Search results for: Provider router

Authors: Mohamed F. Othman

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Manchester, Britain has become the destination of immigrants from different parts of the world. As a result, it is currently home to over 150 different ethnic languages. The present study investigates minority language policy and planning at the micro-level of the city. In order to get an in-depth investigation of such a policy, it was decided to cover it from two angles: the first is the policy making process. This was aimed at getting insights on how decisions regarding the provision of government services in minority languages are taken and what criteria are employed. The second angle is the service provider; i.e. the different departments in Manchester City Council (MCC), the NHS, the courts, and police, etc., to obtain information on the actual provisions of services. Data was collected through semi-structured interviews with different personnel representing different departments in MCC, solicitors, interpreters, etc.; through the internet, e.g. the websites of MCC, NHS, courts, and police, etc.; and via personal observation of provisions of community languages in government services. The results show that Manchester’s language policy is formulated around two concepts that work simultaneously: one is concerned with providing services in community languages in order to help minorities manage their life until they acquire English, and the other with helping the integration of minorities through encouraging them to learn English. In this regard, different government services are provided in community languages, though to varying degrees, depending on the numerical strength of each individual language. Thus, it is concluded that there is awareness in MCC and other government agencies working in Manchester of the linguistic diversity of the city and there are serious attempts to meet this diversity in their services. It is worth mentioning here that providing such services in minority languages are not meant to support linguistic diversity, but rather to maintain the legal right to equal opportunities among the residents of Manchester and to avoid any misunderstanding that may result due to the language barrier, especially in such areas as hospitals, courts, and police. There is actually no explicitly-mentioned language policy regarding minorities in Manchester; rather, there is an implied or covert policy resulting from factors that are not explicitly documented. That is, there are guidelines from the central government, which emphasize the principle of equal opportunities; then the implementation of such guidelines requires providing services in the different ethnic languages.

Keywords: community language, covert language policy, micro-language policy and planning, minority language

Procedia PDF Downloads 249

Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

Procedia PDF Downloads 48

Authors: Teerapong Lorchitamnuay, Thirarut Worapishet

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In the present digital age, today's customers explore various channels before finalizing a purchase, with abundant options and information at their disposal. Despite this, there is a strong digital interconnectedness. With just a few mouse clicks, customers can gather comprehensive information about a product, free from the influence of a salesperson. Salespeople must embrace cutting-edge technology to truly redefine the essence of selling if they are to thrive in this digital era. The significance of customer-salesperson communication in companies is becoming increasingly evident. It prompts the inquiry of how companies can modify or reshape their sales teams' approaches to effectively respond to evolving customer preferences and effectively manage external shifts, all in pursuit of sustaining and expanding their enterprises. Research highlights that digital and intercultural skills are the latest competencies sought by customers from salespeople in today's fast-paced world prior to making purchases of products and services. This study seeks to examine the pivotal influences of these salesperson skills in achieving customer satisfaction. The research design encompasses the analysis of descriptive statistics and quantitative data through a regression model. Data were gathered from an online convenience survey involving 260 respondents who are customers of an air express service provider in Thailand and who engage with salespeople in a traditional manner. The findings underscore that intercultural skills have a substantial impact on customer satisfaction in the digital era, particularly concerning adaptability, foreign language proficiency, active listening, and empathy skills. Organizations should focus on nurturing beneficial habits among their salespeople; since it signifies this effort, it should extend beyond just the frontline but should extend to encompass backline units and high-level management, ensuring that everyone possesses the same customer-oriented skills. The conclusions drawn from this research provide valuable insights, affirming that digital and intercultural skills can empower organizations to optimize their workforce's competencies, thereby achieving customer satisfaction in the digital age.

Keywords: customer behavior, customer satisfaction, digital era, digital skill, intercultural skill

Procedia PDF Downloads 56

Authors: Srećko Favro, Dora Mužinić

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The eastern coast of the Adriatic Sea has been a significant part of the most important traffic corridors since Antiquity due to its position as the deepest indented bay of the Mediterranean and numerous bays on the coast and is-lands. The central place throughout history was occupied by the central part - Split-Dalmatia County, with its center in Antica in Salona and later in Split. Nowadays, in addition to its traffic and economic importance, this area is also important for tourism, an area where Croatia develops its economy and realizing its economic growth. Nautical tourism is the most important form of the tourist economic sector that uses the geographical features of the Croatian Adriatic water area and achieves the greatest growth based on tour-ist trends in the world (coronavirus - separation from the masses, adventure tourism - own arrangements) and thus opens up the possibility of develop-ment for other parts of the tourist economy. This will be described in the ex-ample of the business of the Split-Dalmatia County shipping company from Krilo Jesenice, which operates as a mini-cruising service provider, the lead-ing form of cruising in Croatia. The advantages that this type of tourism provides to travelers in terms of customized itineraries, high-quality services, an intimate atmosphere, and a unique experience through familiarization with local culture and tradition will be considered. Through direct primary research and analysis of available secondary research data, an attempt will be made to show how traditional Croatian mini cruisers manage to stand out in a competitive tourist environment. Their impact on the local economy, sus-tainability, and environmental protection will be considered, as well as how they are integrated into the tourist offer of other destinations in Croatia. In addition, the challenges and opportunities that arise in the maintenance and development of traditional Croatian mini cruisers will be discussed, includ-ing issues such as infrastructure, staff training, and market trends.

