Search results for: elderly care service model

Authors: Md Iqbal Hossain, Tahmeed Ahmed, Kenneth H. Brown

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Objective: To assess the effect of community-based follow up, with or without food-supplementation and/or psychosocial stimulation, as an alternative to current hospital-based follow-up of children with moderate-acute-malnutrition (WHZ < -2 to -3) (MAM). Design/methods: The study was conducted at the ICDDR,B Dhaka Hospital and in four urban primary health care centers of Dhaka, Bangladesh during 2005-2007. The efficacy of five different randomly assigned interventions was compared with respect to the rate of completion of follow-up, growth and morbidity in 227 MAM children aged 6-24 months who were initially treated at ICDDR,B for diarrhea and/or other morbidities. The interventions were: 1) Fortnightly follow-up care (FFC) at the ICDDR,B’s outpatient-unit, including growth monitoring, health education, and micro-nutrient supplementation (H-C, n=49). 2) FFC at community follow-up unit (CNFU) [established in the existing urban primary health-care centers close to the residence of the child] but received the same regimen as H-C (C-C, n=53). 3) As per C-C plus cereal-based supplementary food (SF) (C-SF, n=49). The SF packets were distributed on recruitment and at every visit in CNFU [@1 packet/day for 6–11 and 2 packets/day for 12-24 month old children. Each packet contained 20g toasted rice-powder, 10g toasted lentil-powder, 5g molasses, and 3g soy bean oil, to provide a total of ~ 150kcal with 11% energy from protein]. 4) As per C-C plus psychosocial stimulation (PS) (C-PS, n=43). PS consisted of child-stimulation and parental-counseling conducted by trained health workers. 5) As per C-C plus both SF+PS (C-SF+PS, n=33). Results: A total of 227children (48.5% female), with a mean ± SD age of 12.6 ±3.8 months, and WHZ of - 2.53±0.28 enrolled. Baseline characteristics did not differ by treatment group. The rate of spontaneous attendance at scheduled follow-up visits gradually decreased in all groups. Follow-up attendance and gain in weight and length were greater in groups C-SF, C-SF+PS, and C-PS than C-C, and these indicators were observed least in H-C. Children in the H-C group more often suffered from diarrhea (25 % vs. 4-9%) and fever (28% vs. 8-11%) than other groups (p < 0.05). Children who attended at least five of the total six scheduled follow-up visits gained more in weight (median: 0.86 vs. 0.62 kg, p=0.002), length (median: 2.4 vs. 2.0 cm, p=0.009) than those who attended fewer. Conclusions: Community-based service delivery, especially including supplementary food with or without psychosocial stimulation, permits better rehabilitation of children with MAM compared to current hospital outpatients-based care. By scaling the community-based follow-up including food supplementation with or without psychosocial stimulation, it will be possible to rehabilitate a greater number of MAM children in a better way.

Keywords: community-based management, moderate acute malnutrition, psychosocial stimulation, supplementary food

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Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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

Keywords: care, ethics, expertise, NICU, paternalism

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Authors: Mannan Mridha, Usama Gazay, Kosovare V. Aslani, Hugo Linder, Alice Ravizza, Carmelo de Maria

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In most developing countries, although the vast majority of the people are living in the rural areas, the qualified medical doctors are not available there. Health care workers and paramedics, called village doctors, informal healthcare providers, are largely responsible for the rural medical care. Mishaps due to wrong diagnosis and inappropriate medication have been causing serious suffering that is preventable. While innovators have created many devices, the vast majority of these technologies do not find applications to address the needs and conditions in low-resource settings. The primary motive is to address the acute lack of affordable medical technologies for the poor people in low-resource settings. A low cost smart medical device that is portable, battery operated and can be used at any point of care has been developed to detect breathing rate, electrocardiogram (ECG) and arterial pulse rate to improve diagnosis and monitoring of patients and thus improve care and safety. This simple and easy to use smart medical device can be used, managed and maintained effectively and safely by any health worker with some training. In order to empower the health workers and village doctors, our device is being further developed to integrate with ICT tools like smart phones and connect to the medical experts wherever available, to manage the serious health problems.

