Search results for: healthcare costs

Authors: A. Sathiya Susuman

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Background: The importance of maternal and child healthcare services cannot be stressed enough. These services are very important for the health and health outcomes of the mother and that of the child and in ensuring that both maternal and child deaths are prevented. The objective of the study is to inspire good quality maternal and child health care services in Swaziland. Specifically, is Swaziland on track with the 2015 Millennium Development Goals? Methods: The study used secondary data from the Swaziland Demographic and Health Survey 2006-07. This is an explorative and descriptive study which used pre-selected variables to study factors influencing the use of maternal and child healthcare services in Swaziland. Different types of examinations, such as univariate, bivariate, and multivariate statistical analysis were adopted. Results: The study findings showed a high use rate of antenatal care (97.3%) and delivery care (74.0%), and a low rate of postnatal care use (20.5%). The uptake childhood immunization is also high in the country, averaging more than 80.0%. Moreover, certain factors which were found to be influencing the use of maternal healthcare and childhood immunization include: woman’s age, parity, media exposure, maternal education, wealth status, and residence. The findings also revealed that these factors affect the use of maternal and child health differently. Conclusion: It is important to study factors related to maternal and child health uptake to inform relevant stakeholders about possible areas of improvement. Programs to educate families about the importance of maternal and child healthcare services should be implemented. Swaziland needs to work hard on child survival and maternal health care services, no doubt it is on track with the MDG 4 & 5.

Keywords: maternal healthcare, antenatal care, delivery care, postnatal care, child health, immunization, socio-economic and demographic factors

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Authors: Layane Sara Vieira, Paulo Egidio Bernardo, Roberto Saverio Souza Costa

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Anthropogenic occupations and agricultural explorations without concern for the preservation and sustainability of the activity result in soil degradation that can make rural activity unfeasible. The objective of this work was to characterize and evaluate the recovery costs of an area degraded by major erosion (gully) in the municipality of Monte Alto (SP). Topographic characterization was carried out by means of a planialtimetric survey with a total station. The contours of the gully, internal area, slope height, contribution area, volume, and costs of operations for the recovery of the gully were delimited. The results obtained showed that the gully has a length of 145.56 m, a maximum width of 36.61 m, and a gap of 19.48 m. The external area of the gully is 1,039.8741 m², and the internal area is 119.3470 m². The calculated volume was 3,282.63 m³. The intervention area for breaking slopes was measured at 8,471.29 m², requiring the construction of 19 terraces in this area, vertically spaced at 2.8 m. The estimated costs for mechanical recovery of the gully were R$ 19,167.84 (US$ 3.657,98).

Keywords: erosion, volumetric assessment, soil degradation, terraces

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Authors: Mahdi Bastan, Ali Mohammad Ahmadvand, Fatemeh Soltani Khamsehpour

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Health organizations’ sustainable development has nowadays become highly affected by customers’ satisfaction due to significant changes made in the business environment of the healthcare system and emerging of Competitiveness paradigm. In case we look at the hospitals and other health organizations as service providers concerning profit issues, the satisfaction of employees as interior customers, and patients as exterior customers would be of significant importance in health business success. Furthermore, satisfaction rate could be considered in performance assessment of healthcare organizations as a perceived quality measure. Several researches have been carried out in identification of effective factors on patients’ satisfaction in health organizations. However, considering a systemic view, the complex causal relations among many components of healthcare system would be an issue that its acquisition and sustainability requires an understanding of the dynamic complexity, an appropriate cognition of different components, and effective relationships among them resulting ultimately in identifying the generative structure of patients’ satisfaction. Hence, the presenting paper applies system dynamics approaches coherently and methodologically to represent the systemic structure of customers’ satisfaction of a health system involving the constituent components and interactions among them. Then, the results of different policies taken on the system are simulated via developing mathematical models, identifying leverage points, and using scenario making technique and then, the best solutions are presented to improve customers’ satisfaction of the services. The presenting approach supports taking advantage of decision support systems. Additionally, relying on understanding of system behavior Dynamics, the effective policies for improving the health system would be recognized.

Keywords: customer satisfaction, healthcare, scenario, simulation, system dynamics

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Authors: Patrick David Chirilele

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There are growing interests in improving service delivery in the healthcare sector through the adoption of emerging digital technologies, including the Vocera B3000n communication system badge. As a result, understanding the factors that impact the adoption of such digital technologies is becoming important. This study investigates the determinants of task-technology fit through the adoption of Vocera B3000n communication system badge in healthcare sector in South Africa. Statistical analyses are performed on the data collected from 143 healthcare workers including registered nurses and personal care workers at three hospitals in South Africa through survey to test the relationship between task characteristics, technology characteristics and user characteristics for better understanding the task-technology fit and the adoption of Vocera communication systems in South African hospitals. The result reveals that all three factors have a significant impact on task-technology fit through the adoption of Vocera B3000n communication system badge. Such findings are useful for healthcare sector in their adoption of digital technologies for improving service delivery through effective communication in their workplace.