Keywords: croatia, adriatic, cruising, nautical tourism, mini cruise

Procedia PDF Downloads 43

Authors: Sunethra Jayathilake, Vathsala Jayasuriya-Illesinghe, Kerstin Samarasinghe, Himani Molligoda, Rasika Perera

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In Sri Lanka, postnatal care in the state hospitals is provided by different professional categories: Midwifery trained registered nurses (MTRNs), Registered Nurses (RNs) who do not have midwifery training, doctors and midwives. Even though four professional categories provide postnatal care to mothers and newborn babies, they are not aware of their own tasks and responsibilities in postnatal care. Particularly MTRN’s role in the postnatal unit is unclear. The current study aimed to identify nurses’ (both MTRN and RNs) perception on MTRN’s tasks and responsibilities in postnatal care. This is a descriptive cross sectional study using postal survey. All nurses who were currently working in postnatal units at five selected tertiary care hospitals in the Western Province at that time were invited to participate in the study. Accordingly, the pre evaluated self-administered questionnaire was sent to 201 nurses (53 MTRNs and 148 RNs) in the study setting. The number of valid return questionnaire was 166; response rate was 83%. Respondents rated the responsibility of four professional categories: MTRN, RN, doctor and midwife whether they are 'primarily responsible', 'responsible in absence' and 'not responsible', for each of 15 postnatal (PN) tasks which were previously identified from focus group discussions with care providers during the first phase of the study. Data were analyzed using SPSS version 20; descriptive statistics were calculated. Out of the 15 PN tasks, 13 were identified as MTRNs’ primary responsibilities by 71%-93% of respondents. The respondents also considered six (6) tasks out of 15 as primary responsibility of both MTRN and RN, seven (7) tasks as primary responsibility of MTRN, RN and doctor and the remaining two (2) tasks were identified as the primary responsibility of MTRN, RN and midwife. All 15 PN tasks overlapped with other professional categories. Overlapping tasks may create role confusion leading to conflicts among professional categories which affect the quality of care they provide, eventually, threaten the safety of the client. It is recommended that an official job description for each care provider is needed to recognize their own professional boundaries for ensuring safe, quality care delivery in Sri Lanka.

Keywords: overlapping, postnatal, responsibilities, tasks

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Authors: Medani Prasad Rijal

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Forest itself is a factory as well as product. It supplies tangible and intangible goods and services. It supplies timber, fuel wood, fodder, grass leaf litter as well as non timber edible goods and medicinal and aromatic products additionally provides environmental services. These environmental services are of local, national or even global importance. In Nepal, more than 19 thousands community forests are providing environmental service in less economic benefit than actual efficiency. There is a risk of cost of management of those forest exceeds benefits and forests get converted to open access resources in future. Most of the environmental goods and services do not have markets which mean no prices at which they are available to the consumers, therefore the valuation of these services goods and services establishment of paying mechanism for such services and insure the benefit to community is more relevant in local as well as global scale. There are few examples of carbon trading in domestic level to meet the country wide emission goal. In this contest, the study aims to explore the public attitude towards carbon offsetting and their responsibility over service providers. This study helps in promotion of environment service awareness among general people, service provider and community forest. The research helps to unveil the carbon pool scenario in community forest and willingness to pay for carbon offsetting of people who are consuming more energy than general people and emitting relatively more carbon in atmosphere. The study has assessed the carbon pool status in two community forest and valuated carbon service from community forest through willingness to pay in Dharan municipality situated in eastern. In the study, in two community forests carbon pools were assessed following the guideline “Forest Carbon Inventory Guideline 2010” prescribed by Ministry of Forest and soil Conservation, Nepal. Final outcomes of analysis in intensively managed area of Hokse CF recorded as 103.58 tons C /ha with 6173.30 tons carbon stock. Similarly in Hariyali CF carbon density was recorded 251.72 mg C /ha. The total carbon stock of intensively managed blocks in Hariyali CF is 35839.62 tons carbon.

Keywords: carbon, offsetting, sequestration, valuation, willingness to pay

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Authors: Sitti Rahmawati

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Payment system of cataract surgery implemented by professional attendant of doctor and nurse has been increasing, through health insurance program and this has become one of the factors that affects a lot of government in the budget establishment. This system has been implemented in purpose of quality and expenditure control, i.e., controlling health overpayment to obtain benefit (moral hazard) by the user of insurance or health service provider. The increasing health cost becomes the main issue that hampers the society to receive required health service in cash payment-system. One of the efforts that should be taken by the government in health payment is by securing health insurance through society's health insurance. The objective of the study is to learn the capability of a patient to pay cataract eye operation for the elders. Method of study sample population in this study was patients who obtain health insurance board card for the society that was started in the first of tri-semester (January-March) 2015 and claimed in Indonesian software-Case Based Group as a purposive sampling of 40 patients. Results of the study show that total unit cost analysis of surgery service unit was obtained $75 for unit cost without AFC and salary of nurse and doctor. The operation tariff that has been implemented today at Anutapura hospitals in eye department is tariff without AFC and the salary of the employee is $80. The operation tariff of the unit cost calculation with double distribution model at $65. Conclusion, the calculation result of actual unit cost that is much greater causes incentive distribution system provided to an ophthalmologist at $37 and nurse at $20 for one operation. The surgery service tariff is still low; consequently, the hospital receives low revenue and the quality of health insurance in eye operation department is relatively low. In purpose of increasing the service quality, it requires adequately high cost to equip medical equipment and increase the number of professional health attendant in serving patients in cataract eye operation at hospital.

Keywords: economic evaluation, cataract operation, health attendant, health insurance system

Procedia PDF Downloads 142

Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool

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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.

Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis

Procedia PDF Downloads 111

Authors: Marybec Griffin

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Purpose: The purpose of this cross-sectional study was to get a better understanding of healthcare usage and satisfaction among young adult gay men (YAGM), including the facility used as the usual source of healthcare, preference for coordinated healthcare, and if their primary care provider (PCP) adequately addressed the health needs of gay men. Methods: Interviews were conducted among n=800 YAGM in New York City (NYC). Participants were surveyed about their sociodemographic characteristics and healthcare usage and satisfaction access using multivariable logistic regression models. The surveys were conducted between November 2015 and June 2016. Results: The mean age of the sample was 24.22 years old (SD=4.26). The racial and ethnic background of the participants is as follows: 35.8% (n=286) Black Non-Hispanic, 31.9% (n=225) Hispanic/Latino, 20.5% (n=164) White Non-Hispanic, 4.4% (n=35) Asian/Pacific Islander, and 6.9% (n=55) reporting some other racial or ethnic background. 31.1% (n=249) of the sample had an income below $14,999. 86.7% (n=694) report having either public or private health insurance. For usual source of healthcare, 44.6% (n=357) of the sample reported a private doctor’s office, 16.3% (n=130) reported a community health center, and 7.4% (n=59) reported an urgent care facility, and 7.6% (n=61) reported not having a usual source of healthcare. 56.4% (n=451) of the sample indicated a preference for coordinated healthcare. 54% (n=334) of the sample were very satisfied with their healthcare. Findings from multivariable logistical regression models indicate that participants with higher incomes (AOR=0.54, 95% CI 0.36-0.81, p < 0.01) and participants with a PCP (AOR=0.12, 95% CI 0.07-0.20, p < 0.001) were less likely to use a walk-in facility as their usual source of healthcare. Results from the second multivariable logistic regression model indicated that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare (AOR=0.63, 95% CI 0.42-0.96, p < 0.05). In the final multivariable logistic model, results indicated that participants who had disclosed their sexual orientation to their PCP (AOR=2.57, 95% CI 1.25-5.21, p < 0.01) and were comfortable discussing their sexual activity with their PCP (AOR=8.04, 95% CI 4.76-13.58, p < 0.001) were more likely to agree that their PCP adequately addressed the healthcare needs of gay men. Conclusion: Understanding healthcare usage and satisfaction among YAGM is necessary as the healthcare landscape changes, especially given the relatively recent addition of urgent care facilities. The type of healthcare facility used as a usual source of care influences the ability to seek comprehensive and coordinated healthcare services. While coordinated primary and sexual healthcare may be ideal, individual preference for this coordination among YAGM is desired but may be limited due to experiences of discrimination in primary care settings.

Keywords: healthcare policy, gay men, healthcare access, Affordable Care Act

Procedia PDF Downloads 207

Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

Procedia PDF Downloads 169

Authors: Kgabo H. Badimo, Sheryl Buckley

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Knowledge is increasingly recognised in this, the knowledge era, as a strategic resource, by public sector organisations, in view of the public sector reform initiatives. People and knowledge play a vital role in attaining improved organisational performance and high service quality. Many government departments in the public sector have started to realise the importance of knowledge management in streamlining their operations and processes. This study focused on knowledge management in the public healthcare service organisations, where the concept of service provider competitiveness pales to insignificance, considering the huge challenges emanating from the healthcare and public sector reforms. Many government departments are faced with challenges of improving organisational performance and service delivery, improving accountability, making informed decisions, capturing the knowledge of the aging workforce, and enhancing partnerships with stakeholders. The purpose of this paper is to examine the knowledge management practices of the Gauteng Department of Health in South Africa, in order to understand how knowledge management practices influence improvement in organisational performance and healthcare service delivery. This issue is explored through a review of literature on dominant views on knowledge management and healthcare service delivery, as well as results of interviews with, and questionnaire responses from, the general staff of the Gauteng Department of Health. Web-based questionnaires, face-to-face interviews and organisational documents were used to collect data. The data were analysed using both the quantitative and qualitative methods. The central question investigated was: To what extent can the conditions required for successful knowledge management be observed, in order to improve organisational performance and healthcare service delivery in the Gauteng Department of Health. The findings showed that the elements of knowledge management capabilities investigated in this study, namely knowledge creation, knowledge sharing and knowledge application, have a positive, significant relationship with all measures of organisational performance and healthcare service delivery. These findings thus indicate that by employing knowledge management principles, the Gauteng Department of Health could improve its ability to achieve its operational goals and objectives, and solve organisational and healthcare challenges, thereby improving organisational.

Keywords: knowledge management, Healthcare Service Delivery, public healthcare, public sector

Procedia PDF Downloads 237

Authors: Nor Azlina A. Rahman, Jamaliah Said, Salwana Hassan

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Prompt changes in global business environment, such as passionate competition, managerial/operational, changing governmental regulation and innovation in technology have significant impacts on the organizations. At present, global business environment demands for more proactive institutions on microfinance to provide an opportunity for the business success. Microfinance providers in Malaysia still accelerate its activities of funding by cash and cheque. These institutions are at high risk as the paper-based system is deemed to be slow and prone to human error, as well as requiring a major annual reconciliation process. The global transformation of financial services, growing involvement of technology, innovation and new business activities had progressively made risk management profile to be more subjective and diversified. The persistent, complex and dynamic nature of risk management activities in the institutions arise due to highly automated advancements of technology. This may thus manifest in a variety of ways throughout the financial services sector. This study seeks out to examine current operational risks management being experienced by microfinance providers in Malaysia; investigate the process of current practices on facilitator control factor mechanisms, and explore how the adoption of technology, innovation and use of management accounting practices would affect the risk management process of operation system in microfinance providers in Malaysia. A case study method was employed in this study. The case study also need to find that the vital past role of management accounting will be used for mitigation of risk management activities towards accountability as an information or guideline to microfinance provider. An empirical element obtainable with qualitative method is needed in this study, where multipart and in-depth information are essential to understand the issues of these institution phenomena. This study is expected to propose a theoretical model for implementation of technology, innovation and management accounting practices into the system of operation to improve internal control and subsequently lead to mitigation of risk management activities among microfinance providers to be more successful.

Keywords: microfinance, accountability, operational risks, management accounting practices

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Authors: Yuen Man Yan

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Peer support has been a rising prevalent mental health service in the globe. The community-based mental health services employ persons with lived experience of mental illness to be peer support workers (PSWs) to provide peer support service to those who are in the progress of recovery (PIRs). It represents the transformation of mental health service system to a recovery-oriented and person-centered care. Literatures proved the feasibility and effectiveness of the peer support service. Researchers have attempted to explore the unique good qualities of peer support service that benefit the PIRs. Empirical researches found that the strength of the relationship between those who sought for change and the change agents positively related to the outcomes in one-to-one therapies across theoretical orientations. However, there is lack of literature on investigating the relationship building between the PSWs and PIRs in the one-to-one community-based peer support service. This study aims to identify and characterise the relationship in the community-based one-to-one peer support service from the perspectives of PSWs and PIRs; and to conceptualize the components of relationship building between PSWs and PIRs in the community-based one-to-one peer support service. The study adopted the constructivist grounded theory approach. 10 pairs of the PSWs and PIRs participated in the study. Data were collected through multiple qualitative methods, including observation of the interaction and exchange of the PSWs and PIRs in the 1ₛₜ, 3ᵣ𝒹 and 9th sessions of the community-based one-to-one peer support service; and semi-structural interview with the PSWs and PIRs separately after the 3ᵣ𝒹and 9ₜₕ session of the peer support service. This presentation is going to report the preliminary findings of the study. PSWs and PIRs identified their relationship as “life alliance”. Empathy was found to be one of key components of the relationship between the PSWs and the PIRs. Unlike the empathy, as explained by Carl Roger, in which the service provider was able to put themselves into the shoes of the service recipients as if he was the service recipients, the intensity of the empathy was much greater in the relationship between PSWs and PIRs because PSWs had the lived experience of mental illness and recovery. The dimensions of the empathy in the relationship between PSWs and PIRs was found to be multiple, not only related to the mental illness but also related to various aspects in life, like family relationship, employment, interest of life, self-esteem and etc.