Keywords: e-health for low resources settings, health awareness education, improve patient care and safety, smart and affordable medical device

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Authors: Andrew Anis Fakhrey Mosaad

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Objectives: Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers to applying physiotherapy in ICUs. Materials and Methods: A 54-item survey for determining the characteristics physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through the Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23–52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. Results: The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapists (low level of employment and practice, lack of shift); patients (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. Conclusion: The most common interventions were positioning, active, passive, breathing exercises, and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, teams, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Keywords: intensive care units, physical therapy, physiotherapy, exercises

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Authors: Abera Kotu, Girma Tesema, Mitiku Tadesse

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This study investigated ACE supported instruction and pre-service mathematics teachers’ mental construction in solving equations and inequalities. A mixed approach with concurrent parallel design was employed. It was conducted on two intact groups of regular first-year pre-service mathematics teachers at Fiche College of Teachers’ Education in which one group was assigned as an intervention group and the other group as a comparison group using the lottery method. There were 33 participants in the intervention and 32 participants in the comparison. Six pre-service mathematics teachers were selected for interview using purposive sampling based on pre-test results. An instruction supported with ACE cycle was given to the intervention group for two weeks duration of time. Written tasks, interviews, and observations were used to collect data. Data collected from written tasks were analyzed quantitatively using independent samples t-test and effect size. Data collected from interviews and observations were analyzed narratively. The findings of the study uncovered that ACE-supported instruction has a moderate effect on Pre-service Mathematics Teachers’ levels of conceptualizations of action, process, object, ad schema. Moreover, the ACE supported group out scored and performed better than the usual traditional method supported groups across the levels of conceptualization. The majority of pre-service mathematics teachers’ levels of conceptualizations were at action and process levels and their levels of conceptualization were linked with genetic decomposition more at action and object levels than object and schema. The use of ACE supported instruction is recommended to improve pre-service mathematics teachers’ mental construction.

Keywords: ACE teaching cycle, APOS theory, mental construction, genetic composition

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Authors: T. Nakpun, T. Kanjanarach, T. Kittisopee

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Turnover of community pharmacist can affect continuity of patient care and most importantly the quality of care and also the costs of a pharmacy. It was hypothesized that organizational resources, job characteristics, and social supports had direct effect on pharmacist turnover intention, and indirect effect on pharmacist turnover intention via pharmacist engagement. This research aimed to study influencing factors on pharmacist engagement and pharmacist turnover intention by testing the proposed structural hypothesized model to explain the relationship among organizational resources, job characteristics, and social supports that effect on pharmacist turnover intention and pharmacist engagement in Thai community pharmacists. A cross sectional study design with self-administered questionnaire was conducted in 209 Thai community pharmacists. Data were analyzed using Structural Equation Modeling technique with analysis of a moment structures AMOS program. The final model showed that only organizational resources had significant negative direct effect on pharmacist turnover intention (β =-0.45). Job characteristics and social supports had significant positive relationship with pharmacist engagement (β = 0.44, and 0.55 respectively). Pharmacist engagement had significant negative relationship with pharmacist turnover intention (β = - 0.24). Thus, job characteristics and social supports had significant negative indirect effect on turnover intention via pharmacist engagement (β =-0.11 and -0.13, respectively). The model fit the data well (χ2/ degree of freedom (DF) = 2.12, the goodness of fit index (GFI)=0.89, comparative fit index (CFI) = 0.94 and root mean square error of approximation (RMSEA) = 0.07). This study can be concluded that organizational resources were the most important factor because it had direct effect on pharmacist turnover intention. Job characteristics and social supports were also help decrease pharmacist turnover intention via pharmacist engagement.

Keywords: community pharmacist, influencing factor, turnover intention, work engagement

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Authors: Web Huei Chou, Li Yi Chun, Wenwe Yu, Han Teng Weng, H. Yuan, T. Yang