Keywords: adoption, communication systems, task-technology fit, user characteristics, Vocera

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Authors: Mohammad Ranjbar, Mohammad Bazyar, Blake Angell, Thomas Lung, Yibeltal Assefa

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Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). We hypothesize that improving the enrollment rate and moving towards a more sustainable UHC can be achieved by improving the benefits package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran. Methods: A discrete choice experiment (DCE) was conducted in 2021, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual preferences for the SHI in Yazd, Iran. Respondents were presented with an eight-choice set and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants' preferences. Willingness to pay for each attribute was also calculated. Results: Most included attributes were significant predictors of the choice of a health insurance package. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes, etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly influence respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month. Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs, and ancillary services were the most important determining factors for their choice. The data suggest that additional resources coming into the Iranian health system might best be prioritized to cover hospitalization and drug costs and those associated with ancillary services.

Keywords: social health insurance, preferences, discrete choice experiment, willingness to pay

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Authors: Sahani Rathnasiri, Pritee Ray, Sardar M. N. Isalm, Carlos A. Vega-Mejia

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This study develops a cooperative game theory-based cost-sharing contract model for a business to consumer (B2C) e-commerce supply chain to minimize the overall supply chain costs and the individual costs within an information asymmetry scenario. The objective of this study is to address the issues of strategic interactions among the key players of the e-commerce supply chain operation, which impedes the optimal operational outcomes. Game theory has been included in the field of supply chain management to resolve strategic decision-making issues; however, most of the studies are limited only to two-echelons of the supply chains. Multi-echelon supply chain optimizations based on game-theoretic models are less explored in the previous literature. This study adopts a cooperative game model to focus on the common payoff of operations and addresses the issues of information asymmetry and coordination of a three-echelon e-commerce supply chain. The cost-sharing contract model integrates operational features such as production, inventory management and distribution with the contract related constraints. The outcomes of the model highlight the importance of maintaining lower operational costs by all players to obtain benefits from the cost-sharing contract. Further, the cost-sharing contract ensures true cost revelation, and hence eliminates the information asymmetry issues among the players. Comparing the results of the contract model with the de-centralized e-commerce supply chain operation further emphasizes that the cost-sharing contract derives Pareto-improved outcomes and minimizes the costs of overall e-commerce supply chain operation.

Keywords: cooperative game theory, cost-sharing contract, e-commerce supply chain, information asymmetry

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Authors: Shannon Richards-Green, Suzanne Gough, Sharon Mickan

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Background: Healthcare leaders work in highly complex and rapidly changing environments. Consequently, they need both flexibility and the capacity to hold multiple perspectives simultaneously. My research explored how healthcare leaders understand and make sense (meaning) of their leadership experiences and how this understanding was manifested in their leadership behaviours. Methods: This grounded theory study was conducted via 2 x 1-hour interviews with healthcare leaders within acute care hospitals. A total of 33 hours of interviews were conducted with 17 participants. Participants were recruited using a combination of purposive and snowball sampling. Interviews were recorded, transcribed, and coded to explore emergent patterns and relationships within the data, utilising constant comparative analysis. Adult developmental stage was defined through a subject-object interview with each participant, in alignment with the tenets of constructive development theory. Findings: Participants from acute care hospitals within Australia have participated in the study, with the majority representing the executive leadership level. Broad categories emerging from the data include; Broadening perspectives and abilities as a leader, Dealing with and experiencing conflict within the workplace, Experiencing rewarding times as a leader, and Leading in alignment with a strong personal values system. Discussion: Successfully dealing with complex challenges requires an ability to engage with nuanced perspectives and responses, an integral part of adult developmental growth. In dealing with conflict, for example, leaders at various levels of adult development approached the situation quite differently. Understanding how healthcare leaders make sense of their experiences can assist in providing insights into the value of supporting adult developmental growth in healthcare leadership.

Keywords: leadership, adult development, complexity, growth

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Authors: Mugabe Nzarama Gabriel

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In Rwanda, many healthcare organizations are still using a paper based patients’ data record system although it still present weaknesses to share health patients’ information across different services when necessary. In developed countries, the EHR has been put in place to revolutionize the paper based record system but still the EHR has some challenges related to privacy, security, or interoperability. The purpose of this research was to assess the existing patients’ data record system in healthcare sector in Rwanda, see what an EHR can improve to the system in place and assess the acceptance of EHR as system which is interoperable, very secure and interoperable and see whether stakeholders are ready to adopt the system. The case based methodology was used and TAM theoretical framework to design the questionnaire for the survey. A judgmental sample across two cases, CHUB and Hopital de Nemba, has been selected and SPSS has been used for descriptive statistics. After a qualitative analysis, the findings showed that the paper based record is useful, gives complete information about the patient, protects the privacy of patients but it is still less secure and less interoperable. The respondents shown that they are ready to use the proposed EHR System and want it secure, capable of enforcing the privacy but still they are not all ready for the interoperability. A conclusion has been formulated; recommendations and further research have been proposed.