Keywords: person with lived experience, peer support worker, peer support service, relationship building, therapeutic alliance, community-based mental health setting

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Authors: Tonya P. Bowers

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Background: The community/patient-focused quality improvement (QI) project has resolved a clinical problem using a quantitative design evaluating behavior change practices in a convenience sample from a multi-cultural congregation in a faith-based setting. AD is a legal document that speaks for the patient when they are unable to speak for themselves. The AD provides detailed information regarding critical medical decisions on behalf of the patient if they’re unable to make decisions themselves. The goal of an AD is to improve EOL care renderings that align with the patient’s desires. The AD diminishes anxiety and stress associated with making difficult EOL care decisions for patients and their families. Method: The project has two intervention strategies: pre-intervention and post-intervention formative surveys and a final summative survey. Most of the data collection takes place during implementation. The Let’s Talk About It Program utilized an online meeting platform for presentation. Participants were asked to complete informed consent and surveys via an online portal. Education included slide presentation, Advance Directive demonstration, video clips, discussions and 1:1 assistance with AD completion with a project manager. Results: Considering the overwhelming likelihood responses where 87.5% identified they “definitely would” hold an End-Of-Life conversation with their healthcare provider or family, and 81.25% indicated their likelihood that they “definitely would” complete an advance directive. In addition, the final summative post-intervention survey (n-14) also demonstrated an overwhelming 93% positive response. Which undoubtedly demonstrates favorable outcomes for the project. Conclusion: the Let’s Talk About It Program demonstrated effectiveness in improving participants' attitudes and acceptance towards Advance Directives and expanding End-of-Life care discussions. Emphasis on program sustainment within the church is imperative in fostering continued awareness and improved health outcomes for the local community with low health literacy.

Keywords: advance directive, end of life, advance care planning, palliative care, low health literacy, faith-based

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Authors: Lorho Mary Maheo, Arundhati Maibam Devi

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Background: Maternal and child health (MCH) cares are the health services provided to mothers and children. It includes the health promotion, preventive, curative and rehabilitation health care for mothers and children. Materials and method: The present study sample comprises of 208 women within the age range 15-69 years from two remote villages of Tamenglong District in Manipur. They were randomly chosen for assessing their health as well as the child’s health adopting an interview schedule method. Results: The findings of the study revealed that majority (80%) of the women have their first conception in their first year of married life. A decadal change has been observed with regard to the last pregnancy i.e., antenatal check-up, place of delivery as well as the service provider. However, irrespective of age of the women, home delivery is still preferred though very few are locally trained. Pre- and post-delivery resting period vary depending on the busy schedule of the agricultural works as the population under study is basically agriculturist. Postnatal care remains to be traditional as they are strongly associated with cultural beliefs and practices that continue to prevail in the studied community. Breast feeding practices such as colostrums given, initiation of breastfeeding, weaning was all taken into account.  Immunization of children has not reached the expected target owing to a variety of reasons. Maternal health care also includes use of birth control measures. The health status of women would invariably improve if family planning is meaningfully adopted. Only 10.1% of the women adopted the modern birth control implying its deep-rooted value attached to the children. Based on the self-assessment report on their health treatment a good number of the respondents resorted to self-medication even to the extent of buying allopathic medicine without a doctor’s prescription. One important finding from the study is the importance attributed to the traditional health care system which is easily affordable and accessible to the villagers. Conclusion: The overall condition of maternal and child care is way behind till now as no adequate/proper health services are available.

Keywords: antenatal, breastfeeding, child health, maternal, Tamenglong District

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Authors: Veronica S. Moertini, Vinsensius Kevin, Gede Karya

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Customer reviews have been collected by many kinds of e-commerce websites selling products, services, hotel rooms, tickets and so on. Each website collects its own customer reviews. The reviews can be crawled, collected from those websites and stored as big data. Text analysis techniques can be used to analyze that data to produce summarized information, such as customer opinions. Then, these opinions can be published by independent service provider websites and used to help customers in choosing the most suitable products or services. As the opinions are analyzed from big data of reviews originated from many websites, it is expected that the results are more trusted and accurate. Indonesian customers write reviews in Indonesian language, which comes with its own structures and uniqueness. We found that most of the reviews are expressed with “daily language”, which is informal, do not follow the correct grammar, have many abbreviations and slangs or non-formal words. Hadoop is an emerging platform aimed for storing and analyzing big data in distributed systems. A Hadoop cluster consists of master and slave nodes/computers operated in a network. Hadoop comes with distributed file system (HDFS) and MapReduce framework for supporting parallel computation. However, MapReduce has weakness (i.e. inefficient) for iterative computations, specifically, the cost of reading/writing data (I/O cost) is high. Given this fact, we conclude that MapReduce function is best adapted for “one-pass” computation. In this research, we develop an efficient technique for extracting or mining opinions from big data of Indonesian reviews, which is based on MapReduce with one-pass computation. In designing the algorithm, we avoid iterative computation and instead adopt a “look up table” technique. The stages of the proposed technique are: (1) Crawling the data reviews from websites; (2) cleaning and finding root words from the raw reviews; (3) computing the frequency of the meaningful opinion words; (4) analyzing customers sentiments towards defined objects. The experiments for evaluating the performance of the technique were conducted on a Hadoop cluster with 14 slave nodes. The results show that the proposed technique (stage 2 to 4) discovers useful opinions, is capable of processing big data efficiently and scalable.

