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Visintini, Sarah, Mish Boutet, Melissa Helwig, and Alison Manley. "Research Support in Health Sciences Libraries: A Scoping Review." Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du Canada 39, no. 2 (July 24, 2018): 56–78. http://dx.doi.org/10.29173/jchla29366.
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Background:As part of a health sciences library’s internal assessment of its research support services, an environmental scan and literature review were conducted to identify research services offered elsewhere in Canada. Through this process, it became clear that a more formal review of the academic literature would help libraries make informed decisions about their services. To address this gap, we conducted a scoping review of research services provided in health sciences libraries contexts.Methods:Searches were conducted in Medline, Embase, ERIC, CINAHL, LISTA, LISS, Scopus, Web of Science, Google Scholar and Google for articles which described the development, implementation, or evaluation of one or more research support initiatives in a health sciences library context. We identified additional articles by searching reference lists of included studies and soliciting medical library listservs.Results:Our database searches retrieved 7134 records, 4026 after duplicates were removed. Title/abstract screening excluded 3751, with 333 records retained for full-text screening. Seventy-five records were included, reporting on 74 different initiatives. Included studies were published between 1990 and 2017, the majority from North American and academic library contexts. Major service areas reported were the creation of new research support positions, and support services for systematic review support, grants, data management, open access and repositories.Conclusion:This scoping review is the first review to our knowledge to map research support services in the health sciences library context. It identified main areas of research service support provided by health sciences libraries that can be used for benchmarking or information gathering purposes.
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Bell, Ruth, Svetlana V. Glinianaia, Zelda van der Waal, Andrew Close, Eoin Moloney, Susan Jones, Vera Araújo-Soares, et al. "Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation." Tobacco Control 27, no. 1 (February 15, 2017): 90–98. http://dx.doi.org/10.1136/tobaccocontrol-2016-053476.
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ObjectivesTo evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.DesignInterrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation.SettingEight acute NHS hospital trusts and 12 local authority areas in North East England.Participants37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy.InterventionsA package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol.Main outcome measuresReferrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting.ResultsAfter introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.ConclusionsThe implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.
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Hayter, Mark, Catriona Jones, Jenny Owen, and Christina Harrison. "A qualitative evaluation of home-based contraceptive and sexual health care for teenage mothers." Primary Health Care Research & Development 17, no. 03 (September 28, 2015): 287–97. http://dx.doi.org/10.1017/s1463423615000432.
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AimThis paper reports on the findings from a qualitative study exploring the experiences of teenage mothers using a nurse-led, home-based contraceptive service designed to prevent repeat unplanned pregnancies. The aim was to understand if, and how the service was effective in equipping teenage mothers to make informed choices about contraception, thus preventing a second pregnancy.BackgroundUnplanned teenage pregnancy remains a significant focus of health and social policy in the United Kingdom (UK). Despite the long-term pattern of declining conception rates, the UK continues to report higher rates than comparable countries elsewhere in Europe. Current estimates suggest that approximately one fifth of births amongst under 18’s are repeat pregnancies (Teenage Pregnancy Independent Advisory Group, 2009). Services that are designed to reduce second unplanned pregnancies are an important element in promoting teenage sexual health. However, there has been no UK research that explores this kind of service and the experiences of service users.MethodsWe conducted a qualitative interview study. From 2013–2014 we interviewed 40 teenage mothers who had engaged with the nurse-led, home-based contraceptive service.FindingsThe data demonstrates that the service was effective in preventing repeat pregnancies in a number of cases. Among the aspects of the service which were found to contribute to its effectiveness were privacy, convenience, flexibility, appropriately timed access, the non-judgemental attitude of staff and ongoing support.
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Rehm, Jürgen, Mindaugas Štelemėkas, Carina Ferreira-Borges, Huan Jiang, Shannon Lange, Maria Neufeld, Robin Room, Sally Casswell, Alexander Tran, and Jakob Manthey. "Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000–2019." International Journal of Environmental Research and Public Health 18, no. 5 (March 2, 2021): 2419. http://dx.doi.org/10.3390/ijerph18052419.
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Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.
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Homer, Sophie R., Linda Solbrig, Despina Djama, Anne Bentley, Sarah Kearns, and Jon May. "The Researcher Toolkit: a preventative, peer-support approach to postgraduate research student mental health." Studies in Graduate and Postdoctoral Education 12, no. 1 (February 3, 2021): 7–25. http://dx.doi.org/10.1108/sgpe-06-2020-0039.
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Purpose Rates of mental ill-health among postgraduate research students (PGRs) are alarmingly high. PGRs face unique challenges and stigma around accessing support. The purpose of this paper is to introduce The Researcher Toolkit: a novel, open-source, preventative approach to PGR mental health. The Toolkit empowers PGRs and promotes positive research culture. This paper describes and evaluates the Toolkit to encourage adoption across the sector. Design/methodology/approach Four workshops were designed by integrating researcher development, critical pedagogy and psychological knowledge of well-being. A diverse group of PGRs co-designed workshops and delivered them to their peers. Workshops engaged 26% of the PGR population (total 116 attendees). PGR Workshop Leaders and attendees submitted anonymous, online feedback after workshops (74 total responses). A mixed-method approach combined quantitative analysis of ratings and qualitative analysis of open-ended comments. Findings Feedback was overwhelmingly positive. Workshops were universally appealing, enjoyable and beneficial and the peer-support approach was highly valued, strongly supporting adoption of the programme in other universities. Findings are discussed alongside wider systemic factors and recommendations for policy. Practical implications The Toolkit translates readily to other UK institutions and can be adapted for use elsewhere. Recommendations for practice are provided. Originality/value The Researcher Toolkit is a novel PGR well-being initiative. Its originality is threefold: its approach is prevention rather than intervention; its content is new and bespoke, created through interdisciplinary collaboration between psychologists, researcher development professionals and PGR stakeholders; and support is peer-led and decentralised from student support services. Its evaluation adds to the limited literature on PGR well-being and peer-support.
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Dutt, Priyanka, Anna Godfrey, Sara Chamberlain, and Radharani Mitra. "Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice." Integrated Healthcare Journal 4, no. 1 (December 2022): e000139. http://dx.doi.org/10.1136/ihj-2022-000139.
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Between 2011 and 2019, an integrated communication programme to address reproductive, maternal, neonatal and child health was implemented in the Indian state of Bihar. Along with mass media, community events and listening groups, four mobile health services were co-designed with the government of Bihar. These wereMobile Academy—a training course for frontline health workers (FLHWs) supporting them as the last mile of the health system;Mobile Kunji—a job aid to support FLHWs’ interactions with families;Kilkari—a maternal messaging service delivering information directly to families’ mobile phones, encouraging families to seek public health services through their FLHWs; andGupShup Potli—mobile audio stimulus used by FLHWs in community events. WhileMobile KunjiandGupShup Potliscaled to other states (two and one, respectively), neither was adopted nationally. The Government of India adoptedKilkariandMobile Academyand scaled to 12 additional states by 2019. In this article, we describe the programme’s overarching person-centred theory of change, reflect on how the mHealth services supported integration with the health system and discuss implications for the role of health communication solutions in supporting families to navigate healthcare systems. Evaluations ofKunji, AcademyandGupShup Potliwere conducted in Bihar between 2013 and 2017. Between 2018-2020, an independent evaluation was conducted involving a randomised controlled trial forKilkariin Madhya Pradesh; qualitative research onKilkariandAcademyand secondary analyses of call record data. While the findings from these evaluations are described elsewhere, this article collates key findings for all the services and offers implications for the role digital and non-digital communication solutions can play in supporting joined-up healthcare and improving health outcomes.
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Ahonle, Zaccheus J., Marcia Barnes, Sergio Romero, Audrey M. Sorrells, and Gene I. Brooks. "State-Federal Vocational Rehabilitation in Traumatic Brain Injury: What Predictors Are Associated With Employment Outcomes?" Rehabilitation Counseling Bulletin 63, no. 3 (July 30, 2019): 143–55. http://dx.doi.org/10.1177/0034355219864684.
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This study identified predictors of employment for individuals with traumatic brain injury (TBI). Data from 4,923 individuals with TBI were extracted from the Rehabilitation Services Administration’s Case Service Report (RSA-911) database. A multiple logistic regression model using demographics, disability-related variables, vocational rehabilitation (VR) service variables, and their interactions correctly classified 69.5% of the cases as successfully employed or not successfully employed. The model explained approximately 27.1% of the variance in employment outcomes. Results indicated that level of education, race/ethnicity, age at application, preemployment status, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), comorbid depression, and case expenditure were significantly associated with employment outcomes (all p ≤ .05). VR variables that showed the most significant positive effect on employment outcomes were on-the-job support, job placement, and on-the-job training. Race/ethnicity moderated the effect of college training, supported employment, transportation, and extended evaluation or work trial assessment services on employment outcomes. The findings have implications for promoting the use of those VR services that are strongly related to employment outcomes for persons with TBI. They also point to the need for rehabilitation personnel to address some of the demographic and disability-related barriers to successful employment.
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Bouabid, Ali, and Garrick Louis. "Decision support system for selection of appropriate water supply and sanitation technologies in developing countries." Journal of Water, Sanitation and Hygiene for Development 11, no. 2 (January 28, 2021): 208–21. http://dx.doi.org/10.2166/washdev.2021.203.
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Abstract Access to water supply and sanitation services remains a challenge in many parts of the world. The expected growth of the world's population, from about 7.8 billion people today to 9.8 billion people by 2050, and to around 11 billion people by the end of 2100, will create even higher demand and a greater strain on these basic services. Goal 6 of the United Nations Sustainable Development Goal (SDG) aims to ‘Ensure availability and sustainable management of water and sanitation for all’ by 2030. However, in a recent report, UN-Water warns us that if things continue on the current path, the world will miss the targets of SDG 6. The selection of appropriate water and sanitation technologies is key to meeting SDG 6 targets. This paper presents an original framework of a decision support system (DSS) for the selection of appropriate water supply and sanitation (Watsan) technologies in developing countries. The proposed DSS has three components. The first component is the user interface, where the inputs are the assessment of a community's capacity to manage a given water supply or sanitation system, and its regional specificity. The second component of the DSS is a database of Watsan technologies classified according to the capacity requirement level (CRL) metric, and finally, the third component is a matching algorithm for the selection of appropriate Watsan technology options. Case studies and simulations results are presented for the evaluation of the performance of the decision support system.