Keywords: EHR system, healthcare service, TAM, privacy, interoperability

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Authors: Ayoade Adeyemi, Leo Nherera, Paul Trueman, Antje Emmermann

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Background and objectives: Radiofrequency (RF) generated plasma chondroplasty is considered a promising treatment alternative to mechanical debridement (MD) with a shaver. The aim of the study was to perform a cost-effectiveness analysis comparing costs and outcomes following COBLATION chondroplasty versus mechanical debridement in patients with knee pain associated with a medial meniscus tear and idiopathic ICRS grade III focal lesion of the medial femoral condyle from a payer perspective. Methods: A decision-analytic model was developed comparing economic and clinical outcomes between the two treatment options in German patients following knee chondroplasty. Revision rates based on the frequency of repeat arthroscopy, osteotomy and conversion to total knee replacement, reimbursement costs and outcomes data over a 4-year time horizon were extracted from published literature. One-way sensitivity analyses were conducted to assess uncertainties around model parameters. Threshold analysis determined the revision rate at which model results change. All costs were reported in 2016 euros, future costs were discounted at a 3% annual rate. Results: Over a 4 year period, COBLATION chondroplasty resulted in an overall net saving cost of €461 due to a lower revision rate of 14% compared to 48% with MD. Threshold analysis showed that both options were associated with comparable costs if COBLATION revision rate was assumed to increase up to 23%. The initial procedure costs for COBLATION were higher compared to MD and outcome scores were significantly improved at 1 and 4 years post-operation versus MD. Conclusion: The analysis shows that COBLATION chondroplasty is a cost-effective option compared to mechanical debridement in the treatment of patients with a medial meniscus tear and idiopathic ICRS grade III defect of the medial femoral condyle.

Keywords: COBLATION, cost-effectiveness, knee chondroplasty, mechanical debridement

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Authors: Zakieh Piri, Shahla Damanabi, Peyman Rezaii Hachesoo

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Introduction: Healthcare organizations like other organizations suffer from a number of disorders such as Business Sponsor Disorder, Business Acceptance Disorder, Cultural/Political Disorder, Data Disorder, etc. As quality in healthcare care mostly depends on the quality of data, we aimed to identify data disorders and its symptoms in two teaching hospitals. Methods: Using a self-constructed questionnaire, we asked 20 questions in related to quality and usability of patient data stored in patient records. Research population consisted of 150 managers, physicians, nurses, medical record staff who were working at the time of study. We also asked their views about the symptoms and treatments for any data disorders they mentioned in the questionnaire. Using qualitative methods we analyzed the answers. Results: After classifying the answers, we found six main data disorders: incomplete data, missed data, late data, blurred data, manipulated data, illegible data. The majority of participants believed in their important roles in treatment of data disorders while others believed in health system problems. Discussion: As clinicians have important roles in producing of data, they can easily identify symptoms and disorders of patient data. Health information managers can also play important roles in early detection of data disorders by proactively monitoring and periodic check-ups of data.

Keywords: data disorders, quality, healthcare, treatment

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Authors: Aremu Abdulmujeeb Babatunde

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Background: Low back pain was not only considered to be the most common reason for functional disability worldwide, but also estimated to have affected 90% of the universal population. This study aimed at determining the prevalence, consequences and socio-demographic factors associated with low back pain. Methods; A cross-sectional survey was employed and a total number of 150 self-structured questionnaire was distributed among healthcare workers and this was used to determine the prevalence of low back pain and work related absenteeism. Data was entered using Epi info soft-ware and analyzed using SPSS. Results; An overall response rate of 84% (n = 140) was achieved. The study established that majority (37%) of the respondents were in the age bracket of 20-39 years, 57% female (n=59) and 64% of them were married. the pint prevalence was 84%, 31% of the respondents took leave from work as a result of low back pain. There was high prevalence of sick leave among nursing staff 45.2%, Chi-square test shows that there was a statistically significant association between the respondents occupations and daily time spent during their work (P value 0.011 and 0.042) respectively. Socio-demographic factors like age, marital status and gender were not statistically significant at P<0.05. Conclusions; The medical and socio-professional consequences of low back pain among healthcare workers was as a result of their occupation designations and the daily time spent in carry out this occupations.

Keywords: low back pain, healthcare workers, prevalence, sick leave

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Authors: Pariya Sheykhmaleki, Debajyoti Pati

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Rural areas in the United States face numerous challenges in providing quality and assessable primary healthcare services, especially during emergencies such as natural disasters or pandemics. This study showcases a cutting-edge flexible module that aims to overcome these challenges by offering adaptable healthcare facilities capable of providing comprehensive health services in remote and disaster-prone regions. According to the Health Resources and Services Administration (HRSA), approximately 62 million Americans, or 1 in 5 individuals, live in areas designated as Health Professional Shortage Areas (HPSAs) for primary care. These areas are characterized by limited access to healthcare facilities, shortage of healthcare professionals, transportation barriers, inadequate healthcare infrastructure, higher rates of chronic diseases, mental health disparities, and limited availability of specialized care, including urgent circumstances like pandemics that can exacerbate this issue. To address these challenges, the literature study began by examining primary health solutions in very remote areas, e.g., spaceships, to identify the state-of-the-art technologies and the methods used to facilitate primary care needs. The literature study on flexibility in architecture and interior design was also adapted to develop a conceptual design for rural areas. The designed flexible module provides an innovative solution. This module can be prefabricated as all parts are standardized. The flexibility of the module allows the structure to be modified based on local and geographical requirements as well as the ability to expand as required. It has been designed to stand either by itself or work in tandem with public buildings. By utilizing sustainable approaches and flexible spatial configurations, the module optimizes the utilization of limited resources while ensuring efficient and effective healthcare delivery. Furthermore, the poster highlights the key features of this flexible module, including its ability to support telemedicine and telehealth services for all five levels of urgent care conditions, i.e., from facilitating fast tracks to supporting emergency room services, in two divided zones. The module's versatility enables its deployment in rural areas located far from urban centers and disaster-stricken regions, ensuring access to critical healthcare services in times of need. This module is also capable of responding in urban areas when the need for primary health becomes vastly urgent, e.g., during a pandemic. It emphasizes the module's potential to bridge the healthcare gap between rural and urban areas and mitigate the impact of rural health challenges.