Keywords: big data analysis, Hadoop MapReduce, analyzing text data, mining Indonesian reviews

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Authors: Roghieh A. Biroon, Zoleikha Abdollahi

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The recent growth of renewables, e.g., solar panels, batteries, and electric vehicles (EVs) in residential and small commercial sectors, has potential impacts on the stability and operation of power grids. Considering approximately 50 percent share of the residential and the commercial sectors in the electricity demand market, the significance of these impacts, and the necessity of addressing them are more highlighted. Utilities and power system operators should manage the renewable electricity sources integration with power systems in such a way to extract the most possible advantages for the power systems. The most common effect of high penetration level of the renewables is the reverse power flow in the distribution feeders when the customers generate more power than their needs. The reverse power flow causes voltage rise and thermal issues in the power grids. To overcome the voltage rise issues in the distribution system, several techniques have been proposed including reducing transformers short circuit resistance and feeder impedance, installing autotransformers/voltage regulators along the line, absorbing the reactive power by distributed generators (DGs), and limiting the PV and battery sizes. In this study, we consider a medium-scale battery energy storage to manage the power energy and address the aforementioned issues on voltage deviation and power loss increase. We propose an optimization algorithm to find the optimum size and location for the battery. The optimization for the battery location and size is so that the battery maintains the feeder voltage deviation and power loss at a certain desired level. Moreover, the proposed optimization algorithm controls the charging/discharging profile of the battery to absorb the negative power flow from residential and commercial customers in the feeder during the peak time and sell the power back to the system during the off-peak time. The proposed battery regulates the voltage problem in the distribution system while it also can play frequency regulation role in islanded microgrids. This battery can be regulated and controlled by the utilities or a third-party ancillary service provider for the utilities to reduce the power system loss and regulate the distribution feeder voltage and frequency in standard level.

Keywords: ancillary services, battery, distribution system and optimization

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Authors: Rina Arum Prastyanti

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Information technology has changed the ways of transacting and enabling new opportunities in business transactions. Problems to be faced by consumers M Commerce, among others, the consumer will have difficulty accessing the full information about the products on offer and the forms of transactions given the small screen and limited storage capacity, the need to protect children from various forms of excess supply and usage as well as errors in access and disseminate personal data, not to mention the more complex problems as well as problems agreements, dispute resolution that can protect consumers and assurance of security of personal data. It is no less important is the risk of payment and personal information of payment dal am also an important issue that should be on the swatch solution. The purpose of this study is 1) to describe the phenomenon of the use of Mobile Commerce in Indonesia. 2) To determine the form of legal protection for the consumer use of Mobile Commerce. 3) To get the right type of law so as to provide legal protection for consumers Mobile Commerce users. This research is a descriptive qualitative research. Primary and secondary data sources. This research is a normative law. Engineering conducted engineering research library collection or library research. The analysis technique used is deductive analysis techniques. Growing mobile technology and more affordable prices as well as low rates of provider competition also affects the increasing number of mobile users, Indonesia is placed into 4 HP users in the world, the number of mobile phones in Indonesia is estimated at around 250.1 million telephones with a population of 237 556. 363. Indonesian form of legal protection in the use of mobile commerce still a part of the Law No. 11 of 2008 on Information and Electronic Transactions and until now there is no rule of law that specifically regulates mobile commerce. Legal protection model that can be applied to protect consumers of mobile commerce users ensuring that consumers get information about potential security and privacy challenges they may face in m commerce and measures that can be used to limit the risk. Encourage the development of security measures and built security features. To encourage mobile operators to implement data security policies and measures to prevent unauthorized transactions. Provide appropriate methods both time and effectiveness of redress when consumers suffer financial loss.

Keywords: mobile commerce, legal protection, consumer, effectiveness

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Authors: Jean Ross

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Rural nursing is not an identified professional identity in the UK, unlike the USA, Canada, and Australia which recognizes rural nursing as a specialty scope of practice. In New Zealand rural nursing is an underrepresented aspect of nursing practice, is misunderstood and does not fit easily within the wider nursing profession and policies governing practice. This study situated within the New Zealand context adds to the international studies’ aligned with rural nursing practice. The study addresses a gap in the literature by striving to identify and strengthen the awareness of and increase rural nurses’ understanding and articulation of their changing and adapting identity and furthermore an opportunity to appreciate their contribution to the delivery of rural health care. In addition, this study adds to the growing global rural nursing knowledge and theoretical base. This research is a continuation of the author’s academic involvement and ongoing relationships with the rural nursing sector, national policy analysts and health care planners since the 1990s. These relationships have led to awareness, that despite rural nurses’ efforts to explain the particular nuances which make up their practice, there has been little recognition by profession to establish rural nursing as a specialty. The research explored why nurses’ who practiced in the rural Otago region of New Zealand, between the 1990s and early 2000s moved away from the traditional identity as a district, practice or public health nurse and looked towards a more appropriate identity which reflected their emerging practice. This qualitative research situated within the interpretive paradigm embeds this retrospective study within the discipline of nursing and engages with the concepts of place and governmentality. National key informant and Otago regional rural nurse interviews generated data and were analyzed using thematic analysis. Stemming from the analyses, an analytical diagrammatic matrix was developed demonstrating rural nursing as a ‘place–based practice’ governed both from within and beyond location presenting how the nurse aligns the self in the rural community as a meaningful provider of health care. Promoting this matrix may encourage a focal discussion point within the international spectrum of nursing and likewise between rural and non-rural nurses which it is hoped will generate further debate in relation to the different nuances aligned with rural nursing practice. Further, insights from this paper may capture key aspects and issues related to identity formation in respect to rural nurses, from the UK, New Zealand, Canada, USA, and Australia.

