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Furda, Robert, and Michal Gregus. "Impediments in Healthcare Digital Transformation." International Journal of Applied Research on Public Health Management 4, no. 1 (January 2019): 21–34. http://dx.doi.org/10.4018/ijarphm.2019010102.
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This article is addressing the specific impediments that appear in the process of healthcare digital transformation. Enterprise architecture provides the framework for investigating the behavioral and active structural aspects that apply to business and application layers. This includes an analysis of, including inherent relationship between, selected scopes such as strategy, business, and education to standard elements such as process, service, and function of an application. The presented classification and assignment of individual impediments indicate to healthcare managers where they may potentially struggle during different stages of digital transformation. Among others, they facilitate strategic planning and managerial decisions during implementation of the emerging information technologies and techniques. In addition, the idea is to contribute to the successful implementation of healthcare digital transformation, thereby delivering business value within healthcare sector, and consequently to a better quality of life.
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Claiborne, Anne B., Julia R. Hesse, and Daniel T. Roble. "Legal Impediments to Implementing Value-Based Purchasing in Healthcare." American Journal of Law & Medicine 35, no. 4 (December 2009): 442–504. http://dx.doi.org/10.1177/009885880903500401.
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The U.S. healthcare system continually confronts the challenge of controlling costs, improving quality and patient safety, and increasing or maintaining patient access to care. Payors and purchasers of healthcare (both public and private) strive to develop mechanisms to guarantee that they are purchasing the highest-value care – seeking to ensure that amounts paid take into account and provide incentives encouraging the delivery of high-quality, cost-efficient care. Through “value-based purchasing” (“VBP”) strategies, healthcare payors and purchasers are transforming from passive payors of claims (as in a traditional fee for service system) to active purchasers of quality care. To date, employers, health plans, and the Centers for Medicare and Medicaid Services (“CMS”) have implemented well over 100 VBP programs. However, progress is slower than anticipated. As the Institute of Medicine (“IOM”) and others have noted, adoption of VBP reforms may be hampered by legal barriers arising from a number of state and federal laws. The goal of this paper is to identify potential state and federal legal impediments to implementing VBP in healthcare.
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Andrews, Russell J., and Nigel Crisp. "The Healthcare Landscape: Are Doctors Agents of Change or Impediments to Change?" World Neurosurgery 105 (September 2017): 997–1000. http://dx.doi.org/10.1016/j.wneu.2017.06.099.
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Himmelstein, Mary S., and Diana T. Sanchez. "Masculinity impediments: Internalized masculinity contributes to healthcare avoidance in men and women." Journal of Health Psychology 21, no. 7 (October 7, 2014): 1283–92. http://dx.doi.org/10.1177/1359105314551623.
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Labuschaigne, M., and S. Mahomed. "Regulatory challenges relating to tissue banks in South Africa: Impediments to accessing healthcare." South African Journal of Bioethics and Law 12, no. 1 (July 3, 2019): 27. http://dx.doi.org/10.7196/sajbl.2019.v12i1.674.
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Zaaijman, John Du Toit. "Rural district hospitals: Ambulance services, staff attitudes, and other impediments to healthcare delivery." South African Medical Journal 105, no. 12 (November 3, 2015): 1001. http://dx.doi.org/10.7196/samj.2015.v105i12.10174.
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Bernard, Andrew C., Audra Summers, Jennifer Thomas, Myrna Ray, Anna Rockich, Stephen Barnes, Bernard Boulanger, and Paul Kearney. "Novel Spanish Translators for Acute Care Nurses and Physicians: Usefulness and Effect on Practitioners’ Stress." American Journal of Critical Care 14, no. 6 (November 1, 2005): 545–50. http://dx.doi.org/10.4037/ajcc2005.14.6.545.
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• Background Language barriers are significant impediments to providing quality healthcare, and increased stress levels among nurses and physicians are associated with these barriers. However, little evidence supports the usefulness of a translation tool specific to healthcare. • Objectives To evaluate the effectiveness of a novel English-Spanish translator designed specifically for nurses and physicians. The hypothesis was that the translator would be useful and that use of the translator would decrease stress levels among nurses and physicians caring for Spanish-speaking patients. • Methods Novel English-Spanish translators were developed entirely on the basis of input from critical care nurses and physicians. After 7 months of use, users completed surveys. Usefulness of the translator and stress levels among users were reported. • Results A total of 60% of nurses (n = 32) and 71% (n = 25) of physicians responded to the survey. A total of 96% of physicians and 97% of nurses considered the language barrier an impediment to delivering quality care. Nurses reported significantly more stress reduction than did physicians (P = .01). Most nurses and physicians had used the translator during the survey period. Overall, 91% of nurses and 72% of physicians found that the translator met their needs at the bedside some, most, or all of the time. All nurses thought that they most likely would use the translator in the future. • Conclusions The translator was useful for most critical care nurses and physicians surveyed. Healthcare providers, especially nurses, experienced decreased stress levels when they used the translator.
