Search results for: tambon health promoting hospital

Authors: Gary Young, David Zepeda, Gilbert Nyaga

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This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

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Authors: Ryan Adams

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Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.

Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine

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Authors: Yusuke Katayama, Tetsuhisa Kitamura, Kosuke Kiyohara, Sumito Hayashida, Taku Iwami, Takashi Kawamura, Takeshi Shimazu

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Background: Recently, the number of ambulance dispatches has been increasing in Japan and it is, therefore, difficult to accept emergency patients to hospitals smoothly and appropriately because of the limited hospital capacity. To facilitate the request for patient transport by ambulances and hospital acceptance, the emergency information system using information technology has been built up and introduced in various communities. However, its effectiveness has not been insufficiently revealed in Japan. In 2013, we developed a smartphone application system that enables the emergency-medical-service (EMS) personnel to share information about on-scene ambulance and hospital situation. The aim of this study was to assess the introduction effect of this application for EMS system in Osaka City, Japan. Methods: This study was a retrospective study with population-based ambulance records of Osaka Municipal Fire Department. This study period was six years from January 1, 2010 to December 31, 2015. In this study, we enrolled emergency patients that on-scene EMS personnel conducted the hospital selection for them. The main endpoint was difficulty in hospital acceptance at the scene. The definition of difficulty in hospital acceptance at the scene was to make >=5 phone calls by EMS personnel at the scene to each hospital until a decision to transport was determined. The definition of the smartphone application group was emergency patients transported in the period of 2013-2015 after the introduction of this application, and we assessed the introduction effect of smartphone application with multivariable logistic regression model. Results: A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 smartphone application group (50.0%) in 2010-2012 and 300,395 non-smartphone application group (50.0%) in 2013-2015. The proportion of the difficulty in hospital acceptance was 14.2% (42,585/300,131) in the smartphone application group and 10.9% (32,819/300,395) in the non-smartphone application group, and the difficulty in hospital acceptance significantly decreased by the introduction of the smartphone application (adjusted odds ration; 0.730, 95% confidence interval; 0.718-0.741, P<0.001). Conclusions: Sharing information between ambulance and hospital by introducing smartphone application at the scene was associated with decreasing the difficulty in hospital acceptance. Our findings may be considerable useful for developing emergency medical information system with using IT in other areas of the world.

Keywords: difficulty in hospital acceptance, emergency medical service, infomation technology, smartphone application

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Authors: Armin Samarghandi, Amirreza Jafari, Mohamad Ghiasi

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Numerous assertions and some empirical evidence imply that 'green' buildings ought to be more productive and healthier (mentally and physiologically) than conventional structures. Since then, empirical data has been equivocal, indicating either that the studies are inaccurate or that the research has just scratched the surface of green buildings in offices, accommodation, and hospital settings and not taken the aforementioned holistically. This study compared four green-certified buildings -one residential green building, one green hospital, and one green school- with conventional structures in Tehran, Iran, by means of a questionnaire spread among those utilizing these buildings, and assessing their productivity and health rate as opposed to the time they resided, worked in conventional buildings. The results demonstrated higher scores pertaining to productivity and physical and mental wellness as a consequence of better indoor environmental quality (IEQ), natural lighting, design, and sustainability of these buildings against non-green buildings. In addition, ancillary matters -environmental, financial, intellectual, emotional, social, and spiritual dimensions of participants- were indirectly evaluated, and the same results were produced.

Keywords: green building, LEED, productivity, physical and mental health, indoor environmental quality

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Authors: Saqib Amina, Waqas Mehmoodb, Iftikhar Yasinc

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This study analyzes the robust association between ethnic violence and mental health from a global perspective (201-countries across the world) by using the panel data for the period 1970 to 2020. Mental health has been determined through various dimensions such as mental disorders, anxiety disorder, depressive disorder, schizophrenia, and bipolar disorder. The empirical findings show that ethnic violence has a significant positive association with all types of mental health indicators, including mental disorders, anxiety disorder, depressive disorder, schizophrenia, and bipolar disorder. The study also reveals that institutional quality may reduce the effect of mental health disorders in a better way than promoting democracy. This study suggests the non-stigmatizing social form of community-based support services instead of a stigmatizing the concept of mental illnesses that promotes hospitalization and drug treatment.