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The prevalence of dementia is estimated to rise to 78 million by 2030 and 139 million by 2050. Among those affected, Alzheimer's disease is the most common form of dementia, contributing to 60–70% of cases. Addressing this growing challenge is crucial, especially considering the impact on older individuals and their caregivers. To reduce the behavioral and psychological symptoms of dementia, people with dementia use a variety of pharmaceutical and non-pharmacological treatments, and some studies have found the use of non-pharmacological interventions. Treatment of depression, cognitive function, and social activities has potential benefits. Butler developed reminiscence therapy as a method of treating dementia. Through ‘life review,’ individuals can recall their past events, activities, and experiences, which can reduce the depression of the elderly and improve their Quality of life to help give meaning to their lives and help them live independently. The life review process uses a variety of memory triggers, such as household items, past objects, photos, and music, and can be conducted collectively or individually and structured or unstructured. However, despite the advantages of nostalgia therapy, past research has always pointed out that current research lacks rigorous experimental evaluation and cannot describe clear research results and generalizability. Therefore, this study aims to study physiological sensing experiments to find a feasible experimental and verification method to provide clearer design and design specifications for reminiscence therapy and to provide a more widespread application for healthy aging. This study is an ongoing research project, a collaboration between the School of Design at Yunlin University of Science and Technology in Taiwan and the Department of Medical Engineering at Chiba University in Japan. We use traditional rice dishes from Taiwan and Japan as nostalgic content to construct a narrative structure for the elderly in the two countries respectively for life review activities, providing an easy-to-carry nostalgic therapy game with an intuitive interactive design. This experiment is expected to be completed in 36 months. The design team constructed and designed the game after conducting literary and historical data surveys and interviews with elders to confirm the nostalgic historical data in Taiwan and Japan. The Japanese team planned the Electrodermal Activity (EDA) and Blood Volume Pulse (BVP) experimental environments and Data calculation model, and then after conducting experiments on elderly people in two places, the research results were analyzed and discussed together. The research has completed the first 24 months of pre-study, design work, and pre-study and has entered the project acceptance stage.

Keywords: reminiscence therapy, aging health, design research, life review

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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: Nattapong Techarattanased

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This survey research aimed to study the influence of attitude in services, product, and marketing mix affected intention to revisit in boutique hotel of foreign travelers in Bangkok, Thailand. The total 400 sets of closed-ended questionnaires were utilized for conducting data from foreign tourists who come to boutique hotel and can communicate in English. The descriptive statistics and multiple regression analysis were used to analyze data. The research found that tourists’ attitude towards the service of check in and check out process, food and beverage, guest room and other facilities affected in opportunity of revisiting, recommending to others and possibility of revisiting in the future at 0.05 statistically significant levels. Tourists’ attitude towards service and marketing mix in term of people, physical evidence, price, process and channel of distribution could forecast intention to revisit in term of recommending to others and intention to revisit in the future at 0.05 statistically significant levels.

Keywords: boutique hotel, foreign tourists, intention to revisit, service marketing mix

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Authors: Vasoontara Yiengprugsawan, Sam-ang Seubsman

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As Thais live longer, caregivers will become even more important to social and healthcare systems. Commonly reported in many low and middle‐income countries in Asia, formal social welfare services to support caregivers are lacking and informal family support will be required for all levels of care. In 2005, 87,151 open‐university adults were recruited to the Thai Cohort Study, with the majority aged between 25 and 39 years, and residing nationwide. At the 4‐year follow up in 2009 (n=60569) and the 8‐year follow‐up in 2013 (n=42785), prospective cohort participants were asked if they provide care for chronically ill, disabled, or frail family members. Among Thai cohort members reporting between 2009 and 2013, approximately 56% were not caregivers in either year, 24.5% reported providing care in 2009 only, 8.6% in 2013 only, and 10.6% reported providing care at both time points. Caregivers in the cohort reported providing financial support, help with shopping, emotional support, and assist with daily activities. Kessler 6 psychological distress scale, measured in both 2009 and 2013, was used as the primary outcome of a relationship between caregiving status and mental health. Using multivariate logistic regression, our 4‐year longitudinal findings revealed that cohort members who reported providing care at both time points were 1.4 to 1.6 times more likely to report high psychological distress than non‐caregivers, after accounting for potential covariates. With increasing needs for informal care provided by family members, the future health and social welfare system will need to provide adequate support to caregivers (e.g., respite care, clinical support and information for the family, and awareness of mental health among caregivers).

Keywords: family caregivers, psychological distress, prospective cohort, longitudinal study, Thailand

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Authors: Rattakorn Poonsuph

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Technological innovation plays a crucial role in virtual healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. As a result, telehealth represents an opportunity to redesign the way health services are delivered. The research objective is to discover a new business model for digital health services and related industries to participate with telehealth solutions. The business opportunity is valuable for healthcare investors as a startup company to further investigations or implement the telehealth platform. The paper presents a digital healthcare business model and business opportunities to related industries. These include digital healthcare services extending from a traditional business model and use cases of business opportunities to related industries. Although there are enormous business opportunities, telehealth is still challenging due to the patient adaption and digital transformation process within a healthcare organization.