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Krul, Jan, Björn Sanou, Eleonara L. Swart, and Armand R. J. Girbes. "Medical Care at Mass Gatherings: Emergency Medical Services at Large-Scale Rave Events." Prehospital and Disaster Medicine 27, no. 1 (February 2012): 71–74. http://dx.doi.org/10.1017/s1049023x12000271.
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AbstractObjective: The objective of this study was to develop comprehensive guidelines for medical care during mass gatherings based on the experience of providing medical support during rave parties.Methods: Study design was a prospective, observational study of self-referred patients who reported to First Aid Stations (FASs) during Dutch rave parties. All users of medical care were registered on an existing standard questionnaire. Health problems were categorized as medical, trauma, psychological, or miscellaneous. Severity was assessed based on the Emergency Severity Index. Qualified nurses, paramedics, and doctors conducted the study after training in the use of the study questionnaire. Total number of visitors was reported by type of event.Results: During the 2006–2010 study period, 7,089 persons presented to FASs for medical aid during rave parties. Most of the problems (91.1%) were categorized as medical or trauma, and classified as mild. The most common medical complaints were general unwell-being, nausea, dizziness, and vomiting. Contusions, strains and sprains, wounds, lacerations, and blisters were the most common traumas. A small portion (2.4%) of the emergency aid was classified as moderate (professional medical care required), including two cases (0.03%) that were considered life-threatening. Hospital admission occurred in 2.2% of the patients. Fewer than half of all patients presenting for aid were transported by ambulance. More than a quarter of all cases (27.4%) were related to recreational drugs.Conclusions: During a five-year field research period at rave dance parties, most presentations on-site for medical evaluation were for mild conditions. A medical team of six healthcare workers for every 10,000 rave party visitors is recommended. On-site medical staff should consist primarily of first aid providers, along with nurses who have event-specific training on advanced life support, event-specific injuries and incidents, health education related to self-care deficits, interventions for psychological distress, infection control, and disaster medicine. Protocols should be available for treating common injuries and other minor medical problems, and for registration, triage, environmental surveillance and catastrophe management and response.
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Song, Ting, Fang Liu, Ning Deng, Siyu Qian, Tingru Cui, Yingping Guan, Leonard Arnolda, Zhenyu Zhang, and Ping Yu. "A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis." Journal of Medical Internet Research 23, no. 6 (June 21, 2021): e25522. http://dx.doi.org/10.2196/25522.
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Background Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.
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Tao, Karina F. M., Christopher G. Brennan-Jones, Dirce M. Capobianco-Fava, Dona M. P. Jayakody, Peter L. Friedland, De Wet Swanepoel, and Robert H. Eikelboom. "Teleaudiology Services for Rehabilitation With Hearing Aids in Adults: A Systematic Review." Journal of Speech, Language, and Hearing Research 61, no. 7 (July 13, 2018): 1831–49. http://dx.doi.org/10.1044/2018_jslhr-h-16-0397.
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Purpose This review examined (a) the current evidence from studies on teleaudiology applications for rehabilitation of adults with hearing impairment with hearing aids and (b) whether it is sufficient to support the translation into routine clinical practice. Method A search strategy and eligibility criteria were utilized to include articles specifically related to hearing aid fitting and follow-up procedures that are involved in consultations for the rehabilitation of adults, where the service was provided by the clinician by teleaudiology. A search using key words and Medical Subject Headings (MeSH) was conducted on the main electronic databases that index health-related studies. The included studies were assessed using validated evaluation tools for methodological quality, level of evidence, and grade recommendations for application into practice. Results Fourteen studies were identified as being within the scope of this review. The evaluation tools showed that none of these studies demonstrated either a strong methodological quality or high level of evidence. Analysis of evidence identified 19 activities, which were classified into service outcomes categories of feasibility, barriers, efficiency, quality, and effectiveness. Recommendations could be made regarding the (a) feasibility, (b) barriers, and (c) efficiency of teleaudiology for the rehabilitation of hearing loss with hearing aids. Conclusion This review provides up-to-date evidence for teleaudiology hearing aid services in new and experienced hearing aid users in different practice settings. Findings direct future research priorities to strengthen evidence-based practice. There is a need for further studies of many aspects of teleaudiology services for rehabilitation with hearing aids to support their implementation into clinical practice. Supplemental Material https://doi.org/10.23641/asha.6534473
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Shanks, Sarah, Alessandra Morelli, Elena Ardines, Gillian Holdsworth, and Paula Baraitser. "Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation." JMIR mHealth and uHealth 8, no. 8 (August 20, 2020): e17191. http://dx.doi.org/10.2196/17191.
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Background Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support. Objective The aim of this study was to quantify the number of messages generated through user interaction with a two-way SMS text messaging support service within an online sexual health service and to thematically explore the content of the messages and type of support required to facilitate self-management. Methods The content of all SMS text messages received by an online sexual health service was analyzed from April 4, 2018, to July 5, 2018. Messages were classified as being either administrative or clinical in nature and service or user initiated. For those messages that were both clinical and user initiated, a qualitative thematic analysis was completed to fully describe the content of the interactions. Results A total of 267 actionable messages were generated per 1000 orders requested through the service. Of the 8562 messages, 5447 (63.62%) messages were administrative and 3115 (36.38%) were clinical. Overall, 4306 of the 8562 messages (50.29%) responded to service-generated queries reflecting the public health and clinical responsibilities of an online provider, and 4256 (49.71%) were user-generated queries, demonstrating a willingness by users to proactively engage with a two-way SMS text messaging support service. Of the 3115 clinical messages, 968 (31.08%) clinical messages were user initiated and shared personal and complex clinical information, including requests for help with the self-testing process and personalized clinical advice relating to symptoms and treatment. Conclusions This study demonstrates the willingness of users of an online sexual health service to engage with two-way SMS text messaging and provides insight into the quantity and nature of the support required to facilitate service delivery and self-care. Further work is required to understand the range of clinical problems that can be managed within this medium.
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Orava, Taryn, Steve Manske, and Rhona Hanning. "Support for healthy eating at schools according to the comprehensive school health framework: evaluation during the early years of the Ontario School Food and Beverage Policy implementation." Health Promotion and Chronic Disease Prevention in Canada 37, no. 9 (September 2017): 303–12. http://dx.doi.org/10.24095/hpcdp.37.9.05.
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Introduction Provincial, national and international public health agencies recognize the importance of school nutrition policies that help create healthful environments aligned with healthy eating recommendations for youth. School-wide support for healthy living within the pillars of the comprehensive school health (CSH) framework (social and physical environments; teaching and learning; healthy school policy; and partnerships and services) has been positively associated with fostering improvements to student health behaviours. This study used the CSH framework to classify, compare and describe school support for healthy eating during the implementation of the Ontario School Food and Beverage Policy (P/PM 150). Methods We collected data from consenting elementary and secondary schools in a populous region of Ontario in Time I (2012/13) and Time II (2014). Representatives from the schools completed the Healthy School Planner survey and a food environmental scan (FES), which underwent scoring and content analyses. Each school’s support for healthy eating was classified as either “initiation,” “action” or “maintenance” along the Healthy School Continuum in both time periods, and as “high/increased,” “moderate” or “low/decreased” within individual CSH pillars from Time I to Time II. Results Twenty-five school representatives (8 elementary, 17 secondary) participated. Most schools remained in the “action” category (n = 20) across both time periods, with varying levels of support in the CSH pillars. The physical environment was best supported (100% high/increased support) and the social environment was the least (68% low/decreased support). Only two schools achieved the highest rating (maintenance) in Time II. Supports aligned with P/PM 150 were reportedly influenced by administration buy-in, stakeholder support and relevancy to local context. Conclusion Further assistance is required to sustain comprehensive support for healthy eating in Ontario school food environments.
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Malin, Nigel, Jane Tunmore, and Angela Wilcock. "How far does a whole family approach make a difference." Social Work and Social Sciences Review 17, no. 2 (October 10, 2014): 63–92. http://dx.doi.org/10.1921/swssr.v17i2.549.
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This article reports findings from a study to support the inclusion of a Whole Family Approach (WFA) within policy and provision for children and families conducted in one large northern local authority in England. In recent years mainly from research and good practice elsewhere WFA had been seen to offer opportunities to focus on shared needs, developing strengths and assessing risk factors. The principal aim was to design an evaluation framework to enable partners to assess and measure progress in the delivery of a WF strategy. Methods included individual interviews with professionals and managers (N=22) on knowledge and experience of WFA, for example their understanding of multi-agency work, along with their evidence of adopting a WFA approach. Findings demonstrate the process of how an evaluation framework was constructed based on adapting preexisting outcome-focused 'models' used to evaluate functions of partnership-working along with indigenous sources. The first type of 'model' entailed a number of dimensions including Vision and Strategy, Partnership Dynamics, Impact and Performance Measurement. The second had two key features: it drew upon the idea of realist evaluation, a paradigm used by practitioner researchers where the focus is upon identifying mechanisms that explain how an action affects outcomes in particular contexts; and the 'model' had been applied extensively to an analysis of family intervention projects. What has emerged is an evaluation framework characterised by a number of key 'signifiers' each of which is populated by a series of questions. The framework embraces introducing changes to the culture of planning and delivering services, placing building family strengths at centre-stage.
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Turan, Janet M., Abigail M. Hatcher, Merab Odero, Maricianah Onono, Jannes Kodero, Patrizia Romito, Emily Mangone, and Elizabeth A. Bukusi. "A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya." AIDS Research and Treatment 2013 (2013): 1–10. http://dx.doi.org/10.1155/2013/736926.
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Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV). We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya.Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups (n=2groups) and in-depth interviews (n=25) with healthcare workers and community members.Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37%) reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting.Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa.
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Gilbert, Anthony William, Joe C. T. Billany, Ruth Adam, Luke Martin, Rebecca Tobin, Shiv Bagdai, Noreen Galvin, et al. "Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative." BMJ Open Quality 9, no. 2 (May 2020): e000985. http://dx.doi.org/10.1136/bmjoq-2020-000985.
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BackgroundThe COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.Local problemThe Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH.MethodsThe COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles.ResultsFollowing the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected.ConclusionsThis report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19.RegistrationThis project was submitted to the RNOH’s Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).
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Mah, Pascal Muam. "Analysis of Artificial Intelligence and Natural Language Processing Significance as Expert Systems Support for E-Health Using Pre-Train Deep Learning Models." Acadlore Transactions on AI and Machine Learning 1, no. 2 (December 31, 2022): 68–80. http://dx.doi.org/10.56578/ataiml010201.