Keywords: ethnic violence, unemployment, mental health, violence

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Authors: Khaliun Nyambayar, Nomindari Azzaya, Batkhuyag Purevjav

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Pharmacovigilance was officially introduced in Mongolia in 2003, in accordance with the Health Minister Order 183 for the registry of adverse drug reactions (ADR), approved in 2006 and was reviewed in 2010. This study was designed to evaluate the incidence and common types of adverse drug reactions among hospitalized children, the frequency of adverse drug reaction reported by health care providers, and the follow-up processes resulting from adverse drug reactions. A retrospective study of paediatric patients who experienced an adverse drug reaction from 2015 to 2019, extracted from the “yellow” card at the State Research Center for Maternal and Child Health, (city). A total of 417 adverse drug reactions were reported with an overall incidence was 80 (21.5%). Adverse reactions resulting from the use of antibiotics (particularly gentamycin, cephalosporins, and vancomycin) were usually mild. ADR’s were reported by physicians and nurses (93.8%), pharmacists (6.25%). Although documentation of physician notification occurred for 93% of adverse drug reactions, only 29% of cases were documented in the patient's medical chart, 13% included follow-up education for individuals involved, and 10% were updated in the allergy profile of the hospital computer system. Measures to improve the detection and reporting of adverse drug reactions by all health care professionals should be improved, to enhance our understanding of the nature and impact of these reactions in children.

Keywords: adverse drug reaction, pediatric, yellow card, Mongolia

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Authors: Ivan Orozco

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Introduction: Forced contraception constitutes part of an effort to control the life and reproductive capacity of women through public health institutions. This phenomenon has affected many Mexican women historically and still persists nowadays. The notion of reproductive governmentality refers to the mechanisms through which different historical configurations of social actors (state institutions, churches, donor agents, NGOs, etc.) use legislative controls, economic incentives, moral mandates, direct coercion, and ethical incitements, to produce, monitor and control reproductive behaviors and practices. This research focuses on the use of these mechanisms by the Mexican State to control women's contraceptive practices in a public hospital. Method: An Institutional Ethnography was carried out, with the objective of knowing women's experiences from their own perspective, as they occur in their daily lives, but at the same time, discovering the structural elements that shape the discourses that promote women's contraception, even against their will. The fieldwork consisted in an observation of the dynamics between different participants within a public hospital and the conduction of interviews with the medical and nursing staff in charge of family planning services, as well as women attending the family planning office. Results: Public health institutions in Mexico are state tools to control and regulate reproduction. There are several strategies that are used for this purpose, for example, health personnel provide insufficient or misleading information to ensure that women agree to use contraceptives; health institutions provide economic incentives to the members of the health staff who reach certain goals in terms of contraceptive placement; young women are forced to go to the family planning service, regardless of the reason they went to the clinic; health campaigns are carried out, consisting of the application of contraceptives outside the health facilities, directly in the communities of people who visit the hospital less frequently. All these mechanisms seek for women to use contraceptives, from the women’s perspective; however, the reception of these discourses is ambiguous. While, for some women, the strategies become coercive mechanisms to use contraceptives against their will, for others, they represent an opportunity to take control over their reproductive lives. Conclusion: Since 1974, the Mexican government has implemented campaigns for the promotion of family planning methods as a means to control population growth. Although it is established in several legislations that the counselling must be carried out with a gender and human rights perspective, always respecting the autonomy of people, these research testify that health personnel uses different strategies to force some women to use contraceptive methods, thereby violating their reproductive rights.

Keywords: feminist research, forced contraception, institutional ethnography, reproductive. governmentality

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Authors: Muhammed Ordu, Eren Demir, Chris Tofallis

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The number of inpatient admissions in the UK has been significantly increasing over the past decade. These increases cause bed occupancy rates to exceed the target level (85%) set by the Department of Health in England. Therefore, hospital service managers are struggling to better manage key resource such as beds. On the other hand, this severe demand pressure might lead to confusion in wards. For example, patients can be admitted to the ward of another inpatient specialty due to lack of resources (i.e., bed). This study aims to develop a simulation-optimization model to reallocate the available number of beds in a mid-sized hospital in the UK. A hospital simulation model was developed to capture the stochastic behaviours of the hospital by taking into account the accident and emergency department, all outpatient and inpatient services, and the interactions between each other. A couple of outputs of the simulation model (e.g., average length of stay and revenue) were generated as inputs to be used in the optimization model. An integer linear programming was developed under a number of constraints (financial, demand, target level of bed occupancy rate and staffing level) with the aims of maximizing number of admitted patients. In addition, a sensitivity analysis was carried out by taking into account unexpected increases on inpatient demand over the next 12 months. As a result, the major findings of the approach proposed in this study optimally reallocate the available number of beds for each inpatient speciality and reveal that 74 beds are idle. In addition, the findings of the study indicate that the hospital wards will be able to cope with 14% demand increase at most in the projected year. In conclusion, this paper sheds a new light on how best to reallocate beds in order to cope with current and future demand for healthcare services.