Keywords: telehealth, Internet hospital, HealthTech, InsurTech

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Authors: Ramzi Shawahna

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Background: Neonatal intensive care units are high-risk settings where medication errors can occur and cause harm to this fragile segment of patients. This multicenter qualitative study was conducted to describe medication errors that occurred in neonatal intensive care units in Palestine from the perspectives of healthcare providers. Methods: This exploratory multicenter qualitative study was conducted and reported in adherence to the consolidated criteria for reporting qualitative research checklist. Semi-structured in-depth interviews were conducted with healthcare professionals (4 pediatricians/neonatologists and 11 intensive care unit nurses) who provided care services for patients admitted to neonatal intensive care units in Palestine. An interview schedule guided the semi-structured in-depth interviews. The qualitative interpretive description approach was used to thematically analyze the data. Results: The total duration of the interviews was 282 min. The healthcare providers described their experiences with 41 different medication errors. These medication errors were categorized under 3 categories and 10 subcategories. Errors that occurred while preparing/diluting/storing medications were related to calculations, using a wrong solvent/diluent, dilution errors, failure to adhere to guidelines while preparing the medication, failure to adhere to storage/packaging guidelines, and failure to adhere to labeling guidelines. Errors that occurred while prescribing/administering medications were related to inappropriate medication for the neonate, using a different administration technique from the one that was intended and administering a different dose from the one that was intended. Errors that occurred after administering the medications were related to failure to adhere to monitoring guidelines. Conclusion: In this multicenter study, pediatricians/neonatologists and neonatal intensive care unit nurses described medication errors occurring in intensive care units in Palestine. Medication errors occur in different stages of the medication process: preparation/dilution/storage, prescription/administration, and monitoring. Further studies are still needed to quantify medication errors occurring in neonatal intensive care units and investigate if the designed strategies could be effective in minimizing medication errors.

Keywords: medication errors, pharmacist, pharmacology, neonates

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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: Adeniyi Onasanya, Maher Elshakankiri

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In recent years, the Internet of Things (IoT) has constituted a driving force of modern technological advancement, and it has become increasingly common as its impacts are seen in a variety of application domains, including healthcare. IoT is characterized by the interconnectivity of smart sensors, objects, devices, data, and applications. With the unprecedented use of IoT in industrial, commercial and domestic, it becomes very imperative to harness the benefits and functionalities associated with the IoT technology in (re)assessing the provision and positioning of healthcare to ensure efficient and improved healthcare delivery. In this research, we are focusing on two important services in healthcare systems, which are cancer care services and business analytics/cloud services. These services incorporate the implementation of an IoT that provides solution and framework for analyzing health data gathered from IoT through various sensor networks and other smart devices in order to improve healthcare delivery and to help health care providers in their decision-making process for enhanced and efficient cancer treatment. In addition, we discuss the wireless sensor network (WSN), WSN routing and data transmission in the healthcare environment. Finally, some operational challenges and security issues with IoT-based healthcare system are discussed.

Keywords: IoT, smart health care system, business analytics, (wireless) sensor network, cancer care services, cloud services

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Authors: Katerina Kormusheva

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Pricing plays a pivotal role in the marketing discipline as it directly influences consumer perceptions, purchase decisions, and overall market positioning of a product or service. This paper seeks to expand current knowledge in the area of discriminatory and differential pricing, a main area of marketing research. The methodology includes developing a framework and a model for determining how many price points to implement in differential pricing. We focus on choosing the levels of differentiation, derive a function form of the model framework proposed, and lastly, test it empirically with data from a large-scale marketing pricing experiment of services in telecommunications.

Keywords: marketing, differential pricing, price points, optimization

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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: Mohammad Sadeghi

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The subject matter of this article is the efficiency of current knowledge standard to afford the legal integration regarding criteria and approaches to ISP knowledge standards, to shield ISP and copyright, trademark and other parties’ rights in the online information society. The EU recognizes the knowledge-based liability for intermediaries in the European Directive on Electronic Commerce, but the implication of all parties’ responsibility for combating infringement has been immolated by dominating attention on liability due to the lack of the appropriate legal mechanism to devote each party responsibility. Moreover, there is legal challenge on the applicability of knowledge-based liability on hosting services and information location tools service. The aim of this contribution is to discuss the advantages and disadvantages of ECD knowledge standard through case law with a special emphasis on duty of prevention and constructive knowledge role on internet service providers (ISP s’) to achieve fair balance between all parties rights.