Keywords: matrix, place, nursing, rural

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Authors: Zena F. Mushtaq, Iqbal M. Abbas

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Background: Diabetes mellitus during pregnancy is one of the major medical and social problems with increasing prevalence in last decades and may lead to more vulnerable to dental problems and increased risk for periodontal diseases. Objectives: To assess oral hygiene behaviors among pregnant women with diabetes who attended primary health care centers and find out the relationship between oral hygiene behaviors and studied variables. Methodology: A cross sectional design was conducted from 7 July to 30 September 2014 on non probability (convenient sample) of 150 pregnant women with diabetes was selected from twelve Primary Health Care Centers at Baghdad city. Questionnaire format is tool for data collection which had designed and consisted of three main parts including: socio demographic, reproductive characteristics and items of oral hygiene behaviors among pregnant women with diabetes. Reliability of the questionnaire was determined through internal consistency of correlation coefficient (R= 0.940) and validity of content was determined through reviewing it by (12) experts in different specialties and was determined through pilot study. Descriptive and inferential statistics were used to analyze collected data. Result: Result of study revealed that (35.3%) of study sample was (35-39) years old with mean and SD is (X & SD = 33.57 ± 5.54) years, and (34.7%) of the study sample was graduated from primary school and less, half of the study sample was government employment and self employed, (42.7%) of the study sample had moderate socioeconomic status, the highest percentage (70.0%) of the study sample was nonsmokers, The result indicates that oral hygiene behaviors have moderate mean score in all items. There are no statistical significant association between oral hygiene domain and studied variables. Conclusions: All items related to health behavior concerning oral hygiene is in moderate mean of score, which may expose pregnant women with diabetes to high risk of periodontal diseases. Recommendations: Dental care provider should perform a dental examination at least every three months for each pregnant woman with diabetes, explanation of the effect of DM on periodontal health, oral hygiene instruction, oral prophylaxis, professional cleaning and treatment of periodontal diseases(scaling and root planing) when needed.

Keywords: diabetes, health behavior, pregnant women, oral hygiene

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Authors: Christine Eickhoff, Alyssa Adams, Alaine Duncan

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The Washington, DC Veterans Affairs Medical Center (DC VAMC) offers complementary and integrative health (CIH) services such as acupuncture, yoga, meditation, and nutrition education through a coordinated outpatient clinic. The primary population utilizing CIH services are veterans with chronic pain. Acupuncture is one of the most popular of the CIH services available at the DC VAMC. As interest and availability grows, it is important to measure health outcomes associated with CIH service utilization. The purpose of this study was to investigate pain and mental health outcomes for veterans with chronic pain enrolled in individual acupuncture services in the DC VAMC. Veterans at the DC VAMC with self-identified chronic pain and no prior acupuncture experience were recruited for the study (n=70). Veterans were referred for services by a medical provider and completed baseline assessments at the program orientation prior to participating in any CIH services. Veterans received four individual, full-body acupuncture appointments within four weeks of study enrollment. After the first month, participants were scheduled for six appointments that occurred every two weeks and then eight more sessions that were scheduled one month apart. Follow-up assessments were administered at 2, 4, 6, 8, and 12 months. The findings reported will include completed time points at two and four months. Measures include a demographics survey, the Measure Yourself Medical Outcome Profile-2 (MYMOP-2), The Beck Depression Inventory (BDI-II), the Defense Veterans Pain Rating Scale (DVPRS), and the Pain Disability Questionnaire (PDQ). In this sample, 67% identified a pain condition as their primary health concern. Between baseline and two-month follow-up, there were significant improvements in participants’ primary health concern (MYMOP-2 p=0.010), general wellbeing (MYMOP-2 p=0.011), and a significant decrease in the use of medication (MYMOP-2 p<0.000). Between 2 and 4-month follow-up, pain disability (PDQ p=0.035), pain rating (DVPRS p=0.027), and depression (BDI-II p=0.003) significantly improved. Preliminary findings indicate that individual acupuncture therapy can be effective at improving health outcomes, well-being, and decreasing medication use in U.S. military veterans with chronic pain. Findings also suggest that individual acupuncture therapy can improve pain ratings, pain disability, and depression in veterans with chronic pain.

Keywords: acupuncture, chronic pain, depression, integrative health, medication use, military, pain, veterans, wellbeing

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Authors: J. Wozniak-Holecka, T. Holecki, P. Romaniuk

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Spa facilities are being perceived as the ways of healing treatment in Poland and are guaranteed within the public financing. The universal health insurance (National Health Fund, NFZ), and the disability prevention programme held by Social Insurance Institution (ZUS) are the main sources of financing spa facilities. The dominant public payer of spa services is the NFZ. The Social Insurance Institution covers the cost of health treatment realized in spa facilities as medical rehabilitation, in the field of disability prevention. Health services delivered in the spa resorts are characterized by complexity, and the combination of various methods, typical for health prevention, education, balneotherapy, and physiotherapy. Healing with natural methods, believed to enhance the therapeutic effect, is also involved in health spa treatment. Regardless of the type of facility, each form of spa treatment includes health promotion, health education, prevention at all levels, including rehabilitation. The aim of the study was to determine the optimal organization of health education process. Its efficiency strongly depends on the type of service provider and the funding institution (NFZ vs ZUS). It results from the use of different measures of the effectiveness, the quality and the evaluation of the process being assessed by funding institutions. The methods of the study include a comparative and descriptive quantitative and qualitative analysis. In the empirical part, a questionnaire had been developed. It was then distributed among spa personnel, responsible directly for the health promotion, and among patients who are beneficiaries of health services in spa centers. The quantitative part of the study was based on interviews carried with the use of the online survey (CAWI: Computer-Assisted Web Interview), telephone survey (CATI: Computer-Assisted Telephone Interview) and a conventional questionnaire (PAPI: Paper over Pencil Interview). As a result of the conducted research, it was found that the effectiveness of health education activities in spa resort facilities in Poland is higher when the services are organized using structured tools for managerial control. This applies to formalized procedures implemented by one of the dominant payers covering costs of services (ZUS) and involves the application of health education as one of the mandatory elements of treatment, subjected to the process of control during the course of spa therapy and evaluation after it is completed.