Keywords: bed occupancy rate, bed reallocation, discrete event simulation, inpatient admissions, integer linear programming, projected usage

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Authors: Routsukol Sunalai

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This research was to study the relationship between the organizational culture like bureaucratic system, and patronage system in government hospitals with hospital accreditation and its impact on the quality of service in the government hospital accredited. Qualitative research was applied in this study by in-depth interviews with samples containing 20 public welfare service providers, i.e. doctors, nurses and practical nurses and 20 service recipients in the units of study. It was found that the bureaucracy still existed and was evidenced by the structure of the line of command; work systems, clear cut duty divisions, procedures and plans, and the patronage system hindered the quality of service in the government hospitals under the process of development and accreditation. The administrators should encourage and support the creation of a learning process in the organization for self-improvement and work development.

Keywords: hospital in Dusit Area, organization culture, the quality of service, economics and financial engineering

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Authors: Raeda F. Abualrub, Amani Abdulnabi

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Aim: The aims of this study were to (a) examine the levels of nurses' political efficacy and involvement in health policy; and (b) explore the relationships between political efficacy, involvement in health policy, and participants’ background variables. Background: Nurses as citizens and health care providers have the right to express their opinions and beliefs in regard to issues that are concerned with the health care system or the public health domain. Methods: A descriptive, cross-sectional design using was utilized. A self-administered questionnaire (Political Efficacy Scale & Involvement in Health Policy Scale) was completed by a convenience sample of 302 nurses. Results: The results of this study showed low levels of involvement in health policy and political efficacy and a positive weak correlation between political efficacy and involvement in health policy. The perceived level of political efficacy was associated positively with nurses’ age and experience. Conclusions: Nurse administrators and managers may empower, support, and encourage nurses to enhance their involvement in health policy. Implications for Nursing Management: The findings have implications for nursing leaders and administrators to design appropriate strategies to enhance nurses’ involvement in health policy development.

Keywords: health policy, Jordan, nurses, political efficacy

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Authors: Ayesha Asif, Muhammad Zeeshan

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The sensitivity of hospital-microenvironments for all types of pollutants, due to the presence of patients with immune deficiencies, makes them complex indoor spaces. Keeping in view, this study investigated indoor air quality (IAQ) of two most sensitive places, i.e., operation theater (OT) and intensive care unit (ICU), of a publically managed hospital. Taking CO₂ concentration as air quality indicator and temperature (T) and relative humidity (RH) as thermal comfort parameters, continuous monitoring of the three variables was carried out. Measurements were recorded at an interval of 1 min for weekdays and weekends, including occupational and non-occupational hours. Outdoor T and RH measurements were also used in the analysis. Results show significant variation (p < 0.05) in CO₂, T and RH values over the day during weekdays while no significant variation (p > 0.05) have been observed during weekends of both the monitored sites. Maximum observed values of CO₂ in OT and ICU were found to be 2430 and 624 ppm, T as 24.7ºC and 28.9ºC and RH as 29.6% and 32.2% respectively.

Keywords: indoor air quality, CO₂ concentration, hospital building, comfort assessment

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Authors: Vanlounni Sibounheuang, Wanarat Anusornsangiam, Pattarin Kittiboonyakun, Chanthanom Manithip

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In worldwide, one of the most common use of oral anticoagulant is warfarin. Its margin between therapeutic inhibition of clot formation and bleeding complications is narrow. Mahosot Hospital, warfarin clinic had not been established yet. The descriptive study was conducted by investigating drug-related problems of outpatients using warfarin, the value of the international normalized ratio (INR) higher than normal ranges (25.40 % of the total 272 outpatients) were mostly identified at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. This result led to the present study conducting qualitative interviews in order to help establish a warfarin clinic at Mahosot Hospital for the better outcomes of patients using warfarin. The purpose of this study was to explore perspectives of healthcare professional providing services for outpatients using warfarin. The face to face, in-depth interviews were undertaken among nine healthcare professionals (doctor=3, nurse=3, pharmacist=3) working at out-patient clinic, Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. The interview guides were developed, and they were validated by the experts in the fields of qualitative research. Each interview lasted approximately 20 minutes. Three major themes emerged; healthcare professional’s experiences of current practice problems with warfarin therapy, healthcare professionals’ views of medical problems related to patients using warfarin, and healthcare professionals’ perspectives on ways of service improvement. All healthcare professionals had the same views that it’s difficult to achieve INR goal for individual patients because of some important patient barriers especially lack of knowledge about to use warfarin properly and safety, patients not regularly follow-up due to problems with transportations and financial support. Doctors and nurses agreed to have a pharmacist running a routine warfarin clinic and provided counselling to individual patients on the following points: how to take drug properly and safety, drug-drug and food-drug interactions, common side effects and how to manage them, lifestyle modifications. From the interviews, some important components of the establishment of a warfarin clinic included financial support, increased human resources, improved the system of keeping patients’ medical records, short course training for pharmacists. This study indicated the acceptance of healthcare professionals on the important roles of pharmacists and the feasibility of setting up warfarin clinic by working together with the multidisciplinary health care team in order to help improve health outcomes of patients using warfarin at Mahosot Hospital, Lao PDR.