Keywords: internet service providers, liability, copyright infringement, hosting, caching, mere conduit service, notice and takedown, E-commerce Directive

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Authors: Bih-O Lee, Hsiu-Wan Hsieh, Hsiu-Chen Liu, Mer Yu Pan

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Background: Illness perceptions are developed when people face health-threatening situations. Previous research suggests that understanding discrepancies between illness perceptions of patients and caregivers may need to improve quality of health care. Objective: This study examined the differences between illness perceptions of injured patients and those of their caregivers. Methods: Comparative study design was used. The study setting was the surgical wards of a teaching hospital in Taiwan. Participants were 127 pairs of injured patients and their caregivers. The participants completed socio-demographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which comprises eight subscales. Clinical data of the injured patients was obtained from medical records. Results: This study found that injured patients were more pessimistic than their caregivers about the injury. There were significant differences between patients and caregivers insofar as patients perceived more physical symptoms, scored higher in terms of reasons for their injury, had more negative emotions and experienced more consequences than caregivers. Elderly caregivers and caregivers for patients who were over 65, severely injured and admitted to an ICU perceived more negative perceptions about the injury. Conclusions: This study indicated that patients and caregivers had negative illness representations several months after injury although the intensity of their perceptions was different. The interventions should highlight the need to assist patients and caregivers after injury.

Keywords: illness representations, injury, caregivers, comparative study

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Authors: Abimbola Olaotan Akinsete

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Government all over the world has intensified efforts in making internet and resource centres readily available in public institutions and centres for the advancement of humanity and working processes. Information and communication resource centre will not only help in the reduction of task that are presumed to be herculean. This centres influenced the working rate and productivity of both staffs and students and its benefit. The utilization of the internet and information resource centre will not only speed up service delivery, working time and efficiency of the system. Information and Communication Technology plays significant roles in presenting equalization strategy for developing university community and improving educational service delivery. This equalization will not only advance, accelerate and ensure results are accessed electronically, ensuring the transfer and confirmation of students’ academic records and their results in the world without physically available to request for these services. This study seeks to make Critical Appraisal of Adekunle Ajasin University Policy on Internet Resource Centre in Service Delivery Adekunle Ajasin University, Akungba-Akoko, Ondo State. The study employ descriptive survey design method in identifying hindrances of the non-utilization of technology in the service delivery in the university. Findings revealed that the adoption of internet and resource centre in the Exams and Records unit of the University shall help in delivering more in students’ records/results processing.

Keywords: internet, resource, centre, policy and service delivery

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Proteus mirabilis (P. mirabilis) is one of Gram-negative pathogens in human and it causes urinary tract and nosocomial infections. P. mirabilis is susceptible to β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. It was aimed to investigate the resistance status to antimicrobial agents of Proteus mirabilis strains produced from samples sent to Afyon Kocatepe University, ANS Research and Practice Hospital, Microbiology Laboratory from different clinics and polyclinics during the period of 24 months. Methods: Between October 2013 and September 2015, a total of 30 Proteus were isolated from clinical samples of patients were hospitalized in intensive care units and in various departments of Afyon Kocatepe University, ANS Research and Practice Hospital. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bioMérieux, France) was used additionally. Antibacterial susceptibility tests were performed by Kirby Bauer disc (Oxoid, Hempshire, England) diffusion method following the recommendations of CLSI. Results: Of the total 30 Proteus strains isolated from clinical samples, 19 from urine, 7 from wound, 4 from tracheal aspiration materials were isolated. Antimicrobial resistant for these strains were determined to 24,3% for meropenem, 26.2% for imipenem, 20.2% for amikacin 10.5% for cefepim, 33.3% for ciprofloxacin and levofloxacine, 31.6% for ceftazidime, 20% for ceftriaxone, 15.2% for gentamicin and 26.6% for amoxicillin-clavulanate, 26.2% trimethoprim-sulfamethoxale. Conclusion: In the present study, the highest number of clinical isolates of P. mirabilis were isolated from urine (63,3%), followed by the others (36,6%). The distribution of samples P. mirabilis strains to the clinics were as fallows; 16,8% intensive care unit (ICU), 29,9% polyclinics, 53,3% hospital service units The most effective antibiotic on the total of strains were found to be cefepim, the least effective antibiotics on the total of strains were found to be trimethoprim-sulfamethoxale.