Keywords: rural health, healthcare challenges, flexible modular design, telemedicine, telehealth

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Authors: M. Naidoo

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AI in healthcare can have a massive positive effect in low-resource states like South Africa, where patients outnumber personnel greatly. However, the complexity and ‘black box’ aspects of these technologies pose challenges for the liability regimes of states. This is currently being discussed at the international level. This research finds that within the South African medical negligence context, the current common law fault-based inquiry proves to be wholly inadequate for patient redress. As a solution to this, this research paper culminates in legal reform recommendations designed to solve these issues.

Keywords: artificial intelligence, law, liability, policy

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Authors: Ma Chu Jui

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Culture plays a pivotal role in shaping societal responses to change and fostering adaptability. In the realm of healthcare provision, hospitals serve as dynamic settings molded by the cultural consciousness of healthcare professionals. This intricate interplay extends to their expectations of leadership, communication styles, and attitudes towards patient care. Recognizing the cultural inclinations of healthcare professionals becomes imperative in navigating this complex landscape. This study will utilize Hofstede's Value Survey Module 2013 (VSM 2013) as a comprehensive analytical tool. The targeted participants for this research are in-service nursing professionals with a tenure of at least three months, specifically employed in the nursing department of an Eastern hospital. This quantitative approach seeks to quantify diverse cultural tendencies among the targeted nursing professionals, elucidating not only abstract cultural concepts but also revealing their cultural inclinations across different dimensions. The study anticipates gathering between 400 to 500 responses, ensuring a robust dataset for a comprehensive analysis. The focused approach on nursing professionals within the Eastern hospital setting enhances the relevance and specificity of the cultural insights obtained. The research aims to contribute valuable knowledge to the understanding of cultural tendencies among in-service nursing personnel in the nursing department of this specific Eastern hospital. The VSM 2013 will be initially distributed to this specific group to collect responses, aiming to calculate scores on each of Hofstede's six cultural dimensions—Power Distance Index (PDI), Individualism vs. Collectivism (IDV), Uncertainty Avoidance Index (UAI), Masculinity vs. Femininity (MAS), Long-Term Orientation vs. Short-Term Normative Orientation (LTO), and Indulgence vs. Restraint (IVR). the study unveils a significant correlation between different cultural dimensions and healthcare professionals' tendencies in understanding leadership expectations through PDI, grasping behavioral patterns via IDV, acknowledging risk acceptance through UAI, and understanding their long-term and short-term behaviors through LTO. These tendencies extend to communication styles and attitudes towards patient care. These findings provide valuable insights into the nuanced interconnections between cultural factors and healthcare practices. Through a detailed analysis of the varying levels of these cultural dimensions, we gain a comprehensive understanding of the predominant inclinations among the majority of healthcare professionals. This nuanced perspective adds depth to our comprehension of how cultural values shape their approach to leadership, communication, and patient care, contributing to a more holistic understanding of the healthcare landscape. A profound comprehension of the cultural paradigms embraced by healthcare professionals holds transformative potential. Beyond a mere understanding, it acts as a catalyst for elevating the caliber of healthcare services. This heightened awareness fosters cohesive collaboration among healthcare teams, paving the way for the establishment of a unified healthcare ethos. By cultivating shared values, our study envisions a healthcare environment characterized by enhanced quality, improved teamwork, and ultimately, a more favorable and patient-centric healthcare landscape. In essence, our research underscores the critical role of cultural awareness in shaping the future of healthcare delivery.

Keywords: hofstede's cultural, cultural dimensions, cultural values in healthcare, cultural awareness in nursing

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Authors: Israel Becerril Rosales, Manuel González De La Rosa, Gerardo Villa Sánchez

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In this work, the effects that produce not having a good inventory management is analyzed, in addition of the way that how it affects the storage costs. The research began conducting the historical analysis about stored products, its storage capacity, and distribution. The results were not optimal, since in all its raw materials (RM) have overstocking, the warehouse capacity is only used by 61%, does not have a specific place for each of its RM, causing that the delivery times increases and makes difficult a cyclical inventory. These shortcomings allowed to view and select as design alternatives the inventory ABC, so that depending on the consumption of each RM would be redistributed by using economic amount requested. Also, the Delphi method to ensure the practical applicability of the proposed tool was used, taking in account comments and suggestions of the involved experts, as well as the compliance of NOM-059-SSA1-2015 good manufacturing practices of drug. With the actions implemented, the utilization rate drops of 61% to 32% capacity, it shows that the warehouse was not designed properly due to there is not an industrial engineering area.