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Bhakoo, Vikram, and Alistair Brandon-Jones. "Opening the Black Box of Impediments to Healthcare IOS Assimilation: A Study of Australian Hospitals." Academy of Management Proceedings 2013, no. 1 (January 2013): 15549. http://dx.doi.org/10.5465/ambpp.2013.15549abstract.
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Dalrymple, Prudence. "Applying Evidence in Practice: What We Can Learn from Healthcare." Evidence Based Library and Information Practice 5, no. 1 (March 17, 2010): 43. http://dx.doi.org/10.18438/b85s54.
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Applying research findings to practice is the foundation of evidence based practice. In healthcare, evidence-based practice depends upon the development, promulgation and application of clinical guidelines. While EBM has been enthusiastically embraced by many, gaps persist, and transmission from research to practice remains slow and uneven. The perception that EBM threatens professional autonomy accounts for some resistance but, even among practitioners who support EBM in concept, uptake of guidelines has encountered numerous barriers. A recent study of guideline implementation by residents in a tertiary care medical center provides insight into the barriers to guideline adoption, and draws parallels between the uptake of EBM in the healthcare sector and the uptake of EBLIP in the library and information field. Through increased understanding of the diffusion of evidence-based practice in one field, LIS practitioners can position themselves to avoid similar impediments.
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Gunasekaran, J., and P. Neelu Sree. "Prevalence of Non-Responsiveness to an Indigenous Recombinant Hepatitis B Vaccine: A Study among Health Care Workers in A Tertiary Hospital." International Journal for Modern Trends in Science and Technology 6, no. 6 (May 30, 2020): 1–5. http://dx.doi.org/10.46501/ijmtst060601.
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Background and Aim: Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. Study Design and Method: Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay Automated ELISA. HLA typing was done using AllSet+™ Gold SSP. Conclusion: Our findings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might influence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as post vaccination anti-HBs testing to prevent HAHI among HCWs.
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Yusuf, Muhammad. "Emerging Psychological Impediments and Challenges in the Context of COVID-19: Evidence from Healthcare Perspectives in Pakistan." Pakistan Social Sciences Review 5, no. I (March 31, 2021): 47–60. http://dx.doi.org/10.35484/pssr.2021(5-i)05.
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Wyer, Peter. "The Tree of Wisdom: Maintaining epistemological health within an (emerging) evidence-free environment." European Journal for Person Centered Healthcare 6, no. 3 (September 28, 2018): 485. http://dx.doi.org/10.5750/ejpch.v6i3.1551.
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Mounting concerns regarding the corruption of the clinical research enterprise by the pharmaceutical industry, as well as demonstrations of the inappropriateness of traditional research designs and consequent clinical guidelines to direct application to patient care, have led to challenges to the integrity of the evidence-based medicine (EBM) movement. However, the emerging crisis of confidence in clinical research should be seen as a threat to the viability of the entire healthcare system, not simply to EBM. Efforts of the EBM movement to represent itself as the brokers and mediators of the clinical research-healthcare interface are impediments to a full appreciation of the dilemma. Recognizing the implications of contrasting epistemological stances regarding the relationship of clinical research findings to healthcare policy and practice is essential to maximizing the value of research to the healthcare system. A synergy between empiricism-rationalism epistemologies, particularly conspicuous within the EBM movement, is identified as an important philosophical barrier to achievement of this goal. The notion of an evolutionary hierarchy of knowledge and wisdom is proposed as a vehicle to demonstrate a social constructivist alternative to a dualistic epistemology. Contrasting examples of social constructivist and empiricist-rationalist descriptions of integration of research with healthcare practice are provided for purposes of illustration.
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Chignell, M. H., J. B. Morton, M. Kastner, and J. S. Lee. "Can Cognitive Assessment Games Save Us From Cognitive Decline?" Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 10, no. 1 (June 2021): 7–12. http://dx.doi.org/10.1177/2327857921101058.
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Loss of cognitive potential is one of the greatest impediments to human wellbeing and productivity. Our healthcare system does a poor job of managing cognitive development and cognitive decline because it measures cognitive status relatively infrequently and in the limited times when cognitive measures are taken, the instruments used tend to be blunt. In the panel that we presented at HCS 2021 we examined the potential for cognitive assessment games to provide more frequent cognitive assessment. We reported on the use of a cognitive assessment game to screen for delirium risk in emergency patients, and the development of a suite of assessment games that can assess executive functions and other cognitive abilities in both young and old. We conclude with a discussion of knowledge translation and implementation science strategies for incorporating game-based cognitive assessment into healthcare practice.
