Search results for: hospital policy

Authors: Eliud Kiprop, Kenichi Matsui, Joseph Karanja, Hesborn Ondiba

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To double the share of renewable energy in the global energy mix by 2030 as part of actions for the Paris Agreement, policymakers in each ratifying country must accelerate their efforts within the next few years by implementing their own renewable energy strategies. Kenya has increased its funding for research and development in renewable energy sources largely because it intends to reduce greenhouse gas GHG emissions by 30% from business as usual (BAU) levels (143 MtCO₂eq) by 2030. In 2013, the Kenyan government launched an ambitious plan to increase the installed power generation capacity from 1,768MW to more than 5,000MW by the end of 2017. This paper examines the formulation and implementation process of this plan and shows how this plan will affect Kenya’s renewable energy industry and national policy implementation in general. Results demonstrate that, despite having a well- documented policy in place, the Kenyan government cannot meet its target of 5000MW by the end of 2017. Among other factors, we find that the main reason is attributable to the failure in adhering to the main principles of the policy plan. We also find that the government has failed to consider the future energy demand. Had the policy been implemented on time, we argue that there would have been excess power.

Keywords: policy implementation, policy plan, renewable energy, sustainable development

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Authors: Lucie Litvack, Malaz Elsaddig, Kevin Jones

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There is strong evidence to support the efficacy of the World Health Organization (WHO) Surgical Safety Checklist in improving patient safety; however, its use can be associated with difficulties. This study uses qualitative data collected in Kitovu Healthcare Complex, a rural Ugandan hospital, to identify factors that may influence the use of the checklist in a low-income setting. Potential barriers to and motivators for the hospital’s use of this checklist are identified and explored through observations of current patient safety practices; semi-structured interviews with theatre staff; a focus group with doctors; and trial implementation of the checklist. Barriers identified include the institutional context; knowledge and understanding; patient safety culture; resources and checklist contents. Motivators for correct use include prior knowledge; team attitudes; and a hospital advocate. Challenges are complex and unique to this socioeconomic context. Stepwise change to improve patient safety practices, local champions, whole team training, and checklist modification may assist the implementation and sustainable use of the checklist in an effective way.

Keywords: anaesthesia, patient safety, Uganda, WHO surgical safety checklist

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: E. Kharaishvili

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The paper shows the necessity of farm diversification in accordance with the current trends in agricultural sector of Georgia. The possibilities for the diversification and the corresponding economic policy are suggested. The causes that hinder diversification of farms are revealed, possibilities of diversification are suggested and the ability of increasing employment through diversification is proved. Index of harvest diversification is calculated based on the areas used for cereals and legumes, potatoes and vegetables and other food crops. Crop and livestock production indexes are analyzed, correlation between crop capacity index and value-added per one worker and one ha is studied. Based on the research farm diversification strategies and priorities of corresponding economic policy are presented. Based on the conclusions relevant recommendations are suggested.

Keywords: farm diversification, diversification index, agricultural development policy

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Authors: Ahmed Al Khamisi

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The Disaster Preparedness Standard (DPS) is one of the elements that is evaluated by the Accreditation Canada International (ACI). ACI emphasizes to train and educate all staff, including service providers and senior leaders, on emergency and disaster preparedness upon the orientation and annually thereafter. Lack of awareness and deficit of knowledge among the healthcare providers about DPS have been noticed in a tertiary hospital where ACI standards were implemented. Therefore, this paper aims to introduce a video-based e-learning (VB-EL) module that explains the hospital’s disaster plan in a simple language which will be easily accessible to all healthcare providers through the hospital’s website. The healthcare disaster preparedness coordinator in the targeted hospital will be responsible to ensure that VB-EL is ready by 25 April 2019. This module will be developed based on the Kirkpatrick evaluation method. In fact, VB-EL combines different data forms such as images, motion, sounds, text in a complementary fashion which will suit diverse learning styles and individual learning pace of healthcare providers. Moreover, the module can be adjusted easily than other tools to control the information that healthcare providers receive. It will enable healthcare providers to stop, rewind, fast-forward, and replay content as many times as needed. Some anticipated limitations in the development of this module include challenges of preparing VB-EL content and resistance from healthcare providers.

Keywords: Accreditation Canada International, Disaster Preparedness Standard, Kirkpatrick evaluation method, video-based e-learning

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Authors: Ashley Barnes

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This paper will consider the ways in which varied notions of Space played a central role in a 12-week drama project with patients in a Medium Secure Hospital in the UK. In the project, the patients devised and performed a series of sketches, inspired by Science Fiction films, which echoed their own experience of alienation. During the project, the familiar and rigorously regulated Activity Room became a site of imagination, adventure and laughter; transforming the atmosphere of the hospital and allowing the patients to be transported to another space entirely. A space that was as much in their heads as in the physical domain. It will be argued that, although work created in an institution such as a Medium Secure Hospital is infused with hegemonic associations and meanings, the starting point for such work should be to seek an empty space in which the participants can allow their imaginations to be released. This work sits within a range of contexts and will be consciously interdisciplinary. It will draw from Human Geography and Criminology, as well as Performance and Applied Theatre Literature. It is hoped that this paper will build upon the literature that relates to the very particular environment of Secure Hospitals and to provide a starting point for further practical exploration.

Keywords: criminal justice, mental health, science fiction films, space and place

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Authors: Ahasanul Haque, Noor Hazilah Abd Manaf, Zohurul Anis, Tarekol Islam

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Sustainable community health (SCH) is an example of a new healthcare concept formed from applying the Maqasid al-Shariah principle to hospital management and delivery services. Because the idea is novel, it needs comprehensive and ongoing investigation to be improved. However, there is a lack of research on the necessity of developing sustainable community health (SCH), particularly its organizational structure. Furthermore, there is a misconception about the order of components in Maqasid al-Shariah, particularly in a hospital setting. Furthermore, the use of medicines and treatment by conventional recommendations to carry out the treatment by the Maqasid al Shariah. As such, this study focuses on the essential prerequisite for establishing a sustainable community health system based on Maqasid al-Shariah. This study discusses the use of Maqasid al-Shariah in administration and treatment. In this qualitative research approach, a literature search and interviews with specialists are conducted. The gathered data is examined using content analysis, emphasizing inductive and deductive reasoning. The research reveals that the Shariah Advisory Council and Shariah Critical Point are necessary for sustainable community health. In conclusion, by discussing the causes for each instance, this research adds to the creation of methods for determining the level of Maasid al-Shariah in-hospital care.

Keywords: empowering, sustainability, community health, maqasid al shariah, hospital and malaysia

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Authors: EMMANUEL DWAMENA SASU

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International climate policy actions require countries under Paris Agreement to design instruments, provide support (financial and technical), and strengthen institutional capacity with tendency to transcending policy formulation to implementation and sustainability. Changes associated with moisture depletion has been a growing phenomenon; especially in developing countries with projected global GDP drop from 7% to 2% between 2005 and 2050. These developments have potential to adversely affect food production in feeding the growing world population, with corresponding rise in global hunger. Incongruously, there is global absence of a harmonized policy direction; capable of providing the required indicators on climate policies for monitoring sustainability of international agricultural development projects. We conduct extensive review and synthesis on existing limitations on global climate policy governance, agricultural food security and sustainability of international agricultural development projects, and conjecture the role of non-state and sub-national climate stakeholder engagements, and monitoring and evaluation strategies for improved climate policy action for sustaining international agricultural development projects.

Keywords: climate policy, agriculture, development projects, sustainability

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Authors: Simon Tsipis

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In this study, we propose to analyze Russian foreign policy conduct by applying the theory of Political Realism and the qualitative comparative method of analysis. We find that the paradigm of Political Realism supplies us with significant insights into the sources of contemporary Russian foreign policy conduct since the power factor was and remains an integral element in Russian foreign policies, especially when we apply comparative analysis and compare it with the behavior of its Soviet predecessor. Through the lens of the Realist theory, a handful of Russian foreign policy-making becomes clearer and much more comprehensible.

Keywords: realism, Russia, cold war, Soviet Union, European security

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Authors: Chenhong Peng

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Beijing, the capital city of China, is running out of water. The water resource per capita in Beijing is only 106 cubic meter, accounts for 5% of the country’s average level and less than 2% of the world average level. The tension between water supply and demand is extremely serious. For one hand, the surface and ground water have been over-exploited during the last decades; for the other hand, water demand keep increasing as the result of population and economic growth. There is a massive gap between water supply and demand. This paper will focus on addressing the water shortage in Beijing city by increasing water use efficiency in domestic sector. First, we will emphasize on the changing structure of water supply and demand in Beijing under the economic development and restructure during the last decade. Second, by analyzing the water use efficiency in agriculture, industry and domestic sectors in Beijing, we identify that the key determinant for addressing the water crisis is to increase the water use efficiency in domestic sector. Third, this article will explore the two primary causes for the water use inefficiency in Beijing: The ineffective water pricing policy and the poor water education and communication policy. Finally, policy recommendation will offered to improve the water use efficiency in domestic sector by making and implementing an effective water pricing policy and people-engaged water education and communication policy.

Keywords: Beijing, water use efficiency, domestic sector, water pricing policy, water education policy

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Authors: Dylan Yanano Mangani, Theodore Nkadimeng Mahosi

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Soon after independence on 18th April 1980, Zimbabwe’s foreign policy was shaped by the realities on the ground, which saw the country managing a sound relationship with both the Capitalist West and the Communist Eastern blocs. The post-independence foreign policy was therefore premised on security concerns illuminated by the Cold War era. This was one the reasons President Robert Mugabe adopted a policy of reconciliation and this earned his government recognition on the international platform. However, in Southern Africa apartheid South Africa was still the vanguard of capitalism and oppression such that she posed a serious threat to the newly born Zimbabwean nation which necessitated that Zimbabwe position herself both in the region and the continent to counter potential internal stability from within. Irrespective of how the international community viewed the country’s foreign policy Zimbabwe has continued to influence regional, continental and world geo-politics, especially on behalf of the developing nations. This raises a question why as a result of its foreign policy the country is now regarded a pariah state, especially some Western countries which used to applaud its political economic policies immediately after independence. Therefore, this study argues that the political economy of Zimbabwe had a far-reaching bearing on its foreign policy. For this reason, the problem necessitates the investigation of Zimbabwe’s foreign policy perspectives in Southern Africa since the turn of the 1990s. Two main theories which are Realism, Afro-centrism inform the study as an attempt to understand Zimbabwe’s foreign policy paradigm shift and perhaps provide answers to the objectives raised. The research therefore employs a qualitative approach where the conceptual nature of the study into the foreign policy of Zimbabwe is largely desktop research. However, the nature of the study will also require that oral interviews are conducted to substantiate some of the arguments advanced.

Keywords: cold war set up, foreign policy, look east policy, pan-africanism, post 2000 period, Southern Africa, Zimbabwe

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Authors: Jamil Ahmed

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Access control models aim to decide whether a user should be denied or granted access to the user‟s requested activity. Various access control models have been established and proposed. The most prominent of these models include role-based, attribute-based, policy based access control models as well as role-centric attribute based access control model. In this paper, a novel access control model is presented called “Role centric Attribute based Policy Driven Access Control (RAPDAC) model”. RAPDAC incorporates the concept of “policy” in the “role centric attribute based access control model”. It leverages the concept of "policy‟ by precisely combining the evaluation of conditions, attributes, permissions and roles in order to allow authorization access. This approach allows capturing the "access control policy‟ of a real time application in a well defined manner. RAPDAC model allows making access decision at much finer granularity as illustrated by the case study of a real time library information system.

Keywords: authorization, access control model, role based access control, attribute based access control

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Authors: Kishor P. Kadam

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Foreign direct investment policy (FDI) is defined as an investment involving a long term relationship and reflecting a long duration interest and control of a resident entity in the home country (foreign direct investor or parent firm) in the host country. India has been one of the most translucent and open-minded FDI regimes among the emerging and developing economies. There is clear cut mentioned about the sectoral caps for foreign investment. The policy problems that have been identified by time to time surveys as acting as additional hurdles for FDI are laws, regulatory systems and government monopolies that do not have contemporary relevance. Foreign investment policies in the post-reforms period have emphasized greater encouragement and mobilization of non-debt creating private inflows for plunging reliance on debt flows. This paper will focus on how foreign direct investment policy changed from 1990-91 up to now. A time series data of 25 years is used for analysing the policy changes. It is observed that India has more liberal policy. The growth in number of Greenfield investments in India has been more impressive than the number of M&A deals whereas equity capital for incorporated bodies FDI inflows has been increased continuously 2014-15. India has made major changes in FDI Policy, and it has positive impact on economic development.

Keywords: FDI, India, economic development, government

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Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

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Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang

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Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.

Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine

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Authors: Anjelika Kremer, Irina Nachimov, Dan Justo

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Background: C-reactive protein (CRP) serum levels are commonly measured in hospitalized patients. Elevated admission CRP serum levels and in-hospital mortality has been seldom studied in the general population of elderly patients admitted to the acute Geriatrics department. Methods: A retrospective cross-sectional study was conducted at a tertiary medical center. Included were all elderly patients (age 65 years or more) admitted to a single acute Geriatrics department from the emergency room between April 2014 and January 2015. CRP serum levels were measured routinely in all patients upon the first 24 hours of admission. A logistic regression analysis was used to study if admission CRP serum levels were associated with in-hospital mortality independent of age, gender, functional status, and co-morbidities. Results: Overall, 498 elderly patients were included in the analysis: 306 (61.4%) female patients and 192 (38.6%) male patients. The mean age was 84.8±7.0 years (median: 85 years; IQR: 80-90 years). The mean admission CRP serum levels was 43.2±67.1 mg/l (median: 13.1 mg/l; IQR: 2.8-51.7 mg/l). Overall, 33 (6.6%) elderly patients died during the hospitalization. A logistic regression analysis showed that in-hospital mortality was independently associated with history of stroke (p < 0.0001), heart failure (p < 0.0001), and admission CRP serum levels (p < 0.0001) – and to a lesser extent with age (p = 0.042), collagen vascular disease (p=0.011), and recent venous thromboembolism (p=0.037). Receiver operating characteristic (ROC) curve showed that admission CRP serum levels predict in-hospital mortality fairly with an area under the curve (AUC) of 0.694 (p < 0.0001). Cut-off value with maximal sensitivity and specificity was 19.7 mg/L. Conclusions: Admission CRP serum levels may be used to predict in-hospital mortality in the general population of elderly patients admitted to the acute Geriatrics department.

Keywords: c-reactive protein, elderly, mortality, prediction

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Authors: Aleksandra Nocoń (Szunke)

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The study is a review of the literature concerning the consequences of non-standard monetary policy, which are used by central banks during unconventional periods, threatening instability of the banking sector. In particular, the attention was paid to the effects of non-standard monetary policy tools for financial markets. However, the empirical evidence about their effects and real consequences for the financial markets are still not final. The main aim of the study is to survey the consequences of standard and non-standard monetary policy instruments, implemented during the global financial crisis in the United States, United Kingdom and Euroland, with particular attention to the results for the stabilization of global financial markets. The study analyses the consequences for short and long-term market interest rates, interbank interest rates and LIBOR-OIS spread. The study consists mainly of the empirical review, indicating the impact of the implementation of these tools for the financial markets. The following research methods were used in the study: literature studies, including domestic and foreign literature, cause and effect analysis and statistical analysis.

Keywords: asset purchase facility, consequences of monetary policy instruments, non-standard monetary policy, quantitative easing

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Authors: Hiroaki Sumi, Kiichiro Hayashi

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Now, the use of renewable energy power generation has been advanced. In this paper, we compared the expansion support policy of photovoltaic power generation which was researched using The internet and the amount of resource for photovoltaic power generation which was estimated using the NEDO formula in the municipality level in Hokkaido and Aichi Prefecture, Japan. This paper will contribute to grasp the current situation especially about the policy. As a result, there were municipalities which seemed to be no consideration of the amount of resources. We think it would need to consider the suitability between the policies and resources.

Keywords: photovoltaic power generation, dissemination and support policy, amount of resources, Japan

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Authors: Nawaf Alyaseen

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This paper provides a comparative analysis of the Islamic and Western public policy and morality principles governing trademarks. The aim of this paper is to explore public policy and morality principles that affect trademark registration and protection under Shari'a by using Kuwaiti law as a case study. The findings provide a better understanding of trademark recognition from the perspective of Shari'a and the requirements demanded by Islamic Shari'a, especially of those who deal with strict Shari'a jurisdiction countries. In addition, this understanding is required for corporations or legislators that wish to take into consideration Muslim consumers. The conclusion suggests that trademarks in Western and Islamic systems are controlled by a number of public policy and morality rules that have a direct effect on the registration and protection of trademarks. Regardless of the fact that there are many commonalities between the two systems, there are still fundamental differences.

Keywords: trademark, public policy and morality, Islamic sharia, western legal systems

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Authors: Danuvasin Charoen

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This study investigates the development of the digital economy policy in Thailand. The researcher describes the importance of digital technologies for competitiveness development of the country. In addition, the researcher analyzes the components and roadmap of the digital economy policy in Thailand. Main problems and challenges of the policy were identified. The data were gathered and analyzed from secondary sources. The finding can be used to guide the implementation of the digital economy in Thailand and other developing economies.

Keywords: digital economy, ICT in developing countries, Thailand, ICT development

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Authors: Zohreh Bang Tavakoli, Shuktika Chatterjee

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This study investigates the fiscal policy impact on countries’ economic growth in developing countries with a different external debt level. The fiscal policy effectiveness has been re-emphasized in the global financial crisis of 2008 with the external debt as its new contemporary driver (Ruščáková and Semančíková, 2016). According to Bouakez, (2014 ) different theories have proposed the economic consequence of fiscal policy, specifically for developing countries. However, fiscal policy literature is lacking research regarding the fiscal policy’s effectiveness with the external debt’s contributions through comprehensive study (Canh, 2018). Also, according to scholars, high levels of external debt will influence economic growth. First, through foreign resources and channel of investment in which high level of debt decreases the amount of foreign investment in the developing countries. Second, through the deterioration of foreign investors and fiscal policies related to a high level of debt (Cordella, et.al., 2010). Therefore, this study proposed that only countries with a low external debt level and appropriate fiscal policies and good quality institutions can gain the proper quantity and quality of foreign investors, which will help the economic growth. For this, this research is examining the impact of fiscal policy on developing countries' economic growth in the situation of different external debt levels.

Keywords: fiscal policy, external debt, gross domestic product, developing countries

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Authors: Stephen McCarthy, Joanne Gray, Esther Carr, Gerard Danjoux, Paul Baker, Rhiannon Hackett

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Background: The Go Well Health (GWH) platform is a web-based programme that allows patients to access personalised care plans and resources, aimed at prehabilitation prior to surgery. The online digital platform delivers essential patient education and support for patients prior to undergoing total hip replacements (THR) and total knee replacements (TKR). This study evaluated the impact of an online digital platform (ODP) in terms of functional health outcomes, health related quality of life and hospital length of stay following surgery. Methods: A retrospective cohort study comparing a cohort of patients who used the online digital platform (ODP) to deliver patient education and support (PES) prior to undergoing THR and TKR surgery relative to a cohort of patients who did not access the ODP and received usual care. Routinely collected Patient Reported Outcome Measures (PROMs) data was obtained on 2,406 patients who underwent a knee replacement (n=1,160) or a hip replacement (n=1,246) between 2018 and 2019 in a single surgical centre in the United Kingdom. The Oxford Hip and Knee Score and the European Quality of Life Five-Dimensional tool (EQ5D-5L) was obtained both pre-and post-surgery (at 6 months) along with hospital LOS. Linear regression was used to compare the estimate the impact of GWH on both health outcomes and negative binomial regressions were used to impact on LOS. All analyses adjusted for age, sex, Charlson Comorbidity Score and either pre-operative Oxford Hip/Knee scores or pre-operative EQ-5D scores. Fractional polynomials were used to represent potential non-linear relationships between the factors included in the regression model. Findings: For patients who underwent a knee replacement, GWH had a statistically significant impact on Oxford Knee Scores and EQ5D-5L utility post-surgery (p=0.039 and p=0.002 respectively). GWH did not have a statistically significant impact on the hospital length of stay. For those patients who underwent a hip replacement, GWH had a statistically significant impact on Oxford Hip Scores and EQ5D-5L utility post (p=0.000 and p=0.009 respectively). GWH also had a statistically significant reduction in the hospital length of stay (p=0.000). Conclusion: Health Outcomes were higher for patients who used the GWH platform and underwent THR and TKR relative to those who received usual care prior to surgery. Patients who underwent a hip replacement and used GWH also had a reduced hospital LOS. These findings are important for health policy and or decision makers as they suggest that prehabilitation via an ODP can maximise health outcomes for patients following surgery whilst potentially making efficiency savings with reductions in LOS.

Keywords: digital prehabilitation, online digital platform, orthopaedics, surgery

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Authors: Shangjun Zou, Zhiyuan Wang, Songhui You

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Introduction In recent years, the Chinese government has issued several policies to promote the institutional reform and innovation of the development of campus football, but many problems have been exposed in the process of policy implementation. Therefore, this paper attempts to conduct an empirical analysis of the campus football policy texts to reveal the dynamic development of the microsystem in the process of policy evolution. Methods The selected policy contents are coded by constructing a two-dimensional analysis framework of campus football policy tool-policy objective. Specifically, the X dimension consists of three oriented policy tools: environment, supply and demand, while the Y dimension is divided into six aspects of policy objectives, including institution, competition, player teaching, coach training, resource guarantee and popularization. And the distribution differences of textual analysis units on X and Y dimensions are tested by using SPSS22.0 so as to evaluate the characteristics and development trend of campus football policy on respective subjects. Results 1) In the policy evolution process of campus football stepping into the 2.0 Era, there were no significant differences in the frequency distribution of policy tools(p=0.582) and policy objectives(p=0.603). The collaborative governance of multiple participants has become the primary trend, and the guiding role of Chinese Football Association has gradually become prominent. 2) There were significant differences in the distribution of policy tools before the evolution at a 95% confidence level(p=0.041). With environmental tools always maintaining the dominant position, the overall synergy of policy tools increased slightly. 3) There were significant differences in the distribution of policy objectives after the evolution at a 90% confidence level(p=0.069). The competition system of policy objective has not received enough attention while the construction of institution and resource guarantee system has been strengthened. Conclusion The upgraded version of campus football should adhere to the education concept of health first, promote the coordinated development of youth cultural learning and football skills, and strive to achieve more solid popularization, more scientific institution, more comprehensive resource guarantee and adequate integration. At the same time, it is necessary to strengthen the collaborative allocation of policy tools and reasonable planning of policy objectives so as to promote the high quality and sustainable development of campus football in the New Era. Endnote The policy texts selected in this paper are “Implementation Opinions on Accelerating the Development of Youth Campus Football” and “Action Plans for the Construction of Eight Systems of National Youth Campus Football”, which were promulgated on August 13, 2015 and September 25, 2020 respectively.

Keywords: campus football, content analysis, evolution characteristics, policy objective, policy tool

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Authors: H. K. V. Narayan

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This study was conducted at Tata Memorial Hospital (TMH), Mumbai, India. The study was to evaluate the impact of adapting Smart Card (SC) for clinical and business transactions in order to reduce Lead times and to enforce business rules of the hospital. The objective for implementing the Smart Card was to improve the patient perception of quality in terms of structures process and outcomes and also to improve the productivity of the Institution. The Smart Card was implemented in phases from 2011 and integrated with the Hospital Information System (HIS/EMR). The implementation was a learning curve for all the stake holders as software obviated the need to use hardcopies of transactions. The acceptability to the stake holders was challenge in change management. The study assessed the impact 3 years into the implementation and the observed trends have suggested that it has decreased the lead times for services and increased the no of transactions and thereby the productivity. Patients who used to complain of multiple queues and cumbersome transactions now compliment the administration for effective use of Information and Communication Technology.

Keywords: smart card, high availability of health care information, reduction in potential medical errors due to elimination of transcription errors, reduction in no of queues, increased transactions, augmentation of revenue

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Authors: Scott Ashby, Emily Granger, Mark Connellan

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Background: In-hospital management of Out-of-Hospital Cardiac Arrest (OHCA) is complex as the aetiologies are varied. Acute coronary angiography has been shown to improve outcomes for patients with coronary occlusion as the cause; however, these patients are difficult to identify. ECG results may help identify these patients, but the accuracy of this diagnostic test is under debate, and requires further investigation. Methods: Arrest and hospital management information was collated retrospectively for OHCA patients who presented to a single clinical site between 2009 and 2013. Angiography results were then collected and checked for significance with survival to discharge. The presence of a severe lesion (>70%) was then compared to categorised ECG findings, and the accuracy of the test was calculated. Results: 104 patients were included in this study, 44 survived to discharge, 52 died and 8 were transferred to other clinical sites. Angiography appears to significantly correlate with survival to discharge. ECG showed 54.8% sensitivity for detecting the presence of a severe lesion within the group that received angiography. A combined criterion including any ECG pathology showed 100% sensitivity and negative predictive value, however, a low specificity and positive predictive value. Conclusion: In the cohort investigated, ST elevation on ECG is not a sensitive enough screening test to be used to determine whether OHCA patients have coronary stenosis as the likely cause of their arrest, and more investigation into whether screening with a combined ECG criterion, or whether all patients should receive angiography routinely following OHCA is needed.

Keywords: out of hospital cardiac arrest, coronary angiography, resuscitation, emergency medicine

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Authors: Yibo Shao, Jiajie Liu

Abstract:

This article uncovers the practice of pragmatism of Singaporean foreign policy by analyzing its foreign diplomatic behavior. It also points out the Singapore’s hedging strategy on the relations between China and American and how to balance these two greater powers in Southeast Asian. This paper used qualitative approach by reviewing literature and policy documents intensively to find out the responses to our research questions.

Keywords: hedging, pragmatism, Sino-Singapore relations, South China Sea

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Authors: Maria Kralova, Michal Palecek

Abstract:

We have detected factors leading to recidivism (the Czech Republic data). The employment during imprisonment turned out to be the most significant predictor with a positive effect on reduction of a rate of recidivism. Accordingly, we mainly focus on this predictor and its economic consequences. Smart public policy can cut government costs dramatically as more than a half of prisoners in the Czech Republic are recidivists. The operating cost cut of the Czech prison service could be CZK 127,680,000 (USD 5,889,623) in 2013 if a public policy had been set smarter.

Keywords: cost-cut, effective, optimal, public policy, reducing recidivism

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Authors: Peter Ferguson

Abstract:

In 2018, Japan’s Ministry of Education revised the public elementary school curriculum. As part of widespread reforms, the recent Course of Study established English as an academic subject in Grades 5 and 6 plus lowered the starting age of 'foreign language activities' to Grade 3. These changes were implemented in April 2020. This presentation will examine the process and effects that policy implementation had on schools and teachers. A critical analysis of the 2018 Course of Study policy documents revealed several discourses were expressed concerning not only English education and foreign language acquisition, but that larger political and socioeconomic ideological beliefs on globalization, language, nation, culture, and identity were also articulated. Using excerpts from document analysis, the presenter will demonstrate how competing discourses were expressed in policy texts. Data from interviews with national policymakers also exposed several challenges policymakers faced as they tried to balance competing discourses and articulate important pedagogical concepts while having their voices heard. Findings show that some stakeholders were marginalized during the processes of policy creation, transmission, and implementation. This presentation is part of a larger multiple case study that utilized ethnography of language policy and critical analysis of discourse to examine how English education language policy was implemented into the national elementary school curriculum in Japan, and how stakeholders at the various educational levels contended with the creation, interpretation, and appropriation of the language policy.

Keywords: ethnography of language policy, elementary school EFL, language ideologies, discourse analysis

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Authors: Dina Siniora, Jasia Baig

Abstract:

During the past few decades, the healthcare system has undergone profound changes in their healthcare decision-making competencies and moral aptitudes due to the vast advancement in technology, clinical skills, and scientific knowledge. Healthcare decision-making deals with morally contentious dilemmas ranging from illness, life and death judgments that require sensitivity and awareness towards the patient’s preferences while taking into consideration medicine’s abilities and boundaries. As the ever-evolving field of medicine continues to become more scientifically and morally multifarious; physicians and the hospital administrators increasingly rely on ethics committees to resolve problems that arise in everyday patient care. The role and latitude of responsibilities of ethics committees which includes being dispute intermediaries, moral analysts, policy educators, counselors, advocates, and reviewers; suggest the importance and effectiveness of a fully integrated committee. Despite achievements on Integrated Ethics and progress in standards and competencies, there is an imminent necessity for further improvement in quality within ethics consultation services in areas of credentialing, professionalism and standards of quality, as well as the quality of healthcare throughout the system. These concerns can be resolved first by collecting data about particular quality gaps and comprehend the level to which ethics committees are consistent with newly published ASBH quality standards. Policymakers should pursue improvement strategies that target both academic bioethics community and major stakeholders at hospitals, who directly influence ethics committees. This broader approach oriented towards education and intervention outcome in conjunction with preventive ethics to address disparities in quality on a systematic level. Adopting tools for improving competencies and processes within ethics consultation by implementing a credentialing process, upholding normative significance for the ASBH core competencies, advocating for professional Code of Ethics, and further clarifying the internal structures will improve productivity, patient satisfaction, and institutional integrity. This cannot be systemically achieved without a written certification exam for HCEC practitioners, credentialing and privileging HCEC practitioners at the hospital level, and accrediting HCEC services at the institutional level.

Keywords: ethics consultation, hospital, medical ethics, quality

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Authors: Sumrina Kousar

Abstract:

Objective: The aim of this study was to observe the effect of fortification of expressed human breast milk with olive oil and skimmed milk in improving weight gain in very low birth weight neonates and shortening their length of hospital stay. Study Design and place: A randomized controlled trial was carried out at the Combined Military Hospital Lahore from March 2018 to March 2019. Methods: Neonates admitted with very low birth weight and gestational age of < 34 weeks were included in the study. Sixty babies were enrolled using non-probability consecutive sampling; a random number table was used to allocate them into a fortification group and a control group. The control group received expressed milk alone, while olive oil 1 ml twice daily and skimmed milk 1 gram in every third feed were added to expressed milk in the fortification group. Data was analyzed on SPSS 20. Proportions were compared by applying the chi-square test. An independent sample t-test was applied for comparing means. A p-value of ≤ 0.05 was considered significant. Results: The study comprised of 60 neonates, with 30 in each of the groups. Weight gain was 24.83±5.63 in the fortification group and 11.72±3.95 in the control group (p =< 0.001). Mean hospital stay was 20.5716.511 in the fortification group and 27.678.89 in the control group (p =< 0.043). Conclusion: Olive oil and skimmed milk fortification of breast milk was effective for weight gain and reducing the length of hospital stay in very low birth weight neonates.

Keywords: fortification, olive oil, skimmed milk, weight gain

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