Keywords: lead time, improve delivery, storage costs, inventory management

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Authors: Patrick Nurse, Professor Neil Sebire, Polly Livermore

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The use of digital systems in healthcare is now highly prevalent. With further advancement of technology, these systems will become increasingly utilised within the healthcare sector. Therefore understanding how clinicians (for example, doctors, nurses) interact with technology and digital systems is critical to making care safer. Seven members from the Parent/Carers’ Research Advisory Group and the Young-Persons’ Research Group at a healthcare Trust in London and three staff members contributed to an engagement workshop to assess the impact of digital systems on the practice of nurses. The group also advised on the viability of a research study to investigate this further. A wide range of issues within digital system implementation in healthcare were raised, such as ‘workarounds’, system’s training, and upkeep and regulation of usage, which all emerged as early themes during the discussion. Further discussion focused on the subject of escalation of issues, ‘workarounds’, and problem solving. While challenging to implement, digital systems are hugely beneficial to healthcare providers. The workshop indicated that there is scope for investigation of the prevalence, nature, and escalation of ‘workarounds’, this was of key interest to the advisory group. An interesting concern of the group was their worry from a patient and parental perspective regarding how nurses might feel when needing to complete a ‘workaround’ during a busy shift. This is especially relevant if the reasons to complete the ‘workaround’ were outside the nurse’s control, driven by clinical need and urgency of care. This showed the level of insight that those using healthcare services have into the reality of workflows of those providing care. Additionally, it reflects the desire for patients and families to understand more about the administration and methodology of their care. Future study should be dedicated to understanding why nurses deploy ‘workarounds’, as well as their perspective and experience of them and subsequent escalation through leadership hierarchies

Keywords: patient engagement/involvement, workarounds, medication-administration, digital systems

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Authors: Anyia Nduka, Aslan Bin Amad Senin, Ayu Azrin Binti Abdul Aziz

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Telemedicine is a rapidly developing discipline with enormous promise for better healthcare results for patients. To meet the demands of patients and the healthcare sector, medical providers must be proficient in telemedicine and also need government funding for infrastructure and core competencies. In this study, we surveyed general hospitals in Kuala Lumpur and Selangor to investigate patient’s impressions of both the positive and negative aspects of government funding for telemedicine and its level of acceptance. This survey was conducted in accordance with the Diffusion of Innovations (DOI) hypothesis; the survey instruments were designed through a Google Form and distributed to patients and every member of the medical team. The findings suggested a framework for categorizing patients' levels of technology use and acceptability, which provided practical consequences for healthcare. We therefore recommend the increase in technical assistance and government-backed funding of telemedicine by bolstering the entire system.

Keywords: technology acceptance, quality assurance, digital transformation, cost management.

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Authors: Ayedh Alqahtani, Andrew Whyte

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Life Cycle Cost (LCC) is one of the goals and key pillars of the construction management science because it comprises many of the functions and processes necessary, which assist organisations and agencies to achieve their goals. It has therefore become important to design and control assets during their whole life cycle, from the design and planning phase through to disposal phase. LCCA is aimed to improve the decision making system in the ownership of assets by taking into account all the cost elements including to the asset throughout its life. Current application of LCC approach is impractical during misunderstanding of the advantages of LCC. This main objective of this research is to show a different relationship between capital cost and long-term running costs. One hundred and thirty eight actual building projects in United Kingdom (UK) were used in order to achieve and measure the above-mentioned objective of the study. The result shown that LCC is one of the most significant tools should be considered on the decision making process.

Keywords: building projects, capital cost, life cycle cost, maintenance costs, operation costs

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Authors: Danijela Tuljak-Suban, Valter Suban

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Food as perishable goods represents a specific and sensitive part in the supply chain theory, since changing of its physical or chemical characteristics considerably influences the approach to stock management. The most delicate phase of this process is transportation, where it becomes difficult to ensure stability conditions that limit the deterioration, since the value of the deterioration rate could be easily influenced by the transportation mode. Fuzzy definition of variables allows taking into account these variations. Furthermore an appropriate choice of the defuzzification method permits to adapt results, as much as possible, to real conditions. In the article will be applied the those methods to the relationship between the deterioration rate of perishable goods and transportation by ship, with the aim: (a) to minimize the total costs function, defined as the sum of the ordering cost, holding cost, disposing cost and transportation costs, and (b) to improve supply chain sustainability by reducing the environmental impact and waste disposal costs.

Keywords: perishable goods, fuzzy reasoning, transport by ship, supply chain sustainability

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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: Nuttapimon Bhirommuang, Kulapong Jayanama