Keywords: proteus mirabilis, antibiotic resistance, intensive care unit, Proteus spp.

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Authors: Viktorya Sargsyan, Arax Hovhannesyan, Karine Abelyan

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Introduction: During the last decade, scientific studies have proven the importance of Early Childhood Development (ECD) interventions. These interventions are shown to create strong foundations for children’s intellectual, emotional and physical well-being, as well as the impact they have on learning and economic outcomes for children as they mature into adulthood. Many children in rural Armenia fail to reach their full development potential due to lack of early brain stimulation (playing, singing, reading, etc.) from their parents, and lack of community tools and services to follow-up children’s neurocognitive development. This is exacerbated by high rates of stunting and anemia among children under 3(CU3). This research study tested the effectiveness of an integrated ECD and Maternal, Newborn and Childhood Health (MNCH) model, called “Go Baby, Go!” (GBG), against the traditional (MNCH) strategy which focuses solely on preventive health and nutrition interventions. The hypothesis of this quasi-experimental study was: Children exposed to GBG will have better neurocognitive and nutrition outcomes compared to those receiving only the MNCH intervention. The secondary objective was to assess the effect of GBG on parental child care and nutrition practices. Methodology: The 14 month long study, targeted all 1,300 children aged 0 to 23 months, living in 43 study communities the in Gavar and Vardenis regions (Gegharkunik province, Armenia). Twenty-three intervention communities, 680 children, received GBG, and 20 control communities, 630 children, received MCHN interventions only. Baseline and evaluation data on child development, nutrition status and parental child care and nutrition practices were collected (caregiver interview, direct child assessment). In the intervention sites, in addition to MNCH (maternity schools, supportive supervision for Health Care Providers (HCP), the trained GBG facilitators conducted six interactive group sessions for mothers (key messages, information, group discussions, role playing, video-watching, toys/books preparation, according to GBG curriculum), and two sessions (condensed GBG) for adult family members (husbands, grandmothers). The trained HCPs received quality supervision for ECD counseling and screening. Findings: The GBG model proved to be effective in improving ECD outcomes. Children in the intervention sites had 83% higher odd of total ECD composite score (cognitive, language, motor) compared to children in the control sites (aOR 1.83; 95 percent CI: 1.08-3.09; p=0.025). Caregivers also demonstrated better child care and nutrition practices (minimum dietary diversity in intervention site is 55 percent higher compared to control (aOR=1.55, 95 percent CI 1.10-2.19, p =0.013); support for learning and disciplining practices (aOR=2.22, 95 percent CI 1.19-4.16, p=0.012)). However, there was no evidence of stunting reduction in either study arm. he effect of the integrated model was more prominent in Vardenis, a community which is characterised by high food insecurity and limited knowledge of positive parenting skills. Conclusion: The GBG model is effective and could be applied in target areas with the greatest economic disadvantages and parenting challenges to improve ECD, care practices and developmental outcomes. Longitudinal studies are needed to view the long-term effects of GBG on learning and school readiness.

Keywords: early childhood development, integrated interventions, parental practices, quasi-experimental study

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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: Alexis Piedrahita, Ludi Valencia, Aura Gutierrez

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The migration crisis that is currently being experienced in the world is a continuous phenomenon that has had solutions in form but not in substance, violating the international humanitarian law of people who are in transit through countries foreign to their roots, especially women of age reproductive, this has caused different governments and organizations worldwide to meet around this problem to define concise actions to protect the rights of migrant women in the world. This research compiles the stories of migrant women who arrive in Colombia seeking better opportunities, such as accessibility to comprehensive and quality health services, including primary health care. This is the gateway to the offer of health promotion and disease prevention services.

Keywords: accessibility, primary health care, sexual and reproductive health, sustainable development goals, women migrant

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Authors: Balázs Kulcsár

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Today, there is no part of the world that does not bear the mark of man in some way. This process seems unstoppable. So perhaps the best thing we can do is to touch that handprint gently and with the utmost care. There are multiple uses for the same piece of land, the coordination of which requires careful and sustainable spatial planning. The case study of the Rétközlake in north-eastern Hungary illustrates a habitat rehabilitation project in which a number of human uses were coordinated with the conservation and restoration of the natural environment. Today, the good condition of the habitat can only be maintained artificially, but the project has paid particular attention to finding a sustainable solution. The rehabilitation of Lake Rétköz is considered good practice in resolving land-use conflicts.