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Gajanayake, Randike, Tony Sahama, and Renato Iannella. "Principles of Information Accountability." International Journal of E-Health and Medical Communications 5, no. 3 (July 2014): 40–57. http://dx.doi.org/10.4018/ijehmc.2014070104.
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Information accountability is seen as a mode of usage control on the Web. Due to its many dimensions, information accountability has been expressed in various ways by computer scientists to address security and privacy in recent times. Information accountability is focused on how users participate in a system and the underlying policies that govern the participation. Healthcare is a domain in which the principles of information accountability can be utilised well. Modern health information systems are Internet based and the discipline is called eHealth. In this paper, the authors identify and discuss the goals of accountability systems and present the principles of information accountability. They characterise those principles in eHealth and discuss them contextually. They identify the current impediments to eHealth in terms of information privacy issues of eHealth consumers together with information usage requirements of healthcare providers and show how information accountability can be used in a healthcare context to address these needs. The challenges of implementing information accountability in eHealth are also discussed in terms of our efforts thus far.
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Abhisek Pal, Kiranmai Gudimetla, Riyazuddin Md Y, and Akkalakshmi M. "Digital technology in management of Covid-19: A new ray to healthcare." International Journal of Research in Pharmaceutical Sciences 11, SPL1 (December 14, 2020): 1426–36. http://dx.doi.org/10.26452/ijrps.v11ispl1.3684.
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The sheer severity of the spread of the pandemic is being overwhelmed by hospitals and medical centres. Although the public discourse was already dominated by digital technology in healthcare, the onset of Covid-19 was a landmark creation. Telehealth visits will leap to 1 billion visits this year from a previously estimated 36 million for 2020 as over 200 countries try to counter varying degrees of Covid-19 impact. The term AI refers to a variety of instruments utilized for distinguishing designs in the information. Rather than conventional techniques for design recognizable proof, AI instruments depend on Artificial Intelligence consciousness to delineate patterns from a lot of information, would self be able to improve as and when new information opens up and is snappier in achieving these assignments. This audit portrays different procedures of AI that have been utilized in the past in the forecast, identification and the board of irresistible infections, and how these apparatuses are being brought into the fight against COVID-19. Furthermore, we likewise examine their applications in different phases of the pandemic, the preferences, impediments and conceivable pitfalls.
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Bali, Rajeev K., Russell Mann, Vikram Baskaran, Aapo Immonen, Raouf Naguib, Alan C. Richards, John Puentes, Brian Lehaney, Ian M. Marshall, and Nilmini Wickramasinghe. "Knowledge-Based Issues for Aid Agencies in Crisis Scenarios." International Journal of Information Systems for Crisis Response and Management 3, no. 3 (July 2011): 16–35. http://dx.doi.org/10.4018/jiscrm.2011070102.
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As part of its expanding role, particularly as an agent of peace building, the United Nations (UN) actively participates in the implementation of measures to prevent and manage crisis/disaster situations. The purpose of such an approach is to empower the victims, protect the environment, rebuild communities, and create employment. However, real world crisis management situations are complex given the multiple interrelated interests, actors, relations, and objectives. Recent studies in healthcare contexts, which also have dynamic and complex operations, have shown the merit and benefits of employing various tools and techniques from the domain of knowledge management (KM). Hence, this paper investigates three distinct natural crisis situations (the 2010 Haiti Earthquake, the 2004 Boxing Day Asian Tsunami, and the 2001 Gujarat Earthquake) with which the United Nations and international aid agencies have been and are currently involved, to identify recurring issues which continue to provide knowledge-based impediments. Major findings from each case study are analyzed according to the estimated impact of identified impediments. The severity of the enumerated knowledge-based issues is quantified and compared by means of an assigned qualitative to identify the most significant attribute.
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Nakamura, Hiroshi. "Promotion of Cooperation among Different Types of Occupations and Functions in Healthcare and Countermeasures to Impediments against Cooperation." Iryo To Shakai 22, no. 4 (2013): 329–42. http://dx.doi.org/10.4091/iken.22.329.
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Moses, Mark W., Julius Korir, Wu Zeng, Anita Musiega, Joyce Oyasi, Ruoyan Lu, Jane Chuma, and Laura Di Giorgio. "Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis." BMJ Global Health 6, no. 6 (June 2021): e004707. http://dx.doi.org/10.1136/bmjgh-2020-004707.
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IntroductionA well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya’s public healthcare system at the county level and explore remediable drivers of poor healthcare system performance.MethodsUsing administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance.ResultsThe median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding—measured by the budget absorption rate which is the ratio between funds spent and funds released—were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance.ConclusionPublic healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya—and other countries—provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.
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Dwyer, John M. "The next Australian Health Care Agreements: what clinicians want." Australian Health Review 25, no. 6 (2002): 17. http://dx.doi.org/10.1071/ah020017.