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Artificial intelligence (AI) and natural language processing (NLP) are relentless technologies for healthcare that can support a strong and secure digital system with embedded applications of internet of things (IoTs). The study tried to build an artificial intelligence-natural language processing cluster system. In the system, rich content is extracted using parts of speech and then classified into an understandable dataset. The unavailable uniqueness systems with standardize process and procedures for artificial intelligence and natural language processing across different systems to support E-healthcare sector is a big challenge for nations and the world at large. Aim to train a cluster system that extract rich content and fit into a deep learning model frame to enable interpretation of the dataset for healthcare needs through a fast and secure digital system. The study uses (behavior-oriented driven and influential functions) to determine the significance of AI and NLP on E-health. Based on a selective scorings method, a rate of 1 out of 5 grading was developed called the Key Benefits score. The behavior-oriented drive and influential function allows an in-depth evaluation of E-health based on the selection of text content applied to the sample proposed study. Results show a score of 3.947 scale significance of NLP and AI on E-health. The study concluded that well-defined artificial intelligence and natural language processing applications are perfect areas that advance positive results in healthcare electronic services.
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Njiro, Belinda Jackson, Harrieth Peter Ndumwa, Charles Joseph Msenga, Thomas Kawala, Ezekiel Matola, Juhudi Mhonda, Hillary Corbin, Omary Ubuguyu, and Samuel Likindikoki. "Depression, suicidality and associated risk factors among police officers in urban Tanzania: a cross-sectional study." General Psychiatry 34, no. 3 (June 2021): e100448. http://dx.doi.org/10.1136/gpsych-2020-100448.
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BackgroundThe WHO has classified depression as a disease of public concern. Police officers are a particular subpopulation group that is at an increased risk for mental health problems. This study examined the prevalence of depression, suicidality and associated risk factors among police officers in urban Tanzania.AimsThe aim of this study was to examine the prevalence of depression, suicidality and associated risk factors among police officers in Tanzania.MethodsA cross-sectional study was conducted between April 2019 and October 2020 among 550 participants in Dar es Salaam recruited using a multistage cluster sampling technique. The Patient Health Questionnaire-9 was used to screen for depression and suicidality. The Interpersonal Support Evaluation List-12 tool was used to measure perceived social support. Descriptive statistics were summarised using frequencies and percentages. Bivariate and multivariate analyses were used to establish associations between predictors of interest, depression and suicidality.ResultsThere were 497 participants in the study. Of these, 76.6% (376 of 491) were men, and the median (IQR) age was 37.0 (17) years. Around 19.8% (96 of 486) of the police officers screened positive for depression and 15.4% (75 of 413) for suicidality. A significant proportion was either moderately (29 of 96, 30.2%) or severely depressed (8 of 75, 10.7 %). Of those who experienced suicidal thoughts, 10.7% (8 of 75) reported having daily suicidal thoughts. Perceiving low social support was associated with an increased risk of reporting depression (adjusted OR (aOR): 28.04, 95% CI: 8.42 to 93.37, p<0.001) and suicidality (aOR: 10.85, 95% CI: 3.56 to 33.08, p<0.001) as compared with those with high perceived social support.ConclusionThe magnitude of depression and suicidality among police officers in urban Tanzania is alarmingly high. The study findings indicate the need for routine screening for depression and suicidality among police officers and design appropriate mental health responsive services in this population.
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Halpern, Michael T., Hamlet Gasoyan, and William E. Aaronson. "Metrics to evaluate the performance of cancer center leadership." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 10. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.10.
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10 Background: Cancer centers are diverse health care organizations that involve clinicians and researchers focused on understanding, treating, and controlling cancer in the populations they serve. While there are many metrics used to evaluate cancer center performance, few standardized measures have been identified to evaluate the performance of cancer center leadership. The goal of this manuscript is to systematically identify, compare, and categorize metrics used to evaluate the leadership of U.S. cancer centers. Methods: We performed a structured, systematic electronic search of peer-reviewed journals using Medline to identify English language articles discussing metrics used to evaluate cancer center leadership. Identified studies were reviewed by two independent reviewers to determine appropriateness for inclusion. Metrics were classified using ten a priori-defined categories of evaluation for data abstraction. Results: We included 34 manuscripts in this review. The most commonly-discussed evaluation metric category is organizational strategy/planning (31 of the 34 papers), followed by leader characteristics (25 papers), clinical performance (21), and facility characteristics (20). Organizational strategy/planning include governance structure; strategic development; quality assurance/improvement; mission/vision; business planning; and program development. Leader characteristic metrics include communication; vision/strategic thinking; personal skills; team coordination; leadership style; and staff development. Clinical Performance metrics focus on delivery of and outcomes from clinical services while facility characteristics include space allocation and access to support services. Conclusions: The metrics reviewed and synthesized in this report may be considered measurable outcomes to evaluate whether cancer center leadership demonstrates key competencies. Additional research is needed to explore the link between metrics used to evaluate cancer center leaders, the desired competencies for healthcare leaders, and objective measures of whether a cancer center is “successful”.
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Azevedo, Salome, Teresa Cipriano Rodrigues, and Ana Rita Londral. "Domains and Methods Used to Assess Home Telemonitoring Scalability: Systematic Review." JMIR mHealth and uHealth 9, no. 8 (August 19, 2021): e29381. http://dx.doi.org/10.2196/29381.
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Background The COVID-19 pandemic catalyzed the adoption of home telemonitoring to cope with social distancing challenges. Recent research on home telemonitoring demonstrated benefits concerning the capacity, patient empowerment, and treatment commitment of health care systems. Moreover, for some diseases, it revealed significant improvement in clinical outcomes. Nevertheless, when policy makers and practitioners decide whether to scale-up a technology-based health intervention from a research study to mainstream care delivery, it is essential to assess other relevant domains, such as its feasibility to be expanded under real-world conditions. Therefore, scalability assessment is critical, and it encompasses multiple domains to ensure population-wide access to the benefits of the growing technological potential for home telemonitoring services in health care. Objective This systematic review aims to identify the domains and methods used in peer-reviewed research studies that assess the scalability of home telemonitoring–based interventions under real-world conditions. Methods The authors followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and used multiple databases (PubMed, Scopus, Web of Science, and EconLit). An integrative synthesis of the eligible studies was conducted to better explore each intervention and summarize relevant information concerning the target audience, intervention duration and setting, and type of technology. Each study design was classified based on the strength of its evidence. Lastly, the authors conducted narrative and thematic analyses to identify the domains, and qualitative and quantitative methods used to support scalability assessment. Results This review evaluated 13 articles focusing on the potential of scaling up a home telemonitoring intervention. Most of the studies considered the following domains relevant for scalability assessment: problem (13), intervention (12), effectiveness (13), and costs and benefits (10). Although cost-effectiveness was the most common evaluation method, the authors identified seven additional cost analysis methods to evaluate the costs. Other domains were less considered, such as the sociopolitical context (2), workforce (4), and technological infrastructure (3). Researchers used different methodological approaches to assess the effectiveness, costs and benefits, fidelity, and acceptability. Conclusions This systematic review suggests that when assessing scalability, researchers select the domains specifically related to the intervention while ignoring others related to the contextual, technological, and environmental factors, which are also relevant. Additionally, studies report using different methods to evaluate the same domain, which makes comparison difficult. Future work should address research on the minimum required domains to assess the scalability of remote telemonitoring services and suggest methods that allow comparison among studies to provide better support to decision makers during large-scale implementation.
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Khan, Arifuzzaman, Kalie Green, Gulam Khandaker, Sheleigh Lawler, and Coral Gartner. "How can a coordinated regional smoking cessation initiative be developed and implemented? A programme logic model to evaluate the ‘10,000 Lives’ health promotion initiative in Central Queensland, Australia." BMJ Open 11, no. 3 (March 2021): e044649. http://dx.doi.org/10.1136/bmjopen-2020-044649.
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ObjectiveThis study used a programme logic model to describe the inputs, activities and outputs of the ‘10,000 Lives’ smoking cessation initiative in Central Queensland, Australia.DesignA programme logic model provided the framework for the process evaluation of ‘10,000 Lives’. The data were collected through document review, observation and key informant interviews and subsequently analysed after coding and recoding into classified themes, inputs, activities and outputs.SettingThe prevalence of smoking is higher in the Central Queensland region of Australia compared with the national and state averages. In 2017, Central Queensland Hospital and Health Services set a target to reduce the percentage of adults who smoke from 16.7% to 9.5% in the Central Queensland region by 2030 as part of their strategic vision (‘Destination 2030’). Achieving this target is equivalent to 20,000 fewer smokers in Central Queensland, which should result in 10,000 fewer premature deaths due to smoking-related diseases. To translate this strategic goal into an actionable smoking cessation initiative, the ‘10,000 Lives’ health promotion programme was officially launched on 1 November 2017.ResultThe activities of the initiative coordinated by a senior project officer included building clinical and community taskforces, organising summits and workshops, and regular communications to stakeholders. Public communication strategies (e.g., Facebook, radio, community exhibitions of ‘10,000 Lives’ and health-related events) were used to promote available smoking cessation support to the Central Queensland community.ConclusionThe ‘10,000 Lives’ initiative provides an example of a coordinated health promotion programme to increase smoking cessation in a regional area through harnessing existing resources and strategic partnerships (e.g., Quitline). Documenting and describing the process evaluation of the ‘10,000 Lives’ model is important so that it can be replicated in other regional areas with high prevalence of smoking.
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Ibrahim, A., S. J. Alarfaj, A. Alsantly, D. Alfaran, M. Alenezi, and R. Almutairi. "Community pharmacists’ experiences and beliefs towards providing pharmacy services to deaf and hard of hearing patients: a mixed-method study in Riyadh, Saudi Arabia." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i28—i29. http://dx.doi.org/10.1093/ijpp/riac019.038.