Keywords: perspectives, healthcare professional, warfarin therapy, Mahosot Hospital

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Authors: Won-Seok Kim, Hyung-Ik Shin

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Self-rated health (SRH) is a subjective assessment of individual health and has been identified as a strong predictor for mortality and morbidity. However few studies have been directed to the factors associated with SRH in persons with disabilities (PWD). We used data of 7th Korean national survey for 5307 PWD in 2008. Multiple logistic regression analysis was performed to find out independent risk factors for poor SRH in PWD. As a result, indicators of physical condition (poor instrumental ADL), socioeconomic disadvantages (poor education, economically inactive, low self-rated social class, medicaid in health insurance, presence of unmet need for hospital use) and social participation and networks (no use of internet service) were selected as independent risk factors for poor SRH in final model. Findings in the present study would be helpful in making a program to promote the health and narrow the gap of health status between the PWD.

Keywords: disabilities, risk factors, self-rated health, socioeconomic disadvantages, social networks

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: James Semmens, James Boyd, Anna Ferrante, Katrina Spilsbury, Sean Randall, Adrian Brown

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‘Big data’ is a relatively new concept that describes data so large and complex that it exceeds the storage or computing capacity of most systems to perform timely and accurate analyses. Health services generate large amounts of data from a wide variety of sources such as administrative records, electronic health records, health insurance claims, and even smart phone health applications. Health data is viewed in Australia and internationally as highly sensitive. Strict ethical requirements must be met for the use of health data to support health research. These requirements differ markedly from those imposed on data use from industry or other government sectors and may have the impact of reducing the capacity of health data to be incorporated into the real time demands of the Big Data environment. This ‘big data revolution’ is increasingly supported by national governments, who have invested significant funds into initiatives designed to develop and capitalize on big data and methods for data integration using record linkage. The benefits to health following research using linked administrative data are recognised internationally and by the Australian Government through the National Collaborative Research Infrastructure Strategy Roadmap, which outlined a multi-million dollar investment strategy to develop national record linkage capabilities. This led to the establishment of the Population Health Research Network (PHRN) to coordinate and champion this initiative. The purpose of the PHRN was to establish record linkage units in all Australian states, to support the implementation of secure data delivery and remote access laboratories for researchers, and to develop the Centre for Data Linkage for the linkage of national and cross-jurisdictional data. The Centre for Data Linkage has been established within Curtin University in Western Australia; it provides essential record linkage infrastructure necessary for large-scale, cross-jurisdictional linkage of health related data in Australia and uses a best practice ‘separation principle’ to support data privacy and security. Privacy preserving record linkage technology is also being developed to link records without the use of names to overcome important legal and privacy constraint. This paper will present the findings of the first ‘Proof of Concept’ project selected to demonstrate the effectiveness of increased record linkage capacity in supporting nationally significant health research. This project explored how cross-jurisdictional linkage can inform the nature and extent of cross-border hospital use and hospital-related deaths. The technical challenges associated with national record linkage, and the extent of cross-border population movements, were explored as part of this pioneering research project. Access to person-level data linked across jurisdictions identified geographical hot spots of cross border hospital use and hospital-related deaths in Australia. This has implications for planning of health service delivery and for longitudinal follow-up studies, particularly those involving mobile populations.

Keywords: data integration, data linkage, health planning, health services research

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Authors: Fernanda Ludmilla Rossi Rocha, Thamiris Cavazzani Vegro, Silvia Helena Henriques Camelo, Carmen Silvia Gabriel, Andrea Bernardes