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For the first time experienced clinicians are to be involved in the development of the Australian Health Care Agreements (AHCAs)(2003-2008). As a result doctors, nurses and allied health professionals are hoping that current impediments to necessary change will be removed. Numerous suggestions to improve the Agreement will come forward from the "front line". All clinicians will argue that the next Agreement must result in a marked increase in the funding available to public hospitals. The new Agreement must remove barriers hindering our capacity to integrate all of our healthcare services. Safe, appropriate and cost effective healthcare delivery must embrace a continuum of care involving patients and their primary care physician, community health services and hospitals. The Agreement must embody arrangements for markedly enhancing our public health efforts in the area of prevention of disease. Australia's clinicians are worried about inequity in terms of access and outcome for their patients and are willing to be partners in health care governance to improve the situation.
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Shopati, Abner Kukeyinge, Kabwebwe Honore Mitonga, and Lydia Penomuntu Aipinge. "Factors affecting strategic plan execution process in public healthcare." International Journal Of Community Medicine And Public Health 5, no. 2 (January 24, 2018): 474. http://dx.doi.org/10.18203/2394-6040.ijcmph20180222.
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Background: The managers of healthcare Organization must confront numerous impediments and curbs issues that significantly contribute to the trial of quantifying, testing, and meritoriously use execution strategies that work in healthcare setting. The aim of the research is to explore and confirm the active factors of failure for the strategic plan execution in state healthcare in Namibia. Methods: The research utilized quantitative approach, a survey design and questionnaire was employed to collect data. The study used Gaskin’s CFA/SEM procedure and applies the SPSS 23 AMOS plugins, Pattern Matrix Model Builder” (PMMB), “Master Validity” (MV), “Model fit measures” (MFM) to validate and determine the interrelationships between variables. Results: Studying literature, 17 variables were recognized and Implementation failure factors (IFF) model with two key factors was established, IFF for strategic plan formulation and IFF for strategic plan implementation. The factors were then reduced using exploratory factor analysis which is evaluated using Principal Axis Factoring with Direct Oblimin rotation. Structural modelling equation (SEM) approach was used, variables were assembled into 4 factors dimension measurement. This model, recognized four factors, contextual dimensions (0.34), content dimensions (0.31), operational dimensions (0.23) and Structural dimensions (0.04) are the main reasons for failure of strategic plan implementation in public health care in Namibia. Conclusions: The research shows that exploring and confirming implementation failure factors in public healthcare organization in developing countries, it will be plausible to consider IFFs for strategic plan formulation and IFFs for strategic plan implementation. Structural equation modelling/CFA has been run to prove the validity of basic IFFs in this research.
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Filip, Cristina Iulia, Sorin Berbece, Laura Raducu, Ioan Petre Florescu, Valeriu Ardeleanu, and Cristian Radu Jecan. "The Prospects of Using Meshes in Imediate Implant - Based Breast Reconstructions." Materiale Plastice 54, no. 3 (September 30, 2017): 414–17. http://dx.doi.org/10.37358/mp.17.3.4862.
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Breast reconstruction involves two major conditions: to be oncologically safe and to respect the aesthetic of the reconstructed breast. Moreover, every healthcare system in the world manifests a keen tendency to cut back on medical costs, which influences our surgical techniques and breast reconstruction procedures. The use of biological matrices like the acellular dermal matrix has become an acknowledged alternative in implant-based breast reconstruction, in spite of the many impediments and controversies that surround it. However, these matrices are costly and less attainable as compared to synthetic meshes that are conservative with resources and unyielding to the formation of biofilm bacteria. Accordingly, we decided to research the impact of synthetic meshes in implant-based breast reconstruction.
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Edmonds, Jennifer, and Antoine Flahault. "Refugees in Canada during the First Wave of the COVID-19 Pandemic." International Journal of Environmental Research and Public Health 18, no. 3 (January 22, 2021): 947. http://dx.doi.org/10.3390/ijerph18030947.
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It is crucial to understand how the most vulnerable populations have been impacted by the ongoing COVID-19 pandemic. This paper intends to contextualize the experience of resettled refugees in Canada during the COVID-19 pandemic, framing the issue for further study as the situation evolves. Based on the experience drawn from the first wave of the pandemic, the findings of this paper suggest that refugees in Canada encounter barriers to healthcare, economic support, education, social support, and border crossing impediments, all of which can have a compounding effect. These findings provide needed information to inform the development of effective policies and strategies to support refugees during health security emergencies in Canada.
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Sharpe, Tom, Ali Alsahlanee, Ken D. Ward, and Frank Doyle. "Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings." Journal of Smoking Cessation 13, no. 4 (January 30, 2018): 233–43. http://dx.doi.org/10.1017/jsc.2017.25.