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Abstract Introduction Provision of pharmacy services to patients requires the pharmacist to well communicate with the patients. Research has shown that healthcare providers, including community pharmacists, face many challenges while providing services to deaf and hard-of-hearing patients (DHOH). Aim To investigate community pharmacists’ experiences and beliefs about providing pharmacy services to DHOH in Riyadh, Saudi Arabia. Methods This was a sequential explanatory mixed-method study involving a survey and semi-structured interviews. At first, a web-based, self-administered survey was disseminated to community pharmacists in Riyadh, Saudi Arabia during the period October to November 2020. The survey was disseminated through the official twitter account of Saudi Pharmaceutical Society. Two reminders were sent. It was made clear that the survey targeted community pharmacists working in Riyadh city. To calculate an appropriate sample size, according to Hair et al, the general rule to have a minimum sample size would be five observations per variable (5:1), and an acceptable sample size would be ten observations per variable (10:1). In this survey, there are 16 items, and hence the acceptable sample size was 160 participants. The semi-structured telephone-based interviews were conducted with a purposive sample of survey respondents to gather in-depth information on experiences, beliefs, and barriers about providing pharmacy services to DHOH. The interviews were conducted until saturation occurred. Survey data was analysed using Statistical Package for Social Sciences (SPSS version 24), and the semi-structured interviews were analysed by Framework analysis. Results A total of 175 community pharmacists completed the survey. The majority were: male (84.6%), aged between 25 to 35 years (74.9%). Of the respondents, 32.2% and 29.1% had experience in community pharmacy of 1-5 and 6-10 years, respectively. The number of DHOH patients the pharmacists met during the past 6 months were as follows: 68 (38.9%) pharmacists met 1-2 patients, 71 (40.6%) %) pharmacists met 3-4 patients, and 19 (11%) %) pharmacists met ≥ 5 patients. The provided services included: prescription medications (by 82.9%), counselling on prescription medications (by 56.6%), OTC medication dispensing (by 4.3%), and counselling on OTC medications (by 52.6%). Forty participants (22.8%) reported their awareness of the basics of Saudi sign language (SSL). Of the participants, 101 (57.7%) believed that they have handled communication barriers appropriately, while 61(35%) acknowledged unmanageable communication barriers. Among the main barriers identified were the lack of knowledge of the basics of SSL. (70.9%) and the inability to recognize disability (52.6%). The semi-structured interviews further explored pharmacists’ experiences and views on providing such a service. Of the main themes emerged were: (1) Experience; interviewees preferred written communication with DHOH patients regardless of their literacy level, while spontaneous hand gesturing was the least preferred method of communication, and they also acknowledged that their roles in providing services, to the DHOH, need to be improved (2) Beliefs; interviewees believed that awareness of the basics of SSL is important to ensure safe medication use. The barriers emerged from the interview were classified as pharmacist-related, system-related, and patient-related. Conclusion To our knowledge, this is the first study of its kind to be conducted in Saudi Arabia. The study highlighted that when providing pharmacy services to DHOH patients, community pharmacists encountered multiple barriers. These barriers need to be addressed for better support and provision of pharmacy services to DHOH. Further studies with large sample size, are warranted to better understand the situation. References (1) Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Harlow: Pearson Education Limited; 2014 (2) Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009 Mar 22;40(1):4-11. (3) Ferguson MC, Shan L. Survey evaluation of pharmacy practice involving deaf patients. Journal of pharmacy practice. 2016 Oct;29(5):461-6.
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Muellenbach, Joanne M. "A Pilot to Initiate Research Data Management Services Within Academic Libraries Helps Librarians to Learn About, Engage With, and Enhance Skills Within Their Research Communities." Evidence Based Library and Information Practice 16, no. 1 (March 16, 2021): 104–6. http://dx.doi.org/10.18438/eblip29879.
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A Review of: Read, K. B, Koos, J., Miller, R. S., Miller, C. F., Phillips, G. A., Scheinfeld, L., & Surkis, A. (2019). A model for initiating research data management services at academic libraries. Journal of the Medical Library Association, 107(3), 432–441. https://doi.org/10.5195/jmla.2019.545 Abstract Objectives – To initiate or expand research data management (RDM) services within the participating libraries serving health sciences populations. Design – Case report. Setting – Six institutions consisting of three academic health sciences and three university libraries within the National Network of Libraries of Medicine Middle Atlantic Region in the United States of America. Subjects – Between two and eight librarians participated from each institution, for a total of twenty-six librarian participants. Methods – Pre-pilot phone interviews were conducted and included open-ended questions about RDM services, the library’s motivation for participating, and their degree of institutional commitment. To deepen their understanding of RDM, the participants were required to complete eight educational modules that included text, videos, and quizzes. The participating institutions received data interview questions to connect with their research community to be better informed about their attitudes, language, and practices. The participants also received a Teaching Toolkit, complete with slides, a script, and an attendee evaluation form. The participants were provided with a data series, consisting of branded classes for teaching over a designated period with instructors from within and outside of the library. Collaboration with library partners was encouraged as was the use of a focused marketing plan. In fact, a major component of the pilot was the expert support, provided through biweekly meetings that included marketing tips and presentations on such topics as clinical research data management and data visualization. Finally, post-pilot program interviews were conducted, and the open-ended questions covered the pilot program as a whole and its individual components. Main Results – Of the six participating institutions, five institutions rated the RDM educational modules very positively. Conducting data interviews was valuable for all six institutions because it allowed the librarians to meet with researchers, build relationships, and use what they learned to develop RDM services for the future. The Teaching Toolkit was rated positively by the six institutions, especially for its adaptability, the time saved over developing the content from scratch, and its usability. Finally, the two institutions that held the data series courses stated that the series succeeded in further marketing the RDM services developed by the library. Conclusion – The pilot project met its objectives: the librarians at the participating institutions completed the educational modules, administered the data interviews, and taught an RDM foundations class based on the Teaching Toolkit. In addition, a data series was hosted at two institutions. The components of the pilot project had the intended results at each institution, and the classes were reviewed favorably. Based on the pilot participants’ positive outcomes, the authors are certain that the freely available program materials would achieve success elsewhere.
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Mallhi, Tauqeer Hussain, Naveed Ahmad, Muhammad Salman, Nida Tanveer, Shahid Shah, Muhammad Hammad Butt, Ahmed D. Alatawi, et al. "Estimation of Psychological Impairment and Coping Strategies during COVID-19 Pandemic among University Students in Saudi Arabia: A Large Regional Analysis." International Journal of Environmental Research and Public Health 19, no. 21 (November 1, 2022): 14282. http://dx.doi.org/10.3390/ijerph192114282.
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Background: The COVID-19 pandemic and associated restrictive measures have substantially affected educational processes around the globe, resulting in psychological distress among students. The mental health of students in higher education is of paramount importance, and the COVID-19 pandemic has brought this vulnerable population into renewed focus. In this context, the evaluation of students‘ mental health at educational institutes has gained invaluable popularity during the COVID-19 pandemic. This study aimed to ascertain the psychological health and coping strategies among students from a higher education institute in Saudi Arabia. Methods: An online study instrument was used to assess anxiety (Generalized Anxiety Disorder-7, GAD-7), depression (Patient Health Questionnaire-9, PHQ-9), post-traumatic stress disorder—PTSD (Impact of Event Scale-Revised, IES-R) and coping strategies (Brief-COPE). The severity of the psychological distress was classified as per the scoring criteria and correlated with demographics using appropriate statistical methods. Results: Of 1074 students (age 21.1 ± 2.1 years), 12.9% and 9.7% had severe anxiety and depression, respectively. The mean anxiety and depression scores were 7.50 ± 5.51 and 9.31 ± 6.72, respectively. About one-third (32%) of students reported suicidal ideation, with 8.4% students having such thoughts nearly every day. The average PTSD score was 21.64 ± 17.63, where avoidance scored higher (8.10 ± 6.94) than intrusion and hyperarousal. There was no association of anxiety, depression and PTSD score with the demographics of the study participants. Religious/spiritual coping (5.43 ± 2.15) was the most adoptive coping mechanism, followed by acceptance (5.15 ± 2.10). Male students were significantly (p < 0.05) associated with active copings, instrumental support, planning, humor, acceptance and religious coping. Substance use was the least adopted coping strategy but practiced by a considerable number of students. Conclusions: The long-lasting pandemic situation, onerous protective measures and uncertainties in educational procedures have resulted in a high prevalence of psychological ailments among university students, as indicated in this study. These findings accentuate the urgent need for telepsychiatry and appropriate population-specific mental health services to assess the extent of psychological impairment and to leverage positive coping behaviors among students.
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Tanabe, Paula, Ted Wun, Victoria Thornton, Knox Todd, and John S. Lyons. "Development of a Decision Support Tool to Guide Management of Adults with Sickle Cell Disease: The Emergency Department Sickle Cell Assessment of Strengths and Needs (ED-SCANS)." Blood 114, no. 22 (November 20, 2009): 1413. http://dx.doi.org/10.1182/blood.v114.22.1413.1413.
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Abstract Abstract 1413 Poster Board I-436 Objectives: There are relatively few centers across the United States that either specialize in SCD care or have day hospitals where patients can be evaluated and urgently treated for acute pain crises. While most patients come to the ED for management of an acute pain crisis, SCD patients are at risk for many life-threatening complications. Most patients with SCD require an ED visit at some point. The complexity of SCD warrants a comprehensive assessment in the emergency department. While it may be challenging to conduct such an assessment in the ED, a succinct decision support tool may help guide clinicians in the performance of such an assessment. The benefits of such an assessment would identify unmet patient needs and help guide ED management and referrals. The goal of this project was to develop a brief, easy to use tool that guides the emergency clinicians in the identification of such needs and aid in accomplishing the following goals: 1) rapidly and aggressively manage ED pain, 2) identify other life-threatening conditions, 3) decrease hospital admission rates, 4) decrease return visits to the ED, 5) identify and increase the number of referrals made from the ED setting, and 6) increase both patient and clinician satisfaction with the ED experience. Methods: A series of seven clinician and patient focus groups were conducted in four cities across the United States (Chicago, Denver, Durham, and New York) to obtain key stakeholder input. Visits at three SCD centers of excellence (University of Colorado Denver, Duke University, Virginia Commonwealth University) were conducted, a literature search was conducted, and the PI attended SCD clinics to observe practice patterns with sickle cell experts at the University of Illinois and University of Chicago sickle cell clinics. Focus group data was analyzed using qualitative methods and is reported elsewhere. All data was synthesized and a draft tool was created and reviewed by outside experts. Revisions were made. Results: The following six key decisions were identified as being critical in achieving the tools aims: (1) what is the correct triage level, (2) how should pain be treated, (3) does the patient require a diagnostic work-up, (4) should the patient be admitted to the hospital, (5) if discharged home, is there a need for analgesic prescriptions, and (6) does the patient need a referral to a sickle cell expert or mental health or social services? Supporting data elements for each decision were also identified and included as part of the tool which will be formulated into an easy to use algorithm. Data elements include key history and physical indicators of a potential high risk situation necessitating further evaluation, pain assessment and history of analgesic use, relationship with a sickle cell expert, ED and hospital utilization history, and evaluation of psychosocial needs (self-report of anxiety or depression, work/employment status, home situation). Conclusions: Critical decisions and associated supporting elements to facilitate ED management were identified. Future work will involve finalizing and testing this communimetric tool, which will guide emergency department evaluation and management, as well as guide analgesic management in real time. Disclosures: Tanabe: NIH, and Mayday Fund: Research Funding. Todd: NIH: Research Funding; Xanodyne: Consultancy; Merck: Consultancy; Alpharma: Consultancy; Abbott: Consultancy; Baxter Healthcare: Consultancy; Fralex Therapeutics: Consultancy; Intranasal Therapeutics: Consultancy; Baxter Health: Research Funding; Roxro: Consultancy.