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Background: Prevalence of malnutrition in hospitalized patient is higher than general population. As a result of the unawareness of consequence and the more concerning in the other aspects of care, many patients with high risk of malnutrition are unrecognized. Even if malnutrition has been identified as affecting in many patient outcomes, the impact may differ in each population and group of patients. Objectives: The aims of this study were to examine the association between the nutritional status and the length of stay and hospital costs in hospitalized patients, to investigate the factors related these outcomes and to determine the frequency of malnutrition in hospitals. Method: This retrospective cohort study enrolled all patients aged 15 years old or older and admitted in SDMC, Ramathibodi Hospital between 1st January 2016 and 30th September 2016. The nutritional status assessment by Nutrition Alert Form (NAF) was performed by well-trained nurses in all patients at admission. Baseline characteristics were recorded. Length of stay and hospital costs were collected during their hospitalization. Univariate analysis, nonparametric rank test, Kruskal-Wallis test were used to compare means in the case of nonnormally and noncontinuously distributed data. Chi-square used to analyze categorical variables, the nutritional status and the length of stay and hospital costs and identify possible confounding factors (data were analyzed using SPSS version 18.0). Result: Of the 2,906 patients, 3.9% were severe malnutrition (NAF-C score > 10) and 11.4% were moderate malnutrition (NAF-B score 6 - 10). Both length of stay and hospital costs were found significantly higher in more severe malnutrition group (p < 0.001), NAF = A: 3.21 days, 95% CI 3.06-3.35 and 111,544.25 THB, 95% CI 106,994.41 – 116,094.1; NAF = B: 7.54 days, 95% CI 6.32 – 8.76 and 162,302.4 THB, 95% CI 129,557.88 – 195,046.92; NAF =C: 14.77 days, 95% CI 11.34 – 18.2 and 323,572.11 THB, 95% CI 226,958.1 – 420,096.13 (1 THB = 0.03019 USD). Age of each nutritional status group had also significant increase from NAF A to NAF C (p < 0.001): 55.07, 67.03 and 73.88 years old, respectively. Conclusion: The prevalence of malnutrition in Ramathibodi hospital is voluminous. Severe malnutrition screening by NAF is significantly correlated with worse clinical outcome, especially higher length of stay and hospital costs. Elderly is also a significant factor which correlates with malnutrition. The results of this study could change the awareness of health personnel and the practice protocol. Moreover, the further study concerning nutritional support in high-risk group of malnutrition is ongoing to confirm this hypothesis.

Keywords: malnutrition, NAF, length of stay, hospital costs

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Authors: Isa Raquel Alves Soeiro, Cristina Isabel Branco de Sá

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In Portugal, since 2008, there has been a requirement to export the Standard Audit File for Tax Purposes (SAF-T) standard file (in XML format). This file thus gathers tax-relevant information from a company relating to a specific period of taxation. There are two types of SAF-T files that serve different purposes: the SAF-T of revenues and the SAF-T of accounting, which requires taxpayers and accounting firms to invest in order to adapt the accounting programs to the legal requirements. The implementation of the SAF-T accounting file aims to facilitate the collection of relevant tax data by tax inspectors as support of taxpayers' tax returns for the analysis of accounting records or other information with tax relevance (Portaria No. 321-A/2007 of March 26 and Portaria No. 302/2016 of December 2). The main objective of this research project is to verify, through quantitative analysis, what is the cost of compliance of Small and Medium Enterprises (SME) in the district of Leiria in the introduction and implementation of the tax obligation of SAF-T - Standard Audit File for Tax Purposes of accounting. The information was collected through a questionnaire sent to a population of companies selected through the SABI Bureau Van Dijk database in 2020. Based on the responses obtained to the questionnaire, the companies were divided into two groups: Group 1 -companies who are self-employed and whose main activity is accounting services; and Group 2 -companies that do not belong to the accounting sector. In general terms, the conclusion is that there are no statistically significant differences in the costs of complying with the accounting SAF-T between the companies in Group 1 and Group 2 and that, on average, the internal costs of both groups represent the largest component of the total cost of compliance with the accounting SAF-T. The results obtained show that, in both groups, the total costs of complying with the SAF-T of accounting are regressive, which appears to be similar to international studies, although these are related to different tax obligations. Additionally, we verified that the variables volume of business, software used, number of employees, and legal form explain the differences in the costs of complying with accounting SAF-T in the Leiria district SME.

Keywords: compliance costs, SAF-T accounting, SME, Portugal

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Authors: Galih Imaduddin

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Knowledge has been viewed as one of the most important resources in organizations, including those that operate in the healthcare sector. On that basis, Knowledge Management (KM) is crucial for healthcare organizations to improve their productivity and ensure effective utilization of their resources. Despite the growing interests to understand how KM might work for healthcare organizations, there is only a modest amount of empirical inquiries which have specifically focused on the tools and initiatives to share knowledge. Hence, the main purpose of this paper is to investigate the way healthcare organizations, particularly public sector ones, utilize knowledge sharing tools and initiatives for the benefit of patient-care. Employing a qualitative method, 13 (thirteen) Community Health Centers (CHCs) from a high-performing district health setting in Indonesia were observed. Data collection and analysis involved a repetition of document retrievals and interviews (n=41) with multidisciplinary health professionals who work in these CHCs. A single case study was cultivated reflecting on the means that were used to share knowledge, along with the factors that inhibited the exchange of knowledge among those health professionals. The study discovers that all of the thirteen CHCs exhibited and applied knowledge sharing means which included knowledge documents, virtual communication channels (i.e. emails and chatting applications), and social learning forums such as staff meetings, morning briefings, and communities of practices. However, the intensity of utilization was different among these CHCs, in which organizational culture, leadership, professional boundaries, and employees’ technological aptitude were presumed to be the factors that inhibit knowledge sharing processes. Making a distance with the KM literature of other sectors, this study denounces the primacy of technology-based tools, suggesting that socially-based initiatives could be more reliable for sharing knowledge. This suggestion is largely due to the nature of healthcare work which is still predominantly based on the tacit form of knowledge.