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Introduction: Organizations are cultural, symbolic and imaginary systems composed by values and norms. These values and norms represent the organizational culture, which determines the behavior of the workers, guides the work practices and impacts the quality of care and the safety culture of health services worldwide. Objective: To analyze the organizational culture of a public and a private hospital in Brazil. Method: Descriptive study with quantitative approach developed in a public and in a private hospital of Brazil. Sample was composed by 281 nursing workers, of which 73 nurses and 208 nursing auxiliaries and technicians. The data collection instrument comprised the Brazilian Instrument for Assessing Organizational Culture. Data were collected from March to December 2013. Results: At the public hospital, the results showed an average score of 2.85 for the values concerning cooperative professionalism (CP); 3.02 for values related to hierarchical rigidity and the centralization of power (HR); 2.23 for individualistic professionalism and competition at work (IP); 2.22 for values related to satisfaction, well-being and motivation of workers (SW); 3.47 for external integration (EI); 2.03 for rewarding and training practices (RT); 2.75 for practices related to the promotion of interpersonal relationships (IR) About the private hospital, the results showed an average score of 3.24 for the CP; 2.83 for HR; 2.69 for IP; 2.71 for SW; 3.73 for EI; 2.56 for RT; 2.83 for IR at the hospital. Discussion: The analysis of organizational values of the studied hospitals shows that workers find the existence of hierarchical rigidity and the centralization of power in the institutions; believed there was cooperation at workplace, though they perceived individualism and competition; believed that values associated with the workers’ well-being, satisfaction and motivation were seldom acknowledged by the hospital; believed in the adoption of strategic planning actions within the institution, but considered interpersonal relationship promotion, continuous education and the rewarding of workers to be little valued by the institution. Conclusion: This work context can lead to professional dissatisfaction, compromising the quality of care and contributing to the occurrence of occupational diseases.

Keywords: nursing management, organizational culture, quality of care, interpersonal relationships

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Authors: Manar Aslan, Ayse Yildiz

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The study was conducted descriptively to assess their hospital institutionalization of upper and mid-level managers of 18 hospitals affiliated to Public Hospitals Association. In its simplest form institutionalization is whatever the subject matter, is dominated by the rules of articulated and determined behavior in all kinds of business, interaction, and communication. Hospital service is a type of service carried out chained together. It should not be forgotten that this kind of services is carried out without barrier, and who and what to do with definite lines, hospital management is a process, and this process can be achieved through institutionalization. With the establishment of the Public Hospitals Unions in Turkey, all the state hospitals in the provinces have been gathered under this roof. One of the goals is to establish control mechanisms to ensure that hospitals reach pre-determined financial, medical, and administrative standards. In this way, the preparations for the institutionalization of units and hospital enterprises will be completed. The data of the study were collected by institutionalization management attitude scale (cronbach alpha: 0.98) of composed of 5 sub-dimensions and 52 questions in 18 hospitals’ managers (N=310) in the largest province in Turkey. The results of the study revealed that the total score taken by managers at the institutionalization scale was 200.80, and this was close to the maximum score. In addition, it was determined that the difference between the mean score of the scale and its sub-dimensions with the gender, the hospitals, and the management position.

Keywords: institutionalization, hospital, manager, evaluation

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Authors: Osuagwu Justine Ugochukwu

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

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

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Authors: Munir Kassa, Mengistu Hailemariam, Meghan Obermeyer, Kefelegn Baruda, Yonas Getachew, Asnakech Dessie

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Improving the quality of sexual and reproductive health services that women receive is expected to have an impact on women’s satisfaction with the services, on their continued use and, ultimately, on their ability to achieve their fertility goals or reproductive intentions. Surprisingly, however, there is little empirical evidence of either whether this expectation is correct, or how best to improve service quality within sexual and reproductive health programs so that these impacts can be achieved. The Recent focus on quality has prompted more physicians to do quality improvement work, but often without the needed skill sets, which results in poorly conceived and ultimately unsuccessful improvement initiatives. As this renders the work unpublishable, it further impedes progress in the field of health care improvement and widens the quality chasm. Moreover, since 2014, the Center for International Reproductive Health Training (CIRHT) has worked diligently with 11 teaching hospitals across Ethiopia to increase access to contraception and abortion care services. This work has included improving pre-service training through education and curriculum development, expanding hands-on training to better learn critical techniques and counseling skills, and fostering a “team science” approach to research by encouraging scientific exploration. This is the first time this systematic approach has been applied and documented to improve access to high-quality services in Ethiopia. The purpose of this article is to report initiatives undertaken, and findings concluded by the clinical service team at CIRHT in an effort to provide a pragmatic approach to quality improvement projects. An audit containing nearly 300 questions about several aspects of patient care, including structure, process, and outcome indicators was completed by each teaching hospital’s quality improvement team. This baseline audit assisted in identifying major gaps and barriers, and each team was responsible for determining specific quality improvement aims and tasks to support change interventions using Shewart’s Cycle for Learning and Improvement (the Plan-Do-Study-Act model). To measure progress over time, quality improvement teams met biweekly and compiled monthly data for review. Also, site visits to each hospital were completed by the clinical service team to ensure monitoring and support. The results indicate that applying an evidence-based, participatory approach to quality improvement has the potential to increase the accessibility and quality of services in a short amount of time. In addition, continued ownership and on-site support are vital in promoting sustainability. This approach could be adapted and applied in similar contexts, particularly in other African countries.