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Yuniastuti, Ari. "Empowerment Of Pospaud Cades In Management Of Posture "Melati" Cepoko Gunungpati Semarang." Jurnal Berkarya Pengabdian Masyarakat 1, no. 2 (November 23, 2019): 149–59. http://dx.doi.org/10.24036/jba.v1i2.20.
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PosPAUD is a form of early childhood education services (PAUD) whose implementation is integrated with the services of Bina Keluarga Balita (BKB) and Posyandu. PosPAUD "Melati" is one of the PAUD Posts in Gunungpati Subdistrict. Based on PosPAUD data "Melati" Getas Cepoko village, the number of children active in PosPAUD aged 0-6 years in 2017 reached 25 children, while in 2018 active PAUD students were 18 people, there was a decrease in the number of community participation in PAUD activities. Likewise in the Posyandu activities which are held routinely on Saturdays on the first week of each month, the longer the number of people who come there is less The main problems faced by this pospaud include the limited number of cadres, the low knowledge and skills of cadres about nutrition and health and nutritional supplementary feeding (PMT) based on local food ingredients, the limited facilities available, the lack of knowledge about administrative order and active-creative learning. Community service methods are applied through pospaud cadre training, and assistance in the implementation of pospaud. Pospaud cadre empowerment activities carried out for 4 months, contributed 1). Increased cadre knowledge in managing PosPAUD; 2) Posyandu cadre skills in providing counseling and counseling about nutrition and health to children participating in PosPAUD and mothers of children under five; 3) Increased knowledge of PosPAUD cadres about nutritional supplementary feeding (PMT) based on local food ingredients; 4) PosPAUD cadre skills in making PMT (Supplementary Feeding) increased, and cadres could innovate types of PMT based on local food ingredients; 5) PosPAUD room is more comfortable and attractive; 6) Establishment of Family Medicine Park (TOGA). The results of the posyandu cadre empowerment activities showed an average initial knowledge of posyandu cadres on various aspects of being cured by 40.45%; the average posyandu cadre final knowledge on various aspects of being educated and trained is 95.25%; thus increasing the final evaluation results by 54.80% (classified in the medium category). The equipment assistance provided is able to support the smooth operation of the Melati pospaud activities.
Keyword : pospaud, nutrition, supplmenetray feeding
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Luke, Carly R., Katherine Benfer, Leeann Mick-Ramsamy, Robert S. Ware, Natasha Reid, Arend F. Bos, Margot Bosanquet, and Roslyn N. Boyd. "Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol." BMJ Open 12, no. 1 (January 2022): e053646. http://dx.doi.org/10.1136/bmjopen-2021-053646.
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IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are ‘at risk’ of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for identifying infants ‘at risk’ of a later diagnosis of adverse NDO or NDD will be determined.Methods and analysisAboriginal and/or Torres Strait Islander infants born in Queensland, Australia (birth years 2020–2022) will be invited to participate. Infants aged <9 months corrected age (CA) will undergo screening using the (1) General Movements Assessment (GMA); (2) Hammersmith Infant Neurological Examination (HINE); (3) Rapid Neurodevelopmental Assessment (RNDA) and (4) Ages and Stages Questionnaire-Aboriginal adaptation (ASQ-TRAK). Developmental outcomes at 12 months CA will be determined for: (1) neurological (HINE); (2) motor (Peabody Developmental Motor Scales 2); (3) cognitive and communication (Bayley Scales of Infant Development III); (4) functional capabilities (Paediatric Evaluation of Disability Inventory-Computer Adaptive Test) and (5) behaviour (Infant Toddler Social and Emotional Assessment). Infants will be classified as typically developing or ‘at risk’ of an adverse NDO and/or specific NDD based on symptomology using developmental and diagnostic outcomes for (1) CP (2) ASD and (3) FASD. The effects of perinatal, social and environmental factors, caregiver mental health and clinical neuroimaging on NDOs will be investigated.Ethics and disseminationEthics approval has been granted by appropriate Queensland ethics committees; Far North Queensland Health Research Ethics Committee (HREC/2019/QCH/50533 (Sep ver 2)-1370), the Townsville HHS Human Research Ethics Committee (HREC/QTHS/56008), the University of Queensland Medical Research Ethics Committee (2020000185/HREC/2019/QCH/50533) and the Children’s Health Queensland HHS Human Research Ethics Committee (HREC/20/QCHQ/63906) with governance and support from local First Nations communities. Findings from this study will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberACTRN12619000969167.
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Benger, Jonathan, Heather Brant, Arabella Scantlebury, Helen Anderson, Helen Baxter, Karen Bloor, Janet Brandling, et al. "General practitioners working in or alongside the emergency department: the GPED mixed-methods study." Health and Social Care Delivery Research 10, no. 30 (October 2022): 1–156. http://dx.doi.org/10.3310/hepb9808.
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Background Emergency care is facing a steadily rising demand. In response, hospitals have implemented new models of care that locate general practitioners in or alongside the emergency department. Objectives We aimed to explore the effects of general practitioners working in or alongside the emergency department on patient care, the primary care and acute hospital team, and the wider system, as well as to determine the differential effects of different service models. Design This was a mixed-methods study in three work packages. Work package A classified current models of general practitioners working in or alongside the emergency department in England. We interviewed national and local leaders, staff and patients to identify the hypotheses underpinning these services. Work package B used a retrospective analysis of routinely available data. Outcome measures included waiting times, admission rates, reattendances, mortality and the number of patient attendances. We explored potential cost savings. Work package C was a detailed mixed-methods case study in 10 sites. We collected and synthesised qualitative and quantitative data from non-participant observations, interviews and a workforce survey. Patients and the public were involved throughout the development, delivery and dissemination of the study. Results High-level goals were shared between national policy-makers and local leads; however, there was disagreement about the anticipated effects. We identified eight domains of influence: performance against the 4-hour target, use of investigations, hospital admissions, patient outcome and experience, service access, workforce recruitment and retention, workforce behaviour and experience, and resource use. General practitioners working in or alongside the emergency department were associated with a very slight reduction in the rate of reattendance within 7 days; however, the clinical significance of this was judged to be negligible. For all other indicators, there was no effect on performance or outcomes. However, there was a substantial degree of heterogeneity in these findings. This is explained by the considerable variation observed in our case study sites, and the sensitivity of service implementation to local factors. The effects on the workforce were complex; they were often positive for emergency department doctors and general practitioners, but less so for nursing staff. The patient-streaming process generated stress and conflict for emergency department nurses and general practitioners. Patients and carers were understanding of general practitioners working in or alongside the emergency department. We found no evidence that staff concerns regarding the potential to create additional demand were justified. Any possible cost savings associated with reduced reattendances were heavily outweighed by the cost of the service. Limitations The reliability of our data sources varied and we were unable to complete our quantitative analysis entirely as planned. Participation in interviews and at case study sites was voluntary. Conclusions Service implementation was highly subject to local context and micro-level influences. Key success factors were interprofessional working, staffing and training, streaming, and infrastructure and support. Future work Further research should study the longer-term effects of these services, clinician attitudes to risk and the implementation of streaming. Additional work should also examine the system effects of national policy initiatives, develop methodologies to support rapid service evaluation and study the relationship between primary and secondary care. Trial registration This trial is registered as ISRCTN51780222. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 30. See the NIHR Journals Library website for further project information.
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Lam, Ching Man. "Editorial: “Gender, Family and Parenting in the Chinese Context." Open Family Studies Journal 7, no. 1 (July 30, 2015): 58–59. http://dx.doi.org/10.2174/1874922401507010058.
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“The family” has long been a focus of cross-party attention. While family is perceived as foundational to society’s success, how parents rear their children is perhaps the most conservative or persistent part of concern. While Chinese immigrant families and Chinese families in Asia – in Hong Kong, Macau, Taiwan, mainland China, and elsewhere – are struggling with a socialization process that has emphasized support for traditional values, they are also simultaneously being confronted by modern ideologies and technologies. Professionals have a growing interest in addressing the culturally diverse needs and the gender issues of Chinese families. The theme of this issue of The Open Family Studies Journal, then, is “Gender, family and parenting in the Chinese context”. The heart of this special issue lies in a concern for families, in particular for the challenges posed to families and parenting practices in a changing world. The family, like any social group, is a product of history, culture and context. Because of economic and technological changes, and the increasingly pluralistic nature of our society, both gender relations and family structures have undergone tremendous change, and many challenges await elucidation. The seven papers in this special issue thus feature new perspectives on family, gender and parenting issues. The issue opens with a paper on scale validation. Since intimacy is a construct that has received limited attention in the Chinese context, the first paper, “Intimacy as a distinct construct: validating the intimacy scale among older adults of residential care homes in Hong Kong”, aims to develop a valid measurement for the quality of the relationship between older adults and family caregivers in the Hong Kong Chinese context. The study results demonstrate the reliability and validity of the instrument across samples of older adults. Paper 2 and 3 that follow are qualitative studies adopting cultural perspectives to understand Chinese American immigrant adults and older female survivors of intimate partner violence in Taiwan. In paper 2, “Understanding family connections and help-seeking behavior in Chinese parental lives. These findings illustrate how existentialism provides a new frame of reference and new practice directions for conducting parent-education programs. The final paper titled “Internet supervision and parenting in the digital age: The case of Shanghai” echoes the technological advancement and its impact on parenting. In a changing world, and in a society permeated by the Internet and by nearly instantaneous communication, families constantly need to adapt to different and changing ways of parenting. The paper explores the issue of parenting confidence in supervision of children’s Internet use in Shanghai, China. Multiple-regression models are used to identify factors affecting parents’ confidence about their own parenting. The findings suggest that efforts to assist parents should help them review their attitudes towards the Internet. American immigrant adults who attempt suicide”, the authors investigate beliefs, values and norms in the Chinese family culture and examine Chinese cultural influences on attitudes and beliefs about mental health and mental health services in the immigrant context. Paper 3, “Older female survivors of intimate partner violence in the Taiwanese cultural context” examines the needs of older female IPV survivors in another Chinese cultural context. The findings of both studies reflect the importance of family and the influence of Chinese family culture; they make it clear that traditional family beliefs are still highly valued and hold a prominent position in Chinese culture. The authors of these two papers question the efficacy of service-delivery models based on Western cultures, and they call for ethnically sensitive intervention approaches that incorporate cultural premises into developing viable options for service recipients. Paper 4 is titled “The Macau family-in-transition: the perceived impact of casino employment on family relationships among dealer families”. This paper draws on findings from a qualitative study to explore the impacts of casino employment on family life and family relationships. The family, like other social group, is a product of culture and context, and the specific socio-economic context of Macau poses challenges to dealer families and casino workers in performing their parental role. The paper sheds much-needed light on our understanding of Macau dealer families. The final three papers in this special issue all address the issue of parenting. Paper 5, “Reflective inquiry on professionals’ view on parents and about parenting”, examines professionals’ views of parents, their attitudes and beliefs about parenting, and the values underpinning their practice. The study’s findings on the theme of parent blaming provide an impetus for professionals to reflect on the attitudes and assumptions they hold, and their impact on parents. The paper calls for reflection on parenting work to recognize the difficulties and challenges faced by contemporary families. Paper 6, “Reviving parents’ life momentum: A qualitative evaluation of a parent education program adopting an existential approach”, reports the results of a qualitative analysis of the participants’ perceptions of a parent-education program. The findings of this study demonstrate that a program of this nature can make parents aware of the existential dimensions of being a parent and help them understand the significance of creating meaning in their In fact, family, parenting and gender are vastly contested terms which encompass a range of topics. The seven varied papers recommended for publication in this special issue reflect the considerable attention that we have placed on family, parenting and gender, and also the vision of this special issue. These papers add to the growing body of research and literature, and they provide both food for thought and a platform for discussion. In the last, I offer both my sincere thanks to the authors who have contributed to this special issue, and my gratitude to those who have participated as blind peer reviewers. Their thoughtful comments and criticisms have certainly improved the quality of each and every paper in this special issue.