Keywords: effectiveness, health education, public health system, spa treatment

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Authors: Torben Hansen, Lars Gronholdt, Alexander Josiassen, Anne Martensen

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Consumers often exhibit a bias in their knowledge; they often think that they know more or less than they do. The concept of 'knowledge over/underconfidence' (O/U) has in previous studies been used to investigate such knowledge bias. O/U appears as a combination of subjective and objective knowledge. Subjective knowledge relates to consumers’ perception of their knowledge, while objective knowledge relates to consumers’ absolute knowledge measured by objective standards. This separation leads to three scenarios: The consumer can either be knowledge calibrated (subjective and objective knowledge are similar), overconfident (subjective knowledge exceeds objective knowledge) or underconfident (objective knowledge exceeds subjective knowledge). Knowledge O/U is a highly useful concept in understanding consumer choice behavior. For example, knowledge overconfident individuals are likely to exaggerate their ability to make right choices, are more likely to opt out of necessary information search, spend less time to carry out a specific task than less knowledge confident consumers, and are more likely to show high financial trading volumes. Through the use of financial services as a case study, this study contributes to previous research by examining how consumer knowledge O/U affects two types of trust (broad-scope trust and narrow-scope trust) and consumer relationship satisfaction. Trust does not only concern consumer trust in individual companies (i.e., narrow.-scope confidence NST), but also concerns consumer confidence in the broader business context in which consumers plan and implement their behavior (i.e., broad scope trust, BST). NST is defined as "the expectation that the service provider can be relied on to deliver on its promises’, while BST is defined as ‘the expectation that companies within a particular business type can generally be relied on to deliver on their promises.’ This study expands our understanding of the interplay between consumer knowledge bias, consumer trust, and relationship marketing in two main ways: First, it is demonstrated that the more knowledge O/U a consumer becomes, the higher/lower NST and levels of relationship satisfaction will be. Second, it is demonstrated that BST has a negative moderating effect on the relationship between knowledge O/U and satisfaction, such that knowledge O/U has a higher positive/negative effect on relationship satisfaction when BST is low vs. high. The data for this study comprises 756 mutual fund investors. Trust is particularly important in consumers’ mutual fund behavior because mutual funds have important responsibilities in providing financial advice and in managing consumers’ funds.

Keywords: knowledge, cognitive bias, trust, customer-seller relationships, financial services

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Authors: Connie Edang, Siti Arpah Noordin, Shamila Mohamed Shuhidan

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For the past few decades, there are growing numbers of knowledge based industries in Malaysia. As competitive edge has become so important nowadays, the consideration of research and development (R&D) should be put at the highest priority. Alike other industries, HEIs are also contributors to the nation’s development and wealth. Hence, to become a hub for creating a knowledge-based society, HEIs not only responsible for producing skillful human capital, but also to get involved in R&D. With the importance of R&D in today’s modern economy and the rise of Science and Technology, it gives opportunities for researchers to explore this sector as to place Malaysia as a provider in some key strategic industries, including medical and health sciences field. Academic researchers/medical researchers possess unique tacit and skills based in accordance with their experience and professional expert areas. In completing a collaborative research work, there must be platforms to enable the conversion of their knowledge hence beneficial towards creation of new knowledge. The objectives of this study are to: i) explore the knowledge creation activities of medical researchers in the Malaysian Higher Education Institution (HEI); ii) explore the driving forces for knowledge creation activities among the researchers; and iii) explore the interpretation of medical researchers on the establishment of ‘ba’ in the creation of knowledge. Based on the SECI model was introduced by Nonaka and Takeuchi and the Japanese concept of ‘ba’, a qualitative study whereby semi structured interview was used as to gather the informants’ viewpoints and insights based on their experience capitalizing ‘ba’ to support their knowledge creation activities. A single the study was conducted at one of the HEIs located in Sabah. From this study, both face to face and the ICT-assisted tools are found to be significant to support interaction of their knowledge. ICT seems to ease their interaction with other research collaborator. However, this study revealed that interaction conducted in physical settings is still be best preferred by the medical researchers especially situations of whereby their knowledge is hard to be externalized. Moreover, it revealed that motivational factors play important roles as for driving forces affecting their knowledge creation activities. Other than that, the medical researchers addressed that the mix interaction bring forth value in terms of facilitating knowledge creation. Therefore this study would benefit the institution to highly optimize the utilization of good platform so that knowledge can be transferred and be made used by others in appropriate ways.

Keywords: ‘ba’, knowledge creation dynamics, Malaysia, higher education institution, medical researchers

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Authors: Senthil Kumar Anantharaman

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Providing telecommunications based network services in developing countries like India which has a population of 1.5 billion people, so that these services reach every individual, is one of the greatest challenges the country has been facing in its journey towards economic growth and development. With growing number of telecommunications service providers in the country, a constant challenge that has been faced by these providers is in providing not only quality but also delightful customer experience while simultaneously generating enhanced revenues and profits. Thus, the role played by process improvement methodologies like Six Sigma cannot be undermined and specifically in telecom service provider based operations, it has provided substantial benefits. Therefore, it advantages are quite comparable to its applications and advantages in other sectors like manufacturing, financial services, information technology-based services and Healthcare services. One of the key reasons that this methodology has been able to reap great benefits in telecommunications sector is that this methodology has been combined with many of its competing process improvement techniques like Theory of Constraints, Lean and Kaizen to give the maximum benefit to the service providers thereby creating a winning combination of organized process improvement methods for operational excellence thereby leading to business excellence. This paper discusses about some of the key projects and areas in the end to end ‘Quote to Cash’ process at big three Indian telecommunication companies that have been highly assisted by applying Six Sigma along with other process improvement techniques. While the telecommunication companies which we have considered, is primarily in India and run by both private operators and government based setups, the methodology can be applied equally well in any other part of developing countries around the world having similar context. This study also compares the enhanced revenues that can arise out of appropriate opportunities in emerging market scenarios, that Six Sigma as a philosophy and methodology can provide if applied with vigour and robustness. Finally, the paper also comes out with a winning framework in combining Six Sigma methodology with Kaizen, Lean and Theory of Constraints that will enhance both the top-line as well as the bottom-line while providing the customers a delightful experience.