Keywords: abortion, contraception, quality improvement, service provision

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospitals Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre-EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors which are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality and the data were analysed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system which can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analysed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospitals staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: communication, emergency communication services, emergency medical teams, emergency physicians, emergency nursing, paramedics, information and communication technology, communication systems

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the prevalence of nosocomial infections in the ICU and to identify the common microorganisms causing these infections and their antimicrobial sensitivity pattern. Nosocomial infection or hospital-acquired infection is a localized or a systemic condition resulting from an adverse reaction to the presence of infectious agents. Nosocomial infections are not present or incubating when the patient is admitted to hospital or other health care facility. They are caused by pathogens that easily spread through the body. Many hospitalized patients have compromised immune systems, so they are less able to fight off infections. These infections occur worldwide, both in the developed and developing the world. They are a significant burden to patients and public health. They are a major cause of death and increased morbidity in hospitalized patients, which is a matter of serious concern today. This study was done during the period of one year (2012-2013) in the ICU of the tertiary care hospital in eastern India. Prevalence of nosocomial infection was determined; site of infection and the pattern of microorganisms were identified along with the assessment of antibiotic susceptibility profile. Patients who developed an infection after 48 hours of admission to the ICU were included in the study. A total of 324 ICU patients were analyzed, of these 79 patients were found to have developed a nosocomial infection (24.3% prevalence). Urinary tract infection was found to be more predominant followed by respiratory tract infection and soft tissue infection. The most frequently isolated microorganism was E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae followed by other organisms respectively. Antibiotic susceptibility test of these isolates was done against commonly used antibiotics. Patients admitted to the ICU are especially susceptible to nosocomial infections. Despite adequate antimicrobial treatment, nosocomial ICU infections can significantly affect ICU stay and can cause an increase in patient’s morbidity and mortality. Adherence to infection protocol, proper monitoring and the judicious use of antibiotics are important in preventing such infections on a regular basis.

Keywords: antibiotic susceptibility, intensive care unit, nosocomial infection, nosocomial pathogen

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Yang Liandong

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The rapid development of cities has triggered a series of urban health problems. Residents' daily lives have generally changed to long-term unhealthy work and rest, and the prevalence of chronic diseases in the population is on the rise. Promoting physical activity is an effective way to enhance the population's health and reduce the risk of various chronic diseases. As the most basic unit of the city, the community is the living space where residents use the highest frequency of daily activities and also the best space carrier for people to carry out all kinds of physical activities, and its planning research is of great significance for promoting physical activities. Under special conditions, the old communities in mountainous cities present compact and three-dimensional spatial characteristics, and there are problems such as disordered spatial organization, scattered distribution, and low utilization rates. This paper selects four communities in Daxigou Street, Yuzhong District, Chongqing as the research object, analyzes the current situation of the research cases through literature combing and field investigation and interviews, and puts forward the planning strategies for promoting physical activity in old communities in mountain cities from four aspects: building a convenient and smooth public space system, creating a diversified and shared activity space, creating a beautiful and healing community landscape, and providing convenient and perfect supporting facilities, to provide a certain reference for the healthy development of old communities in mountain cities.

Keywords: physical activity, community planning, old communities in mountain cities, public space optimization, spatial fairness

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Authors: Rania Albsoul, Muhammad Ahmed Alshyyab, Baraa Ayed Al Odat, Nermeen Borhan Al Dwekat, Batool Emad Al-masri, Fatima Abdulsattar Alkubaisi, Salsabil Awni Flefil, Majd Hussein Al-Khawaldeh, Ragad Ayman Sa’ed, Maha Waleed Abu Ajamieh, Gerard Fitzgerald

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Purpose: The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan. Design/methodology/approach: This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons, and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data. Findings: Three main themes emerged from data analysis, namely compliance with the surgical safety checklist, the impact of the surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion, and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist and help enhance awareness about its importance. Originality/value: While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges to consistent, complete, and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

Keywords: patient safety, surgical safety checklist, compliance, utility, operating room, quality healthcare, communication, teamwork

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Authors: Thampi Rawther, Jack Cecire, Andrew Sutherland