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Gunnlaugsson, Geir, and Jónína Einarsdóttir. "Monitoring and Evaluation of Health System Strengthening: Iceida’s Development Collaboration in Monkey Bay, Malawi, in 2000-2014." Nordicum-Mediterraneum 11, no. 2 (2016). http://dx.doi.org/10.33112/nm.11.2.2.
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The Icelandic International Development Agency (Iceida) supported the health services in the Monkey Bay area in Mangochi district in Malawi in southern Africa in the period 2000-2011. It included construction of physical structures, logistic, training of health staff, and community health activities. One additional feature included support for the national electronic Health Monitoring Information System (HMIS) in place, with extraction and analysis of data generated by the health services in the area. In this paper, the development of the services will be analysed and discussed. Further, difficulties to find appropriate indicators to monitor health services, in Monkey Bay and elsewhere, will be presented and elaborated upon.
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Jakubowski, Andrea, Caroline Rath, Alex Harocopos, Monique Wright, Alice Welch, Jessica Kattan, Czarina Navos Behrends, Teresa Lopez-Castro, and Aaron D. Fox. "Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation." Harm Reduction Journal 19, no. 1 (July 10, 2022). http://dx.doi.org/10.1186/s12954-022-00654-0.
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Abstract Background Syringe services programs (SSPs) hold promise for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. In 2017, the New York City Department of Health and Mental Hygiene (DOHMH) provided funding and technical assistance to nine SSPs to develop “low-threshold” buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. The aim of this study was to identify barriers to and facilitators of implementing SSP-based buprenorphine services. Methods We conducted 26 semi-structured qualitative interviews from April 2019 to November 2019 at eight SSPs in NYC that received funding and technical assistance from DOHMH. Interviews were conducted with three categories of staff: leadership (i.e., buprenorphine program management or leadership, eight interviews), staff (i.e., buprenorphine coordinators or other staff, eleven interviews), and buprenorphine providers (six interviews). We identified themes related to barriers and facilitators to program implementation using thematic analysis. We make recommendations for implementation based on our findings. Results Programs differed in their stage of development, location of services provided, and provider type, availability, and practices. Barriers to providing buprenorphine services at SSPs included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring buprenorphine providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Challenges also arose from serving a population with unmet psychosocial needs. Implementation facilitators included technical assistance from DOHMH, designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Key recommendations include: (1) health departments should provide support for SSPs in training staff, building health service infrastructure and developing policies and procedures, (2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for frontline staff, and (3) buprenorphine providers should be selected or supported to use a harm reduction approach to buprenorphine treatment. Conclusions Despite encountering challenges, SSPs implemented buprenorphine services outside of conventional OUD treatment settings. Our findings have implications for health departments, SSPs, and other community organizations implementing buprenorphine services. Expansion of low-threshold buprenorphine services is a promising strategy to address the opioid overdose epidemic.
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Vaccaro, F. G., A. Oradini Alecreu, A. Scardoni, B. Frascella, G. P. Vigezzi, A. Odone, and C. Signorelli. "Information and communication technology-based interventions to support healthcare in migrants." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz187.011.
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Abstract Background Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations. Methods We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data. Results Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic. Conclusions Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health. Key messages Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.
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Lima, Rodrigo Fonseca, Maria Inês de Toledo, and Janeth de Oliveira Silva Naves. "Evaluation of hospital pharmacy services: an integrative review." Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde 9, no. 2 (October 9, 2019). http://dx.doi.org/10.30968/rbfhss.2018.092.005.
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Background: Pharmaceutical services performed in the hospital context have specific structure and processes, which should be continuously evaluated because they influence the results obtained.
Objective: To identify, describe and compare studies of evaluation of pharmaceutical services performed in the hospital context.
Methods: Integrative review of articles found in databases SciELO, LILACS, MEDLINE and IBECS, indexed in the period from 2000 to 2016, using the following descriptors: “Hospital Pharmacy Service” and “Evaluation“. The references were analyzed according to year, language, country of publication and type of study and classified according to their focus on the components of the hospital pharmacy service logic model that dealt with the management, selection, programming, acquisition, storage and distribution of medicines, information, pharmacotherapeutic, pharmacotechnical and teaching and research follow-up.
Results: Of the 25 publications, 16 (64%) were in the English language, of which 10 (40%) were in the United States; 17 (70%) studies were published from 2010 to 2016 and 13 (52%) were observational descriptive type. The most discussed component of pharmaceutical services was distribution logistics addressed in 15 publications (60%), followed by the management component addressed by 14 (56%) studies.
Conclusions: The publications emphasized the discussion on drug logistics. Only a few presented discussions on the impact of these services on health care, such as patient safety. Such studies can support the decision-making process and the formulation of strategies aimed at increasing the management capacity and the quality of the service provided.
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Macpherson, Reynold, and Barbara Vann. "Cornwall Foundation Trust’s capacity to implement the government’s children and young people’s mental health strategy." International Journal of Educational Management ahead-of-print, ahead-of-print (August 1, 2019). http://dx.doi.org/10.1108/ijem-02-2019-0039.
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Purpose The purpose of this paper evaluates the capacity of the Cornwall Foundation Trust (CFT) of the National Health Service (NHS) to implement the UK Government’s children and young people’s mental health strategy through its school-based integrated health centre (SBIHC) delivery model. Design/methodology/approach This evaluation uses six case studies of SBIHCs to indicate the general effectiveness of this delivery model and its capacity to implement the three core proposals of the Government’s strategy. The core proposals are: to encourage all schools and colleges to identify and train a designated senior lead (DSL) for mental health; to fund new mental health support teams (MHSTs); and to develop strategies to meet the proposed four-week waiting time for access to specialist NHS mental health services. Findings This evaluation found that the Duchy Health Charity and CFT piloted a new delivery model in three SBIHCs from 2009 that successfully integrated health and educational services to children and adolescents, including general health and well-being and sexual and mental health and, more recently, integrated welfare services. Research limitations/implications The main research implication is that longitudinal case studies of organisational innovations can reveal the subtleties of educational management in context and potentially inform advances elsewhere consistent with national policy developments. Practical implications The main practical implication is that the SBIHCs at Penair Community School, Budehaven Community School, Hayle Community School, Looe Community Academy, Treviglas Community Academy and Wadebridge Community School should each be recognised as a “trailblazer site” in the implementation of the Government’s children and young people’s mental health strategy. Social implications Mandatory secondary education is the last opportunity that the UK society has to embed knowledge, skills and attitudes needed for the life-long self-management of health. The CFT’s SBIHC model trialled since 2009 has successfully integrated health and educational services to children and adolescents, including general health and well-being and sexual and mental health and, more recently, integrated welfare services. Originality/value This evaluation research is unique. It reports that the CFT’s SBIHC model is the first and only organisational innovation at a system level in the UK that has successfully integrated health and education services to children and adolescents.
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Kosiyaporn, Hathairat, Sataporn Julchoo, Mathudara Phaiyarom, Pigunkaew Sinam, Watinee Kunpeuk, Nareerut Pudpong, Pascale Allotey, et al. "Strengthening the migrant-friendliness of Thai health services through interpretation and cultural mediation: a system analysis." Global Health Research and Policy 5, no. 1 (December 2020). http://dx.doi.org/10.1186/s41256-020-00181-0.
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Abstract Background In addition to healthcare entitlements, ‘migrant-friendly health services’ in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand. Methods In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHVs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems. Results The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes. Conclusion Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.
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Olson, Jenny Louise, Becky White, Helen Mitchell, Jennifer Halliday, Timothy Skinner, Deborah Schofield, Jennifer Sweeting, and Natasha Watson. "The design of an evaluation framework for diabetes self-management education and support programs delivered nationally." BMC Health Services Research 22, no. 1 (January 9, 2022). http://dx.doi.org/10.1186/s12913-021-07374-4.
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Abstract Background The aim of this work was to develop a National Evaluation Framework to facilitate the standardization of delivery, quality, reporting, and evaluation of diabetes education and support programs delivered throughout Australia through the National Diabetes Services Scheme (NDSS). The NDSS is funded by the Australian Government, and provides access to diabetes information, education, support, and subsidized product across diverse settings in each state and territory of Australia through seven independent service-providers. This article reports the approach undertaken to develop the Framework. Methods A participatory approach was undertaken, focused on adopting nationally consistent outcomes and indicators, nominating objectives and measurement tools, specifying evaluation processes, and developing quality standards. Existing programs were classified based on related, overarching indicators enabling the adoption of a tiered system of evaluation. Results Two outcomes (i.e., improved clinical, reduced cost) and four indicators (i.e., improved knowledge and understanding, self-management, self-determination, psychosocial adjustment) were adopted from the Eigenmann and Colagiuri national consensus position statement for diabetes education. This allowed for the identification of objectives (i.e., improved empowerment, reduced distress, autonomy supportive program delivery, consumer satisfaction) and related measurement instruments. Programs were categorized as comprehensive, topic-specific, or basic education, with comprehensive programs allocated to receive the highest-level of evaluation. Eight quality standards were developed, with existing programs tested against those standards. Based on the results of testing, two comprehensive (OzDAFNE for people with type 1 diabetes, DESMOND for people with type 2 diabetes), and eight topic-specific (CarbSmart, ShopSmart, MonitorSmart, FootSmart, MedSmart, Living with Insulin, Insulin Pump Workshop, Ready Set Go – Let’s Move) structured diabetes self-management education and support programs were nominated for national delivery. Conclusions The National Evaluation Framework has facilitated consistency of program quality, delivery, and evaluation of programs delivered by multiple service providers across diverse contexts. The Framework could be applied by other service providers who facilitate multiple diabetes education and support programs and could be adapted for use in other chronic disease populations where education and support are indicated.