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Background: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting.Methods: A systematic literature search was conducted specific to hospital-based healthcare workers’ perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework.Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequently.Conclusion: Healthcare workers report a plethora of barriers to providing smoking cessation interventions in hospital settings, which cover all aspects of the COM-B framework. These impediments need to be addressed in a multidisciplinary approach, at clinical, educational, and administrative levels, to improve intervention provision.
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Li, Jilong, Memoona Mushtaq, Ayesha Mariam, Shehzad Khalid, Muhammad Ahsan Latif, Muhammad Munwar Iqbal, and Muhammad Javed Iqbal. "Hazy Glimpse Crook Virtual Assistant for Blind and Visual Impaired Community Healthcare." Journal of Medical Imaging and Health Informatics 10, no. 10 (October 1, 2020): 2501–11. http://dx.doi.org/10.1166/jmihi.2020.3182.
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Innovations in the technologies are common and helpful for the visually impaired community. Visually impaired and blind individuals discover challenges in distinguishing barriers and obstacles. They hobble on the road that makes it hazardous. The reason for our responsibility is to offer solace to the visually vitiated individual by giving Hazy Glimpse Crook (HGC). It is a proposed answer for empowering the blind to recognize the world around them. With the assistance of a webcam, the picture of an obstacle is taken. After the digital image processed, a message will be created. From headphone's help, a visually impaired individual can discover the thing present in front of him. Inside the 70 cm scope, one ultrasonic sensor is utilized to recognize some other impediments around the client. While inside the scope of 80 cm, another sensor is set at the base of the stick. With the help of cautioning messages, it tells about puddles and all other obstacles. Additionally, from GPS blind's location can be tracked down. As they feel safe by using a stick, their average speed increases to twice. HGV (Hazy Glimpse Vision) application is our second part. In application talkback, any object recognizing and location of visually impaired can find out. The overall accuracy of Our HGC and HGV is approx. 96.87% in terms of the time required for an image to process.
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Danladi, Saba’atu Elizabeth, Elochukwu Ebunoluwa Ukatu, Osita Samuel Okonkwo, and Oruayefe Agatha Upaka. "Impediments and Perceptions on the Utilization of Family Planning Services in Bauchi State, Nigeria." Volume 5 - 2020, Issue 8 - August 5, no. 8 (September 6, 2020): 1180–84. http://dx.doi.org/10.38124/ijisrt20aug785.
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Health system consists of elements involved in healthcare delivery, including family planning services. At community level, health system comprises a set of local actors, relationship and processes engaged in producing, advocating and supporting health in the communities. As a component of health care delivery, family planning is an important aspect of stabilizing population growth and poverty reduction. This study assesses community perception and barriers influencing utilization of family planning services in Bauchi State, Nigeria. The study design was Focus group discussions (FGDs), qualitative in nature and in-depth interview was conducted across the three senatorial zones of Bauchi state. The study utilized Fifteen (15) Focus Group Discussions (FGDs) using women of reproductive age who had at least one child both users and non-users of modern methods of family planning method. The result shows that respondents acknowledge that barriers exist which affects the utilization of family planning,. The result also shows that some respondents oppose the use of modern methods of family planning which hinders its utilization, remedies to the barriers were offer and we conclude that majority of people in the northern Nigeria specifically Bauchi state are yet to wholeheartedly embrace the initiative because of religious and cultural beliefs and educational level of respondents affects the utilization of family planning services. It is recommended that communities should be sensitize on the benefits of family planning throughout Bauchi state, emphasis should be given on educating the health benefits of family planning to mothers
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Shahid, Shaouli, Lizzie Finn, Dawn Bessarab, and Sandra C. Thompson. "'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment." Australian Health Review 35, no. 2 (2011): 235. http://dx.doi.org/10.1071/ah09835.
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Background. Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. Design, setting and participants. Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. Results. The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. Conclusion. To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services. What is known about the topic? Cancer is a major cause of death among Indigenous Australians who are generally diagnosed later with their disease, have poorer continuity of care and lower uptake and completion of cancer treatment. For cancer diagnosis at an equivalent stage of cancer, Aboriginal people have poorer outcomes. What does this paper add? This study documents Aboriginal perspectives on basic infrastructure and logistical problems which impede their accessing hospital-based cancer treatments: transport, accommodation, preparation for the experience of hospital and cancer treatment, service affordability and the certainty of support services. What are the implications for practitioners? There are difficulties for practitioners in addressing the geographic, socioeconomic and cultural differences that Aboriginal people face in accessing cancer treatment. System level changes to ensure cultural safety, social support and better coordination with primary healthcare are essential to improve outcomes of Aboriginal people with cancer.
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Nelson, Brett D., Snezana Simic, Lauren Beste, Dejana Vukovic, Vesna Bjegovic, and Michael J. VanRooyen. "Multimodal Assessment of the Primary Healthcare System of Serbia: A Model for Evaluating Post-Conflict Health Systems." Prehospital and Disaster Medicine 18, no. 1 (March 2003): 6–13. http://dx.doi.org/10.1017/s1049023x00000613.