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Introduction: CT facilitates the diagnosis of potentially life-threatening injuries and facilitates early management. There is evidence that reduced CT acquisition time reduces mortality and length of hospital stay. Currently, there are variable recommendations for ideal timing. Indeed, the NHS standard contract for a major trauma service and STAG both recommend immediate access to CT within a maximum time of 60min and appropriate reporting within 60min of the scan. At Coffs Harbour Health Campus (CHHC), a CT radiographer is on site between 8am-11pm. Aim: To investigate the average time to CT at CHHC and assess for any significant relationship between time to CT and injury severity score (ISS) or time of triage. Method: All major trauma calls between Jan 2021-Oct 2021 were audited (N=87). Patients were excluded if they went from ED to the theatre. Time to CT is defined as the time between triage to the timestamp on the first CT image. Median and interquartile range was used as a measure of central tendency as the data was not normally distributed, and Chi-square test was used to determine association. Results: The median time to CT is 51.5min (IQR 40-74). We found no relationship between time to CT and ISS (P=0.18) and time of triage to time to CT (P=0.35). We compared this to other centres such as John Hunter Hospital and Gold Coast Hospital. We found that the median CT acquisition times were 76min (IQR 52-115) and 43min, respectively. Conclusion: This shows an avenue for improvement given 35% of CT’s were >30min. Furthermore, being proactive and aware of time to CT as an important factor to trauma management can be another avenue for improvement. Based on this, we will re-audit in 12-24months to assess if any improvement has been made.

Keywords: imaging, rural surgery, trauma surgery, improvement

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Authors: Wei-Chih Huang, Pei-Lung Chung, Ching-Heng Lin, Hsuan-Chia Yang, Der-Ming Liou

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Background: In-Hospital Cardiac Arrest (IHCA) threaten life of the inpatients, cause serious effect to patient safety, quality of inpatients care and hospital service. Health providers must identify the signs of IHCA early to avoid the occurrence of IHCA. This study will consider the potential association between early signs of IHCA and the essence of patient care provided by nurses and other professionals before an IHCA occurs. The aim of this study is to identify significant associations between nursing interventions and abnormal early evaluation results of IHCA that can assist health care providers in monitoring inpatients at risk of IHCA to increase opportunities of IHCA early detection and prevention. Materials and Methods: This study used one of the data mining techniques called association rules mining to compute associations between nursing interventions and abnormal early evaluation results of IHCA. The nursing interventions and abnormal early evaluation results of IHCA were considered to be co-occurring if nursing interventions were provided within 24 hours of last being observed in abnormal early evaluation results of IHCA. The rule based methods were utilized 23.6 million electronic medical records (EMR) from a medical center in Taipei, Taiwan. This dataset includes 733 concepts of nursing interventions that coded by clinical care classification (CCC) codes and 13 early evaluation results of IHCA with binary codes. The values of interestingness and lift were computed as Q values to measure the co-occurrence and associations’ strength between all in-hospital patient care measures and abnormal early evaluation results of IHCA. The associations were evaluated by comparing the results of Q values and verified by medical experts. Results and Conclusions: The results show that there are 4195 pairs of associations between nursing interventions and abnormal early evaluation results of IHCA with their Q values. The indication of positive association is 203 pairs with Q values greater than 5. Inpatients with high blood sugar level (hyperglycemia) have positive association with having heart rate lower than 50 beats per minute or higher than 120 beats per minute, Q value is 6.636. Inpatients with temporary pacemaker (TPM) have significant association with high risk of IHCA, Q value is 47.403. There is significant positive correlation between inpatients with hypovolemia and happened abnormal heart rhythms (arrhythmias), Q value is 127.49. The results of this study can help to prevent IHCA from occurring by making health care providers early recognition of inpatients at risk of IHCA, assist with monitoring patients for providing quality of care to patients, improve IHCA surveillance and quality of in-hospital care.

Keywords: in-hospital cardiac arrest, patient safety, nursing intervention, association rule mining