Keywords: sustainability, ecosystem service, land use conflict, landscape utilization

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Authors: Pui Hong Chung, Cyrus Leung, Jun Li, Kin On Kwok, Ek Yeoh

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Introduction: Studies for TB control in intermediate tuberculosis burden countries (IBCs) comprise a relatively small proportion in TB control literature, as compared to the effort put in high and low burden counterparts. It currently lacks of consensus in the optimal weapons and strategies we can use to combat TB in IBCs; guidelines of TB control are inadequate and thus posing a great obstacle in eliminating TB in these countries. To fill-in the research and services gap, we need to summarize the findings of the effort in this regard and to seek consensus in terms of policy making for TB control, we have devised a series of scoping and Delphi studies for these purposes. Method: The scoping and Delphi studies are conducted in parallel to feed information for each other. Before the Delphi iterations, we have invited three local experts in TB control in Hong Kong to participate in the pre-assessment round of the Delphi study to comments on the validity, relevance, and clarity of the Delphi questionnaire. Result: Two scoping studies, regarding LTBI control in health care workers in IBCs and TB control in elderly of IBCs respectively, have been conducted. The result of these two studies is used as the foundation for developing the Delphi questionnaire, which tapped on seven areas of question, namely: characteristics of IBCs, adequacy of research and services in LTBI control in IBCs, importance and feasibility of interventions for TB control and prevention in hospital, screening and treatment of LTBI in community, reasons of refusal to/ default from LTBI treatment, medical adherence of LTBI treatment, and importance and feasibility of interventions for TB control and prevention in elderly in IBCs. The local experts also commented on the two scoping studies conducted, thus act as the sixth phase of expert consultation in Arksey and O’Malley framework of scoping studies, to either nourish the scope and strategies used in these studies or to supplement ideas for further scoping or systematic review studies. In the subsequent stage, an international expert panel, comprised of 15 to 20 experts from IBCs in Western Pacific Region, will be recruited to join the two-round anonymous Delphi iterations. Four categories of TB control experts, namely clinicians, policy makers, microbiologists/ laboratory personnel, and public health clinicians will be our target groups. A consensus level of 80% is used to determine the achievement of consensus on particular issues. Key messages: 1. Scoping review and Delphi method are useful to identify gaps and then achieve consensus in research. 2. Lots of resources are put in the high burden countries now. However, the usually neglected intermediate-burden countries with TB is an indispensable part for achieving the ambitious WHO End TB 2035 target.

Keywords: dephi questionnaire, tuberculosis, WHO, latent TB infection

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Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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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: Bhavna Malik

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The study is build on a theoretical framework that links characteristics of job, key attitudes and intention to leave, why faculty may be disengaging from institutional service. The literature indicates that job characteristics, key attitudes and intention to leave are very important for effective organizational functioning. In general, the literature showed that some job characteristics might be the antecedents of job satisfaction and the aggregate variable job scope was positively associated with organizational commitment, and these key attitudes predicted intention to leave negatively. The present study attempted to propose a new integrative model of the relationships among job characteristics, key attitudes, and intention to leave. The main purpose of the present study is to examine the effects of job characteristics on intention to leave. While examining the role of job characteristics, the mediating roles of key attitudes were taken into account in order to better understand how job characteristics affect the exhibition of intention to leave. The secondary purpose is to investigate the effects of job characteristics on key attitudes, and the effects of key attitudes on intention to leave. Job characteristics of remuneration, resource for professional activities, career opportunities were positively associated with the work attitude of job satisfaction. The aggregate job scope was positively associated with the work attitude of organizational commitment although no single job characteristic was significantly associated with organizational commitment. Commitment, however, did not significantly affect time spent on institutional service. Two job characteristics—time spent on research and time spent on teaching—were negatively associated with this behavior. In general, the literature showed that some job characteristics might be the antecedents of job satisfaction and the aggregate variable job scope was positively associated with organizational commitment, and these key attiudes predicted intention to leave negatively. In turn, job satisfaction and organizational commitment were negatively associated with the intention to leave. In addition to these, organizational commitment was negatively associated with the intention to leave. However, no significant direct association was found between job characteristics and intention to leave.

Keywords: Job Characteristics Model, job satisfaction, organizational commitment, intention to leave

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