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AbstractIntroduction:Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia.Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods:Integrated quantitative and qualitative methodologies—system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology—were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results:Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions:This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings.
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Qiu, Yukun, Wei Lu, Jianke Guo, Caizhi Sun, and Xinyu Liu. "Examining the Urban and Rural Healthcare Progress in Big Cities of China: Analysis of Monitoring Data in Dalian from 2008 to 2017." International Journal of Environmental Research and Public Health 17, no. 4 (February 12, 2020): 1148. http://dx.doi.org/10.3390/ijerph17041148.
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How to effectively reduce the disparity between urban and rural medical healthcare has become a major global concern. In China, the government has issued a series of reform measures to address the gap between urban and rural medical care. To explore the impact of China’s medical system reforms in improving health services in urban and rural areas and understand the factors promoting and hindering progress, we evaluated the healthcare system in Dalian City, China, from 2008 to 2017. The weighted TOPSIS (technique for order preference by similarity to ideal solution) model was used to assess the development of the healthcare system in the different districts and employed the obstacle model to identify and analyze indicators that hinder progress in health services. Using the local spatial clustering function, we categorized the districts in terms of the hindrance type that significantly hamper the growth of the healthcare system. Our results show the healthcare system in Dalian’s urban areas has steadily increased, while development in rural areas has been erratic. Although the urban–rural healthcare disparity has narrowed distinctly, sustained progress is not guaranteed. Based on the location theory, residents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. When initiating healthcare reforms in urban areas, the impact of varying land prices and per capita disposable income should be considered. For rural areas, constructing more medical institutions to reduce the impact of time costs should be considered. We also found different factors that hinder the growth of the healthcare system for urban and rural areas. To address these impediments to progress, urban areas should pay more attention to coordinated development, while rural areas should address specific concerns based on local needs and conditions. More research on the progress in medical reform is crucial to provide reference and policy-guidance for countries facing similar concerns.
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Martin, Graham Paul, Sarah Chew, and Mary Dixon-Woods. "Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study." Journal of the Royal Society of Medicine 112, no. 4 (December 3, 2018): 153–59. http://dx.doi.org/10.1177/0141076818815509.
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Summary Objectives To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. Design Semi-structured qualitative interviews. Setting National Health Service, regulatory and third-sector organisations in England. Participants Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). Main outcome measures Not applicable. Results Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional ‘cultural engineering’ to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of ‘blacklisting’ of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. Conclusions Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.
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Firdausya, Nadia, Alex Bishop, Barbara Carlson, and Weihua Sheng. "Addressing the Role of Smart Robotic Health Assistants Within the Human-Machine Frontier of Geriatric Healthcare." Innovation in Aging 4, Supplement_1 (December 1, 2020): 409–10. http://dx.doi.org/10.1093/geroni/igaa057.1319.
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Abstract Data for this study was acquired from three separate stakeholder focus group sessions involving nurse case managers (n = 5), social agency caseworkers (n = 5), and rural outreach providers (n = 5). Participants across all groups were asked to address the question: “When it comes to your work, what would you want a smart robot assistant to do for you?” Data from the three sessions were combined, transcribed verbatim, coded, and analyzed for thematic content. Three shared themes emerged, including health monitoring, behavioral intervention, and healthcare literacy. Relative to health monitoring, participants desired a robot that possessed functions in the form of “taking vital signs,” and “tracking water and food intake.” There was also a thematic agreement regarding behavioral intervention capabilities. Most notably, advisory stakeholders acknowledged a need for a smart robotic assistant to provide geriatric care recipients with “an alert or reminder to take medication.” This was viewed as an essential intervention for improving medication adherence. Healthcare literacy emerged as a final theme among advisory groups. In particular, participants noted that a smart robot should assist with bi-directional communication and translation of health care information and instructions as a way to “minimize impediments of care due to language barriers.” Findings will be further used to highlight how future integration of robotic health assistants represents a viable solution in helping geriatric healthcare workers work effectively alongside machines to meet the diverse care needs of older adults in both urban and rural settings.
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Shi, Jianwei, Chenghua Jiang, Duxun Tan, Dehua Yu, Yuan Lu, Pengfei Sun, Ying Pan, Hanzhi Zhang, Zhaoxin Wang, and Beilei Yang. "Advancing Implementation of Evidence-Based Public Health in China: An Assessment of the Current Situation and Suggestions for Developing Regions." BioMed Research International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/2694030.
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Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively.Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR).Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system.Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.
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Zou, Xiang, Ruth Fitzgerald, and Jing-Bao Nie. "“Unworthy of Care and Treatment”: Cultural Devaluation and Structural Constraints to Healthcare-Seeking for Older People in Rural China." International Journal of Environmental Research and Public Health 17, no. 6 (March 23, 2020): 2132. http://dx.doi.org/10.3390/ijerph17062132.