Keywords: emerging markets, lean, process improvement, six sigma, telecommunications, theory of constraints

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Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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Authors: Shir Daphna-Tekoah, Nurit Eitan-Gutman, Uri Balla

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Background: Systemic documentation is essential in social work practice. Collaboration between an institution of higher education and social work health care services enabled adaptation of the medical documentation model of SOAP in the field of social work, by creating the ISOAPS model (Introduction, Subjective, Objective, Assessment, Plan, Summary) model. Aims: The article describes the ISOAPS model and its implementation in the field of social work, as a tool for standardization of documentation and the enhancement of multidisciplinary collaboration. Methods: We examined the changes in standardization using a mixed methods study, both before and after implementation of the model. A review of social workers’ documentation was carried out by medical staff and social workers in the Clalit Healthcare Services, the largest provider of public and semi-private health services in Israel. After implementation of the model, semi-structured qualitative interviews were undertaken. Main findings: The percentage of reviewers who evaluated their documentation as correct increased from 46%, prior to implementation, to 61% after implementation. After implementation, 81% of the social workers noted that their documentation had become standardized. The training process prepared them for the change in documentation and most of them (83%) started using the model on a regular basis. The qualitative data indicate that the use of the ISOAPS model creates uniform documentation, improves standards and is important to teach social work students. Conclusions: The ISOAPS model standardizes documentation and promotes communication between social workers and medical staffs. Implications for practice: In the intricate realm of healthcare, efficient documentation systems are pivotal to ensuring coherent interdisciplinary communication and patient care. The ISOAPS model emerges as a quintessential instrument, meticulously tailored to the nuances of social work documentation. While it extends its utility across the broad spectrum of social work, its specificity is most pronounced in the medical domain. This model not only exemplifies rigorous academic and professional standards but also serves as a testament to the potential of contextualized documentation systems in elevating the overall stature of social work within healthcare. Such a strategic documentation tool can not only streamline the intricate processes inherent in medical social work but also underscore the indispensable role that social workers play in the broader healthcare ecosystem.

Keywords: ISOAPS, professional documentation, medial social-work, social work

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: Noreen Pulte

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Prior to the 'Back to Sleep' Campaign in 1992, 1 of every 300 infants seen by Advanced Practice Providers had plagiocephaly. Insufficient attention is given to plagiocephaly and brachycephaly diagnoses in practice and pediatric education. In this talk, Nurse Practitioners and Pediatric Providers will be able to: (1) identify red flags associated with head shape abnormalities, (2) learn techniques they can teach parents to prevent head shape abnormalities, and (3) differentiate between plagiocephaly, brachycephaly, and craniosynostosis. The presenter is a Primary Care Pediatric Nurse Practitioner at Ann & Robert H. Lurie Children's Hospital of Chicago and the primary provider for its head shape abnormality clinics. She will help participants translate key information obtained from birth history, review of systems, and developmental history to understand risk factors for head shape abnormalities and progression of deformities. Synostotic and non-synostotic head shapes will be explained to help participants differentiate plagiocephaly and brachycephaly from synostotic head shapes. This knowledge is critical for the prompt referral of infants with craniosynostosis for surgical evaluation and correction. Rapid referral for craniosynostosis can possibly direct the patient to a minimally invasive surgical procedure versus a craniectomy. As for plagiocephaly and brachycephaly, this timely referral can also aid in a physical therapy referral if necessitated, which treats torticollis and aids in improving head shape. A well-timed referral to a head shape clinic can possibly eliminate the need for a helmet and/or minimize the time in a helmet. Practitioners will learn the importance of obtaining head measurements using calipers. The presenter will explain head calculations and how the calculations are interpreted to determine the severity of the head shape abnormalities. Severity defines the treatment plan. Participants will learn when to refer patients to a head shape abnormality clinic and techniques they should teach parents to perform while waiting for the referral appointment. The purpose, mechanics, and logistics of helmet therapy, including optimal time to initiate helmet therapy, recommended helmet wear-time, and tips for helmet therapy compliance, will be described. Case scenarios will be incorporated into the presenter's presentation to support learning. The salient points of the case studies will be explained and discussed. Practitioners will be able to immediately translate the knowledge and skills gained in this presentation into their clinical practice.

Keywords: plagiocephaly, brachycephaly, craniosynostosis, red flags

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Authors: Aisha Giwa, Mohammed-Faosy Adeniran, Olufunke Femi-Ojo

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Four decades ago, the World Health Organization (WHO) launched the Expanded Programme on Immunization (EPI). The EPI blueprint laid out the technical and managerial functions necessary to routinely vaccinate children with a limited number of vaccines, providing protection against diphtheria, tetanus, whooping cough, measles, polio, and tuberculosis, and to prevent maternal and neonatal tetanus by vaccinating women of childbearing age with tetanus toxoid. Despite global efforts, the Routine Immunization (RI) coverage in two of the World Health Organization (WHO) regions; the African Region and the South-East Asia Region, still remains short of its targets. As a result, the WHO Regional Director for Africa declared 2012 as the year for intensifying RI in these regions and this also coincided with the declaration of polio as a programmatic emergency by the WHO Executive Board. In order to intensify routine immunization, the National Routine Immunization Strategic Plan (2013-2015) stated that its core priority is to ensure 100% adequacy and availability of vaccines for safe immunization. To achieve 100% availability, the “PUSH System” and then “Push-Plus” were adopted for vaccine distribution, which replaced the inefficient “PULL” method. The NPHCDA plays the key role in coordinating activities in area advocacy, capacity building, engagement of 3PL for the state as well as monitoring and evaluation of the vaccine delivery process. eHealth Africa (eHA) is a player as a 3PL service provider engaged by State Primary Health Care Boards (SPHCDB) to ensure vaccine availability through Vaccine Direct Delivery (VDD) project which is essential to successful routine immunization services. The VDD project ensures the availability and adequate supply of high-quality vaccines and immunization-related materials to last-mile facilities. eHA’s commitment to the VDD project saw the need for an assessment of the project vis-a-vis the overall project performance, evaluation of a process for necessary improvement suggestions as well as general impact across Kano State (Where eHA had transitioned to the state), Bauchi State (currently manage delivery to all LGAs except 3 LGAs currently being managed by the state), Sokoto State (eHA currently covers all LGAs) and Zamfara State (Currently, in-sourced and managed solely by the state).

Keywords: cold chain logistics, health supply chain system strengthening, logistics management information system, vaccine delivery traceability and accountability

Procedia PDF Downloads 236