Keywords: knowledge management, knowledge sharing, knowledge sharing tools and initiatives, knowledge sharing inhibitors, primary health care organizations

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Authors: Domingos Vita, Patrick Brady

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Background: There is a tuberculosis (TB) epidemic in Angola that has been getting worse for more than a decade despite the active implementation of the DOTS strategy. The aim of this study was to directly interrogate healthcare workers involved in TB control on what they consider to be the drivers of the TB epidemic in Angola. Methods: Twenty four in-depth qualitative interviews were conducted with medical staff working in this field in the provinces of Luanda and Benguela. Results: The healthcare professionals see the migrant working poor as a particular problem for the control of TB. These migrants are constructed as ‘Rural People’ and are seen as non-compliant and late-presenting. This is a stigmatized and marginal group contending with the additional stigma associated with TB infection. The healthcare professionals interviewed also see the interruption of treatment and self medication generally as a better explanation for the TB epidemic than urbanization or lack of medication. Conclusions: The local narrative is in contrast to previous explanations used elsewhere in the developing world. To be effective policy must recognize the local issues of the migrant workforce, interruption of treatment and the stigma associated with TB in Angola.

Keywords: Africa, Angola, migrants, qualitative, research, tuberculosis

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Authors: Amela Ajanovic, Reinhard Haas

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Electric vehicles (EVs) are considered as an important means to cope with current environmental problems in transport. However, their high capital costs and limited driving ranges state major barriers to a broader market penetration. The core objective of this paper is to investigate the future market prospects of various types of EVs from an economic and ecological point of view. Our method of approach is based on the calculation of total cost of ownership of EVs in comparison to conventional cars and a life-cycle approach to assess the environmental benignity. The most crucial parameters in this context are km driven per year, depreciation time of the car and interest rate. The analysis of future prospects it is based on technological learning regarding investment costs of batteries. The major results are the major disadvantages of battery electric vehicles (BEVs) are the high capital costs, mainly due to the battery, and a low driving range in comparison to conventional vehicles. These problems could be reduced with plug-in hybrids (PHEV) and range extenders (REXs). However, these technologies have lower CO₂ emissions in the whole energy supply chain than conventional vehicles, but unlike BEV they are not zero-emission vehicles at the point of use. The number of km driven has a higher impact on total mobility costs than the learning rate. Hence, the use of EVs as taxis and in car-sharing leads to the best economic performance. The most popular EVs are currently full hybrid EVs. They have only slightly higher costs and similar operating ranges as conventional vehicles. But since they are dependent on fossil fuels, they can only be seen as energy efficiency measure. However, they can serve as a bridging technology, as long as BEVs and fuel cell vehicle do not gain high popularity, and together with PHEVs and REX contribute to faster technological learning and reduction in battery costs. Regarding the promotion of EVs, the best results could be reached with a combination of monetary and non-monetary incentives, as in Norway for example. The major conclusion is that to harvest the full environmental benefits of EVs a very important aspect is the introduction of CO₂-based fuel taxes. This should ensure that the electricity for EVs is generated from renewable energy sources; otherwise, total CO₂ emissions are likely higher than those of conventional cars.

Keywords: costs, mobility, policy, sustainability,

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Authors: İbrahim Arslan, Mücahit Ünal

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An important issue to ensure justice is to simplify the right to seek justice. But there is a cost of seeking justice in civil law. It costs at least, attorneys' fees and judicial expenses during the beginning and in case of losing a trial. Indeed, most of the people refrain from seeking justice because of these expenses. Therefore, it is not inappropriate to say that the removal of obstacles staying on the way of seeking justice will increase the belief in justice. Legal expenses insurance is a private law contract of insurance in which the insurer is obliged to pay premiums of the insured, to provide the necessary services for the protection of legal interests of the insured person within the agreed scope. This type of insurance is being practiced in the Western world for a long time. The special rights, duties and obligations of the parties to a legal expenses insurance contract shall be governed by the Turkish Commercial Code (TCC) and the contractual agreements which are regularly closed in the form of general terms and conditions. If the number of the legal expenses insurance contracts concluded increase this will definitely improve the percentage of seeking justice before the courts. The general terms and conditions applicable in Turkey generally include litigation costs, referee fees, guarantee fund , enforcement costs , appeal costs borne decision corrections costs. In addition, besides the insured, other family members or the people specified in the policy are protected in the scope of personal/family legal expenses insurance. The commercial law disputes fall outside the scope of coverage in this insurance branch. The insured person chooses his own lawyer and the insurer is not allowed to give advice during the selection of a lawyer. In April 2015, the Prime Minister announced of a new era in the field of legal expenses insurance in Turkey and this announcement excited the insurance industry and legal community.