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This paper examines the experiences of seeking healthcare for rural Chinese older people, a population who experiences the multiple threats of socio-economic deprivation, marginalization, and lack of access to medical care, yet have been relatively overlooked within the existing scholarly literature. Based on ethnographical data collected from six-month fieldwork conducted in a rural primary hospital in Southern China, this paper identifies a widespread discouraging, dispiriting attitude regarding healthcare-seeking for rural older members despite the ongoing efforts of institutional reforms with a particular focus on addressing access to health services amongst rural populations. Such an attitude was expressed by older people’s families as well as the public in their narratives by devaluing older members’ health care demands as “unworthy of care and treatment” (“buzhide zhi” in Chinese). It was also internalized by older people, based on which they deployed a family-oriented health-seeking model and strategically downgraded their expectation on receiving medical care. Moreover, underpinning this discouragement and devaluation, as well as making them culturally legitimate, is the social expectation of rural older people to be enduring and restrained with health-seeking. Simultaneously, this paper highlights the sourc2e of institutional and structural impediments, as they intersect with unfavorable socio-cultural values that normalize discouragement and devaluation.
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Goroff, Daniel, Jules Polonetsky, and Omer Tene. "Privacy Protective Research: Facilitating Ethically Responsible Access to Administrative Data." ANNALS of the American Academy of Political and Social Science 675, no. 1 (December 21, 2017): 46–66. http://dx.doi.org/10.1177/0002716217742605.
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Companies and government entities collect substantial amounts of administrative data through the Internet; mobile communications; and a vast infrastructure of devices and sensors embedded in healthcare facilities, retail outlets, public transportation, social networks, workplaces, and homes. They use administrative data to test new products and services, improve existing offerings, conduct research, and foster innovation. However, the lack of a clear legal framework and ethical guidelines for use of administrative data jeopardizes the value of important research. Concerns over legal impediments and ethical restrictions threaten to diminish productive collaboration between researchers and private sector businesses. This article provides strategies for organizations to minimize risks of reidentification and privacy violations for individual data subjects. In addition, it suggests that privacy and ethical concerns would best be managed by supporting the development of administrative data centers to lower transaction costs and increase the reproducibility of research conducted on administrative data.
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Fernández, Lucía, María Dolores Cima-Cabal, Ana Catarina Duarte, Ana Rodríguez, María del Mar García-Suárez, and Pilar García. "Gram-Positive Pneumonia: Possibilities Offered by Phage Therapy." Antibiotics 10, no. 8 (August 18, 2021): 1000. http://dx.doi.org/10.3390/antibiotics10081000.
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Pneumonia is an acute pulmonary infection whose high hospitalization and mortality rates can, on occasion, bring healthcare systems to the brink of collapse. Both viral and bacterial pneumonia are uncovering many gaps in our understanding of host–pathogen interactions, and are testing the effectiveness of the currently available antimicrobial strategies. In the case of bacterial pneumonia, the main challenge is antibiotic resistance, which is only expected to increase during the current pandemic due to the widespread use of antibiotics to prevent secondary infections in COVID-19 patients. As a result, alternative therapeutics will be necessary to keep this disease under control. This review evaluates the advantages of phage therapy to treat lung bacterial infections, in particular those caused by the Gram-positive bacteria Streptococcus pneumoniae and Staphylococcus aureus, while also highlighting the regulatory impediments that hamper its clinical use and the difficulties associated with phage research.
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Henn, Scott A., James M. Boiano, and Andrea L. Steege. "Precautionary Practices of Healthcare Workers Who Disinfect Medical and Dental Devices Using High-Level Disinfectants." Infection Control & Hospital Epidemiology 36, no. 2 (December 18, 2014): 180–85. http://dx.doi.org/10.1017/ice.2014.37.
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BACKGROUNDHigh-level disinfectants (HLDs) are used throughout the healthcare industry to chemically disinfect reusable, semicritical medical and dental devices to control and prevent healthcare-associated infections among patient populations. Workers who use HLDs are at risk of exposure to these chemicals, some of which are respiratory and skin irritants and sensitizers.OBJECTIVETo evaluate exposure controls used and to better understand impediments to healthcare workers using personal protective equipment while handling HLDs.DESIGNWeb-based survey.PARTICIPANTSA targeted sample of members of professional practice organizations representing nurses, technologists/technicians, dental professionals, respiratory therapists, and others who reported handling HLDs in the previous 7 calendar days. Participating organizations invited either all or a random sample of members via email, which included a hyperlink to the survey.METHODSDescriptive analyses were conducted including simple frequencies and prevalences.RESULTSA total of 4,657 respondents completed the survey. The HLDs used most often were glutaraldehyde (59%), peracetic acid (16%), and ortho-phthalaldehyde (15%). Examples of work practices or events that could increase exposure risk included failure to wear water-resistant gowns (44%); absence of standard procedures for minimizing exposure (19%); lack of safe handling training (17%); failure to wear protective gloves (9%); and a spill/leak of HLD during handling (5%). Among all respondents, 12% reported skin contact with HLDs, and 33% of these respondents reported that they did not always wear gloves.CONCLUSIONFindings indicated that precautionary practices were not always used, underscoring the importance of improved employer and worker training and education regarding HLD hazards.Infect Control Hosp Epidemiol 2014;00(0): 1–6
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Mukherjee, Mome, Kathrin Cresswell, and Aziz Sheikh. "Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system." Health Informatics Journal 27, no. 1 (January 2021): 146045822097757. http://dx.doi.org/10.1177/1460458220977579.
