified according to the purpose of evaluation. The paper also introduces a method of using the model. The evaluating result can provide good advice for evaluating or purchasing the software.

Keywords: evaluation model, software quality, open source code, evaluation indicator

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Authors: Sutanto, Alexander Christy, N. Sutrisno

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The demand of a product is linearly dependent on the price and quality of the product. It is analog to the demand of the employee in job-seeker problem. This paper address a closed-loop supply chain (CLSC) where a university plays role as manufacturer that produce graduates as job-seeker according to the demand and promote them to a certain corporation through a trial. Unemployed occurs when the job-seeker failed the trial or dismissed. A third party accomodates the unemployed and sends them back to the university to increase their quality through training.

Keywords: CLSC, price, quality, job-seeker problem

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Authors: Umedov Mekhroz, Griaznova Svetlana

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The quality of life and well-being of patients, staff and visitors are central to the delivery of health care. Architecture and design are becoming an integral part of the healing and recovery approach. The most significant point that can be implemented in hospital buildings is the therapeutic value of the artificial environment, the design and integration of plants to bring the natural world into the healthcare environment. The hospital environment should feel like home comfort. The techniques that therapeutic architecture uses are very cheap, but provide real benefit to patients, staff and visitors, demonstrating that the difference is not in cost but in design quality. The best environment is not necessarily more expensive - it is about special use of light and color, rational use of materials and flexibility of premises. All this forms innovative concepts in modern hospital architecture, in new construction, renovation or expansion projects. The aim of the study is to identify the methods and principles of therapeutic architecture. The research methodology consists in studying and summarizing international experience in scientific research, literature, standards, methodological manuals and project materials on the research topic. The result of the research is the development of graphic-analytical tables based on the system analysis of the processed information; 3d visualization of hospital interiors based on processed information.

Keywords: therapeutic architecture, healthcare interiors, sustainable design, materials, color scheme, lighting, environment.

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Authors: Sneha Shankar, Orlando Buendia, Will Evans

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Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

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Authors: Othman Ali Alghtani, Yahya Abdul-Ekhalq Ali, Abdullah Abdul-Ekhalq Ali, Ahmed Al Sadiq Abdul Majeed, Najwa Attian Al-Mohammadi, Obead Mozel Alharbi, Sabri Mohamed Ismail, Omar Ibrahim Asiri

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This study assessed the curricula of secondary schools given requirements to enhance the quality of life of students. The components of quality of life were described to build a list of standards and indicators. A questionnaire assessing the dimensions of mental (cognitive and emotional), physical, digital, and social health, and environmental awareness was prepared. A descriptive-analytical approach was used on a sample of 258 teachers and educational supervisors in Tabuk. The results indicated shortcomings in the secondary school curricula regarding developing standards and indicators of components of quality of life. Results also indicated that secondary school curricula incorporated few practices to improve student’s quality of life. No significant differences were found regarding the core subject, job, gender, and years of experience.

Keywords: assessing curricula, teacher practices, quality of life, teaching practices

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Authors: Vimi Jham

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The banking sector has undergone tremendous change in all forms of service it provides to its customers. The efforts of the banks is to avoid customer defection and lead to customer satisfaction. The purpose of the study was to examine the linkages among the constructs such as customer perceived service quality, perceived service recovery quality and customer satisfaction in the banking industry. The moderating effect of negative brand perception due to service failure on recovery satisfaction were investigated. Random sampling methods are used to draw the sample from the population. Data was collected from 262 banking customers and were analyzed with the help of structural equation modelling approach using Smart PLS to understand the relationship among variables being studied. The results of the study contribute to the research by proving that customer service recovery satisfaction is dependent on customer perceived service quality and the moderating effect of negative brand perception due to service failure was insignificant.

Keywords: service recovery satisfaction, perceived service recovery quality, perceived service quality, structural equation modelling