Keywords: insurance, in the Turkish law on legal protection insurance, legal protection insurance, legal protection

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Authors: David Tennison

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Epistemic injustice, an injustice done to a person specifically in their capacity as a “knower”, is a subtle form of discrimination, yet its effects can be as dehumanizing and damaging as more overt forms of discrimination. The lens of epistemic injustice has, in recent years, been fruitfully applied to the field of healthcare, examining questions of agency, power, credibility and belief in doctor-patient interactions. Contested illness patients (e.g., those with illnesses lacking scientific consensuses such as fibromyalgia (FM), Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) and Long Covid) face higher levels of scrutiny than other patient groups and are often disbelieved or dismissed when their ailments cannot be easily imaged or tested for- often encapsulated by the expression “it’s all in your head”. Using the case study of FM, the trials of contested illness patients in healthcare can be conceptualized in terms of epistemic injustice, and what is going wrong in these doctor-patient relationships can be effectively diagnosed. This case study also helps reveal epistemic dysfunction (structural epistemic issues embedded in the healthcare system), how this relates to stigma identity-based prejudice, and how the healthcare system upholds existing societal hierarchies and disenfranchises the most vulnerable. In the modern landscape, where cases of these chronic illnesses are not only on the rise but future pandemics threaten to add to their number, this conversation is crucial for the well-being of patients and providers. This presentation will cover what epistemic injustice is and how it can be applied to the politics of the doctor-patient interaction on a micro level and the politics of the healthcare system more broadly. Contested illnesses will be explored in terms of how the “contested” label causes the patient to experience disease stigma and lowers their credibility in healthcare and across other aspects of life. This will be explored in tandem with a discussion of existing identity-based prejudice in the healthcare system and how social identities (such as those of gender, race, and socioeconomic status) intersect with the contested illness label. The effects of epistemic injustice, which include worsening patients’ symptoms of mental health and potentially disenfranchising them from the healthcare system altogether, will be presented alongside the potential ethical quandaries this poses for providers. Finally, issues with the way healthcare appointments and the modern NHS function will be explored in terms of epistemic injustice and solutions to improve doctor-patient communication and patient care will be discussed. The relationship between contested illness patients and healthcare providers is notoriously poor, and while this can mean frustration or feelings of unfulfillment in providers, the negative effects for patients are much more severe. The purpose of this research, then, is to highlight these issues and suggest ways in which to improve the healthcare experience for these patients, along with improving doctor-patient communication and mending the doctor-patient relationship in a tangible and realistic way. This research also aims to provoke important conversations about belief and hierarchy in medical settings and how these aspects intersect with identity prejudices.

Keywords: epistemic injustice, fibromyalgia, contested illnesses, chronic illnesses, doctor-patient relationships, philosophy of medicine

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Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

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Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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Authors: Palak V. Patel, Jessica Pixley, Steven R. Feldman

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Introduction: Basal cell carcinoma (BCC) is the most common skin cancer worldwide and requires substantial resources to treat. When choosing between indicated therapies, providers consider their associated adverse effects, efficacy, cosmesis, and function preservation. The patient’s tumor burden, infiltrative risk, and risk of tumor recurrence are also considered. Treatment cost is often left out of these discussions. This can lead to financial toxicity, which describes the harm and quality of life reductions inflicted by high care costs. Methods: We studied the guidelines set forth by the American Academy of Dermatology for the treatment of BCC. A PubMed literature search was conducted to identify the costs of each recommended therapy. We discuss costs alongside treatment efficacy and side-effect profile. Results: Surgical treatment for BCC can be cost-effective if the appropriate treatment is selected for the presenting tumor. Curettage and electrodesiccation can be used in low-grade, low-recurrence tumors in aesthetically unimportant areas. The benefits of cost-conscious care are not likely to be outweighed by the risks of poor cosmesis or tumor return ($471 BCC of the cheek). When tumor burden is limited, MMS offers better cure rates and lower recurrence rates than surgical excision, and with comparable costs (MMS $1263; SE $949). Surgical excision with permanent sections may be indicated when tumor burden is more extensive or if molecular testing is necessary. The utility of surgical excision with frozen sections, which costs substantially more than MMS without comparable outcomes, is less clear (SE with frozen sections $2334-$3085). Less data exists on non-surgical treatments for BCC. These techniques cost less, but recurrence-risk is high. Side-effects of nonsurgical treatment are limited to local skin reactions, and cosmesis is good. Cryotherapy, 5-FU, and MAL-PDT are all more affordable than surgery, but high recurrence rates increase risk of secondary financial and psychosocial burden (recurrence rates 21-39%; cost $100-270). Radiation therapy offers better clearance rates than other nonsurgical treatments but is associated with similar recurrence rates and a significantly larger financial burden ($2591-$3460 BCC of the cheek). Treatments for advanced or metastatic BCC are extremely costly, but few patients require their use, and the societal cost burden remains low. Vismodegib and sonidegib have good response rates but substantial side effects, and therapy should be combined with multidisciplinary care and palliative measures. Expert-review has found sonidegib to be the less expensive and more efficacious option (vismodegib $128,358; sonidegib $122,579). Platinum therapy, while not FDA-approved, is also effective but expensive (~91,435). Immunotherapy offers a new line of treatment in patients intolerant of hedgehog inhibitors ($683,061). Conclusion: Dermatologists working within resource-compressed practices and with resource-limited patients must prudently manage the healthcare dollar. Surgical therapies for BCC offer the lowest risk of recurrence at the most reasonable cost. Non-surgical therapies are more affordable, but high recurrence rates increase the risk of secondary financial and psychosocial burdens. Treatments for advanced BCC are incredibly costly, but the low incidence means the overall cost to the system is low.

Keywords: nonmelanoma skin cancer, basal cell skin cancer, squamous cell skin cancer, cost of care

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Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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