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Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts.
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Storeng, Katerini T., Seydou Drabo, and Véronique Filippi. "Too poor to live? A case study of vulnerability and maternal mortality in Burkina Faso." Global Health Promotion 20, no. 1_suppl (March 2013): 33–38. http://dx.doi.org/10.1177/1757975912462420.
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This paper examines the concept of vulnerability in the context of maternal morbidity and mortality in Burkina Faso, an impoverished country in West Africa. Drawing on a longitudinal cohort study into the consequences of life-threatening or ‘near miss’ obstetric complications, we provide an in-depth case study of one woman’s experience of such morbidity and its aftermath. We follow Kalizeta’s trajectory from her near miss and the stillbirth of her child to her death from pregnancy-related hypertension after a subsequent delivery less than two years later, in order to examine the impact of severe and persistent illness and catastrophic health expenditure on her health and on her family’s everyday life. Kalizeta’s case illustrates how vulnerability in health emerges and is maintained or exacerbated over time. Even where social arrangements are supportive, structural impediments, including unaffordable and inadequate healthcare, can severely limit individual resilience to mitigate the negative social and economic consequences of ill health.
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Sharma, K., M. Sharma, M. Modi, N. Singla, A. Sharma, A. Sharma, N. Sharma, and P. Ray. "Comparative analysis of Truenat™ MTB Plus and Xpert® Ultra in diagnosing tuberculous meningitis." International Journal of Tuberculosis and Lung Disease 25, no. 8 (August 1, 2021): 626–31. http://dx.doi.org/10.5588/ijtld.21.0156.
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BACKGROUND: Diagnostic delay and drug resistance not only worsen the outcomes of tuberculous meningitis (TBM), but are also important impediments to TB elimination efforts. Given the need for a near point-of-care test suitable for primary healthcare centres and simultaneous detection of resistance, Truenat™ MTB Plus assay was evaluated on a large cohort of TBM patients.METHODS: Truenat assay was performed on 148 cerebrospinal fluid specimens (76 definite TBM, 32 probable TBM and 40 non-TBM controls) and its performance was compared with Xpert® Ultra.RESULTS: The overall sensitivity of Truenat and Ultra was respectively 78.7% and 67.6% in diagnosing TBM, and respectively 85.5% and 96% in diagnosing definite TBM. Twenty-three additional cases were detected using Truenat and 11 using Ultra. Truenat missed seven cases of rifampicin (RIF) resistance and indicated false RIF resistance in four cases.CONCLUSION: Performance of Truenat was comparable to that of Ultra in diagnosing TBM and inferior to Xpert Ultra in determining RIF resistance.
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Ito, Jun, Sisira Edirippulige, Takeshi Aono, and Nigel R. Armfield. "The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages." Journal of Telemedicine and Telecare 23, no. 10 (October 28, 2017): 828–34. http://dx.doi.org/10.1177/1357633x17732801.
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Background In common with other countries, Japan has an ageing population and geographical impediments to healthcare access. The role of telemedicine within the Japanese health system may be of wide interest, yet it has not been comprehensively explored and documented. Thus, the aim of this study was to systematically review the Japanese and English language literature relating to the clinical use of telemedicine in Japan. Methods For studies published in Japanese, we searched Ichushi and CiNii. For English language publications, we searched Cochrane Library, PubMed, Embase, and Web of Science. All peer-reviewed articles describing the clinical use of telemedicine and published between 2007 and 2016 were included. Data on clinical area, study type, technology used, and type of communication were extracted. Studies were categorised by prevention, screening, diagnosis, surveillance, and treatment. Results The search yielded 1476 records; 26 Japanese language and 15 English language articles were selected for review. A wide range of clinical areas were represented; however, home care and life-style related studies were dominant. More than 50% of studies were related to prevention and early diagnosis. The majority of Japanese studies involved doctor-to-doctor consultation. Smartphones and remote monitoring systems were the main types of technology used. Conclusions Most studies of telemedicine in Japan are published in the