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Authors: Andra Vidyarini

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Adolescence is a transition period in which various changes occur, both biologically, intellectually and psychosocially. Changes in adolescents, one of which is a change in food consumption patterns that make adolescents vulnerable to nutritional problems that can affect their growth and health in the future. Nutritional problems in adolescents have increased from year to year and one of the causes is the low diversity and quality of consumption. The diversity and quality of consumption can be seen through the Individual Dietary Diversity Score and the Healthy Eating Index. Currently, in Indonesia, data on the diversity and quality of food consumption, especially among adolescents, are still scarce. In general, the purpose of this study is to describe the diversity and quality of adolescent food consumption and the relationship between the diversity and quality of food consumption with nutritional status. This study is a cross-sectional study by looking at the diversity and quality of consumption of adolescents aged 15-17 years. The total number of subjects in this study amounted to 70 teenagers. This research was conducted online via a google form. Data analysis in this study was univariate and bivariate. The results showed that the diversity of the subject's food consumption was in the diverse and very diverse category with an average of 6. However, the quality was still not good, whereas it was still in the bad and moderate categories with an average of 12.93. The nutritional status of the majority of the subjects was in the normal category and overweight to obese. The implementation of blended learning where there are still limited face-to-face meetings at school can be the reason why teenagers' food consumption is more diverse than when they are face-to-face schools. In addition, changes in people's diet during the pandemic also influenced the results of the study. The change in pattern is a change in eating habits to three times a day with menu choices ranging from rice, meat, fish, bean and vegetables. Analysis of the relationship between the diversity and quality of food consumption shows that the diversity of consumption has a significant relationship with the quality of food consumption with a p-value of 0.002 (p<0.05). Meanwhile, the diversity and quality of food consumption have no significant relationship with nutritional status, with p values 0.777 and 0.251 (>0.05), respectively. This shows that the diversity of food consumption is directly proportional to the quality of consumption, where if you have a variety of food consumption, the quality or in terms of portions and weight are also sufficient in accordance with the recommendations of PGRS.

Keywords: healthy eating index (HEI), food diversity, quality of consumption, adolescent

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Authors: Kerdsiri Hongthai, Darunee Jongudomkarn, Rutja Phuphaibul

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In Thailand, many adults in rural areas migrate to seek employ¬ment resulting in skipped-generation family where grandparents care for grandchildren with no other adults present. This is a preliminary study using qualitative case study methods, aimed to explore the situations of older adult grandparents' experiences in skipped-generation family in North-East of Thailand. Data were collected by in-depth inter¬views with 6 grandparents living in skipped-generation families; 5 females and 1 males grandparents, aged 62-75, some of them have diabetes mellitus, hypertension, during November to December, 2017. The finding themes are: ‘Caught up in the middle’: the older adults were pleased to have grandchildren but, at the same time, acknowledge the burden that this placed on them, especially when the migrant children failed to send enough money back to support the family. ‘Getting bad health’: they reported to be fatigued and stressed due to burden of caring for their grandchildren without support. This situation can aggravate problems of poor health status and be worsening economic status of the grandparents. In some cases of deprivation, the grandparents feel that having to be the sole care providers of their grandchildren can negative adversely affect their mental status. It is important to find out in other sectors similar to Thailand and lead to more in-depth research to answer the research questions about policy and social support in skipped-generation family in the future.

Keywords: older adult grandparents, experiences, principle care giver, skipped-generation family

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Authors: Debalina Datta, Pratyaypratim Datta, Kunal Kanti Majumdar

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Introduction: In India 8.1% of total population is elderly. The standard of living and meaningfulness of life are indirectly measured by assessing quality of life of elderly. So, it is important to improve quality of life. Quality of life is an individual’s understanding of his/ her life situation with respect to his/ her values and cultural context as well as in relation to his/her goals, expectations and concerns. The present study was planned to assess the quality of life of geriatric people in urban West Bengal, India. Materials and methods: It was a community based cross sectional observational study conducted among people aged 60 years and above in Kolkata and Sonarpur region of West Bengal, India. Data collection was done by house to house visit using Quality of Life- BREF questionnaire (WHOQOL-BERF) developed by WHO. Analysis of quality of life of physical, psychological, social relationship and environmental domain was done using SPSS (version 16.0). Results: Transformed score (0-100 scale) was used for each domain. Mean of physical, psychological, social relationship and environmental domain were found to be 42.25, 40.84, 39.62 and 48.36 respectively. There was no significant difference in score between Kolkata and Sonarpur people in any domain except social relationship domain, where people living at Sonarpur scored significantly better. Conclusion: Rehabilitation of old age people can be done by improving their quality of life. Social interaction with people of all ages, allowing them to take important family decision, engaging them in different social activities can help a lot.

Keywords: quality of life, elderly, Urban West Bengal, India

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Authors: Delband Yekta Moazami

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Background: For proper care and treatment of HIV patients and drug users, the medical staff and physicians must have a correct and positive attitude and knowledge towards such patients. We aimed to assess the attitudes in a sample of health care workers (HCW) working in different hospitals and clinics and medical students in Georgia towards HIV infected people and drug users in Tbilisi. Method: We conducted a cross-sectional study to assess attitudes of health care workers towards people living with HIV and drug users in hospitals and clinics in Tbilisi. The study was carried out from 1st of May 2020 till 30th of September 2020. Data were collected using a self-administered structured online questionnaire. With this tool we evaluated four facets of attitudes: Discrimination, Acceptance of HIV/AIDS patients, Acceptance of drug users and Fear. All data were imported and analyzed with the software SPSS 22 for windows. Results: In total data was collected from168 respondents, that among them 107 (65%) were women and majority of the participants were medical doctors. Women had more acceptance attitudes rather than men towards drug abusers. We found significant differences regarding expressing negative attitudes among HCW who were more than 50 years old comparing with other age groups in all four aspects. Medical doctors expressed more acceptances towards people with HIV and drug users comparing two other groups. Also our study revealed that the group with working experience 21 years and more, showed more discriminatory attitudes comparing other groups. Conclusion: Based on our study findings, there are significant differences regarding respondent’s attitudes based on gender, medical specialty and working experience in health care system. People struggling with HIV and drug use need nonjudgmental and positive behaviors from health care workers and physicians in order to help them for harm reduction and receiving appropriate treatment.

Keywords: hiv, addiction, attitudes, healthcare workers

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Authors: Hana A. Jameel Alsaeed, Rayyan Ibrahim Khaleel, Hanaa Hussein Mukhlif

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Background: Contamination in Iraq's hospitals is a localized problem with high rates of disease And deaths that mainly affect poor areas. Thus, this study aims to evaluate hospital infections in the city of Mosul and to identify the etiology. So to assess environmental infection prevention in pediatric wards and newborn critical care units in Mosul city. Methods: The present study is a cross-sectional hospital based in Mosul-Iraq between (10th February to 1st April 2022). Purposive sample of 60 nurses from neonatal intensive care units and pediatric wards in three pediatric teaching hospitals in Mosul city; Data was gathered using a questionnaire created by the researchers after reviewing previous studies. Results: The study showed that the majority of the study infection prevention and control policy isn't available in 46.7% of departments, and 45% of hospital workers in Iraq don't know if there is an Iraqi version of it. 70% of the study group had participated in an infection control training program. Conclusions: In the majority of samples 55% of respondents to the study claimed not to be aware of these rules. 60% of the study's participants had never attended a course on infection prevention and control, according to the study's findings on education and training programs. In the neonatal and critical care unit, nurses' skill levels, years of experience, and actual duties varied by wide statistically significant differences.

Keywords: pediatric, infection control, assessment, mosul city

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Authors: Ritu Sarsoha

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According to World Summit 2002 health is an integral component of sustainable development. Due to overpopulation and lack of employment opportunities in villages and small towns, the rural youth tend to migrate to the big cities causing mushrooming of slums. These slums lack most of the basic necessities of life particularly regarding environmental pollution and appropriate health care system. Present paper deals with the socio-economic and environmental status of people living in slum area of Chandigarh which has now grown as a big city today as it has become a hub for the migrants from U. P. and Bihar. Here is a case study of Colony no. 5 of Chandigarh which is divided into more than one block.

Keywords: slum, socio-economic, environment pollution, health

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Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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Authors: Daniela Monteiro

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Considering the entry into force of the new EU audit reform regarding statutory auditors, in effect in all member states since 2016, this research aims to identify which audit regulation rules are associated with a high-level audit quality on both its dimensions, i.e., the actual quality and the perceived quality, in relation to public interest entities, within the European Union, and whether those rules have the same impact on both dimensions. Its measurement was based on the following proxies: the quality of financial information through earnings management and the impact of qualified opinions on financial costs. We considered in the research regulation subjects such as auditors’ rotation and provision of services (NAS) and also the level of market concentration. The criteria to include these issues in the research was its contemplation of the new rules. We studied the period before the audit reform (2009-2015) when the regulation measures were less uniform. Besides the consideration of both dimensions of audit quality and several regulation measures, we believe our conclusions configure an important contribution to this research field, considering the involvement of the first 15 member states of the European Union. The results consolidate the assumption that the balance between competence and independence is not the only challenge related to the regulation of the audit profession. The evidence demonstrates that the balance between actual and perceived quality is also a relevant matter. The major conclusion is that the challenge is to keep balanced both actual and perceived audit quality whilst ensuring the independence and competence of auditors.

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