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Authors: Betsy H. Edwards

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Background: Public Health England recognises unprotected sex and consequent transmission of sexually transmitted infections (STIs) as significant problems within student populations. Government surveys show that 50% of sexually-active young adults engage in unprotected sex with new partners, with 10% never using condoms. The recent Channel Four mini-series ‘It’s a Sin’ dramatises the 1980s AIDS epidemic and has been praised for its educational value and for promoting safe sexual practices to its viewers. This mixed-methods questionnaire study aims to investigate whether the series can change attitudes towards safe sex in student populations, can promote the use of condoms in student populations, and whether television, in general, is a useful tool for promoting health education. Methods: A questionnaire, created on Microsoft Forms, was distributed to students at the University of Birmingham via Facebook groups between September 2021 and May 2022. To consent, participants had to be aged 18 or over, a student at the university, have seen the entire series of ‘It’s a Sin’, and read the study information. Data was confidentially stored within the University’s secured OneDrive in accordance with the study’s approved ethics application. Quantitative questions measured participants’ attitudes and behaviours using Likert scales. Qualitative data was analysed using thematic analysis. Quantitative Results: 78 students completed the questionnaire. 43 participants (55%) felt that the series ‘It’s a Sin’ promoted safe sex. 74 participants (96%) and 31 participants (39%) said they were ‘very likely’ or ‘likely’ to use condoms with a casual partner during penetrative sex and oral sex respectively. 27 participants (35%) felt that watching ‘It’s a Sin’ made them more likely to use condoms; of these 27 participants, all were ‘very likely’ or ‘likely’ to use condoms during penetrative sex, and 9 were ‘very likely’ or ‘likely’ to during oral sex. 49 participants (63%) and 53 participants (68%) felt that television is a good way to provide health education and to promote healthy behaviours respectively. Qualitative Results: 56 participants (72%) gave reasons why the series had been associated with an increased uptake in HIV testing. Three themes emerged: increased education and attention, decreased stigmatisation, and relatability of characters on screen. Conclusions: This study suggests that the series ‘It’s a Sin’ can influence attitudes towards and the uptake of safe sexual practices. It would be useful for further research - using larger, randomised samples - to explore impacts upon populations lesser-educated about sexual health, who potentially have more to gain from watching series such as ‘It’s a Sin’.

Keywords: GUM, It's a sin, media, sexual health, students, television, tv

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Authors: Ivonete Teresinha Schulter Buss Heidemann, Michelle Kuntz Durand, Aline Megumi Arakawa-Belaunde, Sandra Mara Corrêa, Leandro Martins Costa Do Araujo, Kamila Soares Maciel

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Primary Health Care is defined as the level of a system of services that enables the achievement of answers to health needs. This level of care produces services and actions of attention to the person in the life cycle and in their health conditions or diseases. Primary Health Care refers to a conception of care model and organization of the health system that in Brazil seeks to reorganize the principles of the Unified Health System. This system is based on the principle of health as a citizen's right and duty of the State. Primary health care has family health as a priority strategy for its organization according to the precepts of the Unified Health System, structured in the logic of new sectoral practices, associating clinical work and health promotion. Thus, this study seeks to know the possibilities and limits of the care developed by professionals working in Primary Health Care. It was conducted by a qualitative approach of the participant action type, based on Paulo Freire's Research Itinerary, which corresponds to three moments: Thematic Investigation; Encoding and Decoding; and, Critical Unveiling. The themes were investigated in a health unit with the development of a culture circle with 20 professionals, from a municipality in southern Brazil, in the first half of 2021. The participants revealed as possibilities the involvement, bonding and strengthening of the interpersonal relationships of the professionals who work in the context of primary care. Promoting welcoming in primary care has favoured care and teamwork, as well as improved access. They also highlighted that care planning, the use of technologies in the process of communication and the orientation of the population enhances the levels of problem-solving capacity and the organization of services. As limits, the lack of professional recognition and the scarce material and human resources were revealed, conditions that generate tensions for health care. The reduction in the number of professionals and the low salary are pointed out as elements that boost the motivation of the health team for the development of the work. The participants revealed that due to COVID-19, the flow of care had as a priority the pandemic situation, which affected health care in primary care, and prevention and health promotion actions were canceled. The study demonstrated that empowerment and professional involvement are fundamental to promoting comprehensive and problem-solving care. However, limits of the teams are observed when exercising their activities, these are related to the lack of human and material resources, and the expansion of public health policies is urgent.

Keywords: health promotion, primary health care, health professionals, welcoming.

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Authors: Gholam Reza Mirzaei, Mehran Roost

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This research was conducted with the aim of predicting the relationship between coronavirus anxiety and psychological hardiness in employees working at Shahid Beheshti Hospital in Shiraz. The current research design was descriptive and correlational. The statistical population of the research consisted of all the employees of Shahid Beheshti Hospital in Shiraz in 2021. From among the statistical population, 220 individuals were selected and studied based on available sampling. To collect data, Kobasa's psychological hardiness questionnaire and coronavirus anxiety questionnaire were used. After collecting the data, the scores of the participants were analyzed using Pearson's correlation coefficient multiple regression analysis and SPSS-24 statistical software. The results of Pearson's correlation coefficient showed that there is a significant negative correlation between psychological hardiness and its components (challenge, commitment, and control) with coronavirus anxiety; also, psychological hardiness with a beta coefficient of 0.20 could predict coronavirus anxiety in hospital employees. Based on the results, plans can be made to enhance psychological hardiness through educational workshops to relieve the anxiety of the healthcare staff.

Keywords: the corona virus, commitment, hospital employees, psychological hardiness

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