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Jego, M., J. Abcaya, C. Calvet-montredon, and S. Gentile. "Improving Health Care Management in Primary Care for Homeless People: A Literature Review." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz186.005.
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Abstract Background Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. However, they face multiple difficulties in accessing primary health care and receive less preventive health care than the general population. Methods We performed a literature review that included articles which described and evaluated primary care programs for homeless people. We searched into the MEDLINE, PsycINFO, COCHRANE library, and Cairn.info databases primary articles published between 1 January 2012 and 15 December 2016. We also performed a grey literature search, and we added relative articles as we read the references of the selected articles. We described the main characteristics of the primary care programs presented in the selected articles. Then we classified these characteristics in main categories, as a descriptive thematic analysis. Secondarily, we synthetized the main results about the evaluation of each intervention or organization. Results Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Key messages To improve the health care management of homeless people it seems necessary to priorize multidisciplinary approach, integrated care, involve community health and answer their specific needs. It is necessary to evaluate more non-tailored primary care programs that collaborate with tailored structures.
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Baron, Kristen, James Herbst, Megan McNicol, Emily Stephan, Mahmoud Abdel-Rasoul, and Kelly Wise. "Evaluation of a remote hybrid staffing model for ambulatory clinical pharmacists in a pediatric health system during the COVID-19 pandemic." American Journal of Health-System Pharmacy, January 28, 2022. http://dx.doi.org/10.1093/ajhp/zxac022.
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Abstract Purpose To describe and quantify patient care activities performed by ambulatory clinical pharmacists supporting medical specialty clinics in a pediatric health system utilizing a hybrid staffing model during the coronavirus disease 2019 (COVID-19) pandemic. Methods Five ambulatory clinical pharmacists, integrated within a health-system specialty pharmacy (HSSP), utilized a web-based data collection tool to record time spent performing patient care activities over a 2-week period. Work location (onsite or offsite) of the pharmacist was reported for each activity. Activities were classified as direct or indirect patient care. Direct patient care activities were subcategorized as telemedicine appointments, in-person clinic appointments, HSSP call center work, medication access support, electronic medical record consults, and previsit planning/postvisit documentation. Administrative tasks and precepting were considered indirect patient care activities. Results A total of 1,190 activities were completed, with 77% of all activities performed offsite. Direct and indirect patient care activities accounted for 871 (73.2%) and 319 (26.8%) of total activities, respectively. No activity took longer for the pharmacists to complete offsite versus onsite. Conclusion Using a hybrid staffing model employed by a pediatric health system, ambulatory clinical pharmacists were able to efficiently provide a high volume of direct patient care activities even when working offsite. Rapid adaptation and implementation of telemedicine services was critical for pharmacists to continue to provide essential services within pediatric medical specialty clinics.
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Sheahan, Kate L., Jennifer Orgill-Meyer, Ilene S. Speizer, Siân Curtis, John Paul, Morris Weinberger, and Antonia V. Bennett. "Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria." Reproductive Health 18, no. 1 (February 23, 2021). http://dx.doi.org/10.1186/s12978-021-01105-y.
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Abstract Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.
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Browne, Lalique, Sarah Cooper, Cheick Tiendrebeogo, Frank Bicaba, Alice Bila, Abel Bicaba, and Thomas Druetz. "Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso." Reproductive Health 19, no. 1 (March 18, 2022). http://dx.doi.org/10.1186/s12978-022-01375-0.
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Abstract Background In 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduce a free family planning (FP) policy. This process evaluation aims to identify obstacles and facilitators to its implementation, examine its coverage in the targeted population after six months, and investigate its influence on the perceived quality of FP services. Methods This process evaluation was conducted from November 2019 through March 2020 in the two regions of Burkina Faso where the new policy was introduced as a pilot. Mixed methods were used with a convergent design. Semi-directed interviews were conducted with the Ministry of Health (n = 3), healthcare workers (n = 10), and women aged 15–49 years (n = 10). Surveys were also administered to the female members of 696 households randomly selected from four health districts (n = 901). Results Implementation obstacles include insufficient communication, shortages of consumables and contraceptives, and delays in reimbursement from the government. The main facilitators were previous experience with free healthcare policies, good acceptability in the population, and support from local associations. Six months after its introduction, only 50% of the surveyed participants knew about the free FP policy. Higher education level, being sexually active or in a relationship, having recently seen a healthcare professional, and possession of a radio significantly increased the odds of knowing. Of the participants, 39% continued paying for FP services despite the new policy, mainly because of stock shortages forcing them to buy their contraceptive products elsewhere. Increased waiting time and shorter consultations were also reported. Conclusion Six months after its introduction, the free FP policy still has gaps in its implementation, as women continue to spend money for FP services and have little knowledge of the policy, particularly in the Cascades region. While its use is reportedly increasing, addressing implementation issues could further improve women’s access to contraception.
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Mash, Robert, Julia Blitz, Jill Edwards, and Steve Mowle. "Training of workplace-based clinical trainers in family medicine, South Africa: Before-and-after evaluation." African Journal of Primary Health Care & Family Medicine 10, no. 1 (May 31, 2018). http://dx.doi.org/10.4102/phcfm.v10i1.1589.
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Background: The training of family physicians is a relatively new phenomenon in the district health services of South Africa. There are concerns about the quality of clinical training and the low pass rate in the national examination.Aim: To assess the effect of a five-day course to train clinical trainers in family medicine on the participants’ subsequent capability in the workplace.Setting: Family physician clinical trainers from training programmes mainly in South Africa, but also from Ghana, Uganda, Kenya, Malawi and Botswana.Methods: A before-and-after study using self-reported change at 6 weeks (N = 18) and a 360-degree evaluation of clinical trainers by trainees after 3 months (N = 33). Quantitative data were analysed using the Statistical Package for Social Sciences, and qualitative data wereanalysed thematically.Results: Significant change (p < 0.05) was found at 6 weeks in terms of ensuring safe and effective patient care through training, establishing and maintaining an environment for learning, teaching and facilitating learning, enhancing learning through assessment, and supporting and monitoring educational progress. Family physicians reported that they were better at giving feedback, more aware of different learning styles, more facilitative and less authoritarian in their educational approach, more reflective and critical of their educational capabilities and more aware of principles in assessment. Despite this, the trainees did notreport any noticeable change in the trainers’ capability after 3 months.Conclusion: The results support a short-term improvement in the capability of clinical trainers following the course. This change needs to be supported by ongoing formative assessment and supportive visits, which are reported on elsewhere.
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De Brito, Franciele Guimarães, Elmiro Santos Resende, Aurélia Aparecida de Araújo Rodrigues, Marcelle Aparecida Barros Junqueira, Vívian Ribeiro Barreto, and João Batista Destro Filho. "Demand forecast in the emergency department in Minas Gerais, Brazil." Bioscience Journal 35, no. 5 (August 21, 2019). http://dx.doi.org/10.14393/bj-v35n5a2019-46115.
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This study presents a mathematical model to carry out the demand forecasts in relation to patientes classified as green in the emergency department of a municipality in Minas Gerais, Brazil. In addition, another approach will investigate whether the green patients demand remains the same over the weekend, as compared to the weekdays, since there is no support from Primary Health Care units over the weekend. A retrospective study of the emergency service in the municipality of Monte Carmelo was carried out from January 2014 to December 2017.The time series of the patients classified as green during the host by the nurse, according to the Manchester Triage Scale, was analyzed in the temporal domain for the construction of a parametric model with the purpose of realizing the demand forecast. The Manchester Triage Scale has been adopted in most emergency department as a guiding instrument for risk classification, prioritizing the most serious cases. The data processing was fulfilled using Software R Version 3.4. The ARIMA model (1,1,1) presented a better fit for this forecast. The predictions of this model are values close to those observed for the number of patients seen that ranges from 1780.4 to 1796.6 patients per month. In relation to the demand of patients classified as green at the weekend, it has shown that it is slightly lower than the weekend, but it is still an expressive demand. The application of the models must be seen by the managers as a tool to aid decisions, thus it must support processes of planning, management and evaluation of public policies. In this context, mathematical models for demand forecasting are an instrument for management care and services.
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Desta, Binyam Fekadu, Azeb Abitew, Ismael Ali Beshir, Mesele Damte Argaw, and Sualiha Abdlkader. "Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care." BMC Family Practice 21, no. 1 (December 2020). http://dx.doi.org/10.1186/s12875-020-01337-0.
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Abstract Background Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC – primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. Methods This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. Results Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = − 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. Conclusion District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.
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Titov, I. G., S. F. Goncharov, B. V. Bobiy, and A. V. Akinshin. "Standard Options for Creating a Grouping of Medical Forces and Means in the Organization of Medical and Evacuation Support for the Victims of a Terrorist Attack." Disaster Medicine, April 2022, 20–30. http://dx.doi.org/10.33266/2070-1004-2022-1-20-30.
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The objectives of the study are: to analyze the experience of organizing medical assistance and medical evacuation of victims during terrorist acts committed with the use of conventional means of destruction; to determine standard options for creating a group of medical forces and means, their possible composition and the main tasks to be solved in the implementation of medical and evacuation support. Materials and research methods. Materials of the research: normative and methodical documents regulating the order of medical aid rendering and carrying out medical evacuation of wounded at acts of terrorism; reports of territorial disaster medicine centers on liquidation of medical and sanitary consequences of acts of terrorism classified as emergencies; data of expert evaluation maps on the research theme; scientific works and publications devoted to the organizationa of medical aid rendering and of carrying out medical evacuation. The following scientific methods were applied: content-analysis, expert estimation, logic and information modeling, analytical method. Research results and their analysis. The results of the study of the basic principles of creating a grouping of medical forces and means intended to provide medical assistance and evacuation of victims of terrorist acts with the use of conventional means of destruction are presented. Substantiated propositions on creation of standard variants of echelon grouping of medical forces and means at liquidation of medical and sanitary consequences of terrorist acts were made; composition of medical forces and means, included in each echelon of the grouping, and their main tasks were defined. The results of the research have shown that medical organizers and specialists of the Disaster Medicine Service of the Russian Ministry of Health experience difficulties when creating and determining the order of functioning of a group of medical forces and means involved in medical and evacuation support of injured, especially during large-scale terrorist attacks. It is conditioned by: insufficient knowledge of peculiarities of modern terrorist acts and of factors, influencing the organization of medical aid and medical evacuation; insufficient practical experience of medical specialists; shortcomings in generalization of experience of public health management bodies, medical organizations and formations, participating in liquidation of consequences of such emergency situations; imperfection of normative and methodical base.
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Mousavi, Arefeh, Ali Ardalan, Amirhossein Takian, Abbas Ostadtaghizadeh, Kazem Naddafi, and Alireza Massah Bavani. "Health system plan for implementation of Paris agreement on climate change (COP 21): a qualitative study in Iran." BMC Public Health 20, no. 1 (September 11, 2020). http://dx.doi.org/10.1186/s12889-020-09503-w.
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Abstract Background Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on climate change is a global contract, through which countries have committed themselves to a public health treaty. The agreement has laid the foundation for mitigation and adaptation. This study was conducted to provide an evidence-based framework for policy-making in the health system of Iran in order to reduce the adverse effects of climate change on public health and to increase the adaptation of the health system as a result. Methods This is a qualitative study. We first used Delphi method to extract the components of Paris Agreement on climate change that were related to the functions and policymaking of health system in Iran. Twenty-three experts in health and climate change were identified purposefully and through snowball sampling as participants in Delphi. Data collection instrument was a structured questionnaire. We used SPSS software version 25 for data analysis based on the descriptive indices including the mean, the percentage of consensus above 75%, and the Kendall coordination coefficient. Results Seventy-nine components classified within nine categories were extracted. The most important examples of the implementation of Paris Agreement on climate change in the health system of Iran were: participation in the formulation of strategies for mitigation and adaptation, identifying vulnerable groups, assessing vulnerability, increasing the capacity of health services delivery during extreme events, using early warning systems, using new technologies to increase the adaptation, evaluation of interventions, financial support, increasing the number of researches, increasing the knowledge and skills of staff, and finally public awareness. Conclusions Evidence-based policy-making is pivotal to develop effective programs to control the health effects of climate change. This research provided policy translation and customization of micro and macro provisions of Paris Agreement on climate change, in line with the political context of health system in Iran. Our finding will pave the ground, we envisage, for further steps towards capacity building and enhancement of resiliency of the health system, adaptation interventions, and evaluation, identification of barriers and facilitators for adaptation and decreasing the adverse health effects caused by the climate change, in Iran and perhaps beyond.
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Ferrante, Anna, James Boyd, Tom Eitelhuber, Sean Randall, Adrian Brown, Max Maller, Davie Botes, and Kurt Sibma. "Using data linkage innovation and collaboration to create a cross-sectoral data repository for Western Australia." International Journal of Population Data Science 4, no. 3 (November 19, 2019). http://dx.doi.org/10.23889/ijpds.v4i3.1233.
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Background/rationaleThe Western Australian (WA) government and the Centre for Data Linkage (CDL) at Curtin University are creating a large, de-identified researchable database – the Social Investment Data Resource (SIDR) – to support a key government initiative called Target 120 (T120). T120 delivers targeted early interventions to young offenders and their families to reduce the likelihood of re-offending.
Main AimThe SIDR brings together de-identified data from across government to be used for actuarial assessment and social investment analytics to assess long-term costs and benefits of T120 interventions.
MethodsSIDR adopts a distributed linkage model where linkage workload is shared between the Department of Health Data Linkage Branch who curate WA Data Linkage System (WADLS) and the CDL. Design elements of the model included a common spine (embedded into the infrastructure of both groups), methods for leveraging quality from WADLS, and inclusion of family relationships data from the WA Family Connections database. The linkage model uses a combination of traditional and privacy-preserving record linkage (PPRL) methods. PPRL does not require release of personal identifiers; instead, data is irreversibly hashed prior to release for probabilistic linkage.
The resultant SIDR repository has been designed to be securely and strictly managed. Access is by authorised, approved users only.
ResultsUse of a distributed linkage model, coupled with traditional and PPRL methods, is an innovative yet pragmatic way of delivering data linkage services to a large, cross-sectoral research project. PPRL methods enable inclusion of otherwise excluded datasets in the project. Sharing of workload harnesses linkage capacity and capabilities across the state. The SIDR includes health data, education records, justice, child protection, disability and housing data.
ConclusionSIDR provides a resource for whole-of-government policy development, service evaluation, academic research and social investment analytics for T120 and beyond. The SIDR distributed linkage model has potential for adaptation and use elsewhere.
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Mathis-Edenhofer, Stefan, Florian Röthlin, David Wachabauer, Romana Haneef, Ilana Ventura, and Gerhard Fülöp. "Regional health care profiles – an improved method for generating case studies on the catchment areas of envisaged primary health care units in Austria: a report to the InfAct Joint Action." Archives of Public Health 80, no. 1 (February 14, 2022). http://dx.doi.org/10.1186/s13690-022-00821-6.
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Abstract Background The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. Results We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. Conclusions The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.
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Littlejohn, Jenna, Michael Bowen, Fofi Constantinidou, Piers Dawes, Christine Dickinson, Patricia Heyn, Emma Hooper, et al. "International Practice Recommendations for the Recognition and Management of Hearing and Vision Impairment in People with Dementia." Gerontology, June 4, 2021, 1–15. http://dx.doi.org/10.1159/000515892.
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<b><i>Introduction:</i></b> Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. <b><i>Methods:</i></b> We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the <i>World Health Organization Handbook for Guideline Development</i>. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. <b><i>Results:</i></b> The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, jwhich are classified into 6 domains of “awareness and knowledge,” “recognition and detection,” “evaluation,” “management,” “support,” and “services and policies.” Pragmatic options for implementation for each domain were then developed. <b><i>Conclusion:</i></b> This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.
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Colbachini, Paulo C. M., Fernando A. L. Marson, Andressa O. Peixoto, Luisa Sarti, and Andrea M. A. Fraga. "Air Rescue for Pediatric Trauma in a Metropolitan Region of Brazil: Profiles, Outcomes, and Overtriage Rates." Frontiers in Pediatrics 10 (June 2, 2022). http://dx.doi.org/10.3389/fped.2022.890405.
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Besides ensuring a quick response and transport of trauma victims, helicopter support also involves risks to patients and professionals and has higher operational costs. Studying prehospital triage criteria and their relationship with patient overtriage and outcomes is important, particularly in newly established services and in developing countries with limited health budgets. This could help improve the use of the helicopter rescue and provide better management of the costs and risks related to it. The objective of this study was to determine the epidemiologic and severity profiles of pediatric victims of trauma attended by helicopter in a Brazilian Metropolitan Area to evaluate the outcomes and overtriage rates related to pediatric air rescue in the region. We conducted an observational and retrospective study using 49 hospital and prehospital records from victims of trauma aged <18 years old (yo) assisted by helicopter and then transferred to a tertiary University Hospital. Of the 49 patients, 39 (79.6%) individuals were male, and the mean age was 11.3 yo. Vehicular collisions accounted for 15 (30.6%) of the traumas, and traumatic brain injuries occurred in 28 (57.1%) cases. A total of 29 (59.1%) individuals had severe trauma (Injury Severity Score; ISS >15), and 34 (69.4%) required admission to the intensive care unit. Overtriage varied from 18.4 to 40.8% depending on the criteria used for its definition, being more frequent in individuals aged between 1 and 5 yo. Death occurred in 10 (20.4%) patients. On prehospital evaluation, we classified 29/32 (90.6%) patients with severe trauma according to the Pediatric Trauma Score (PTS ≤8) and 18/25 (72%) according to the Revised Trauma Score (RTS ≤11). Of these, 7/29 (24.1%) and 6/18 (33.3%), respectively, presented ISS <15 at in-hospital evaluation. None of the patients with PTS >8 and 3/7 (42.8%) of those with RTS >11 presented ISS >15. In conclusion, air rescue of pediatric trauma victims was used mainly for critically ill individuals, resulting in rates of overtriage compatible with that found in the literature. PTS showed the lowest rates of overtriage within excellent rates of undertriage.
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Baldelli, Ilaria, Fabio Gallo, Marco Crimi, Piero Fregatti, Lorenzo Mellini, Pierluigi Santi, and Rosagemma Ciliberti. "Experiences of patients with Poland syndrome of diagnosis and care in Italy: a pilot survey." Orphanet Journal of Rare Diseases 14, no. 1 (November 21, 2019). http://dx.doi.org/10.1186/s13023-019-1253-8.
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Abstract Background Poland Syndrome (PS) is a rare congenital malformation involving functional and aesthetic impairments. Early diagnosis and timely therapeutic approaches play an important role in improving the quality of life of patients and kindred. This study aims to explore healthcare experiences of the diagnosis of patients affected by PS and to investigate the factors associated with diagnostic delay in Italy. Results Seventy-two patients affected by PS were asked to fill in a self- administered questionnaire on: a) diagnostic path; b) perceived quality of care received after diagnosis; c) knowledge of the rights and the socio-economic hardships related to their disease; d) evaluation of the integration of various professional skills involved in the diagnostic and therapeutic approach; e) perception of the social support provided by the Italian Association of Poland Syndrome (AISP). The average age at diagnosis was around 14 years; diagnosis was made at birth in only 31.58% of cases. Although typical symptomatology had appeared on average at an early age (4 months), only 23 patients (40.35%) received an early diagnosis (within the first year of life). Just over half of the patients (n = 30) were diagnosed in their region of origin, while 27 were diagnosed elsewhere. Furthermore, 12.28% were self-diagnoses. Among the patients who were diagnosed outside their region, 15 (88.24%) stated they had foregone some visits or treatments owing to costs and/or organizational issues. Conclusions An analysis of the patients’ experiences highlights several gaps and a lack of homogeneity in the diagnostic and therapeutic follow-up of PS patients in Italy. A specific national diagnostic and therapeutic path is essential to guarantee patients complete and appropriate health services, compliant with the ethical principles of non-discrimination, justice and empathy. Implementation of an effective information and research network and empowerment of patients’ associations are necessary conditions to encourage clinical collaboration and improve the quality of life of people living with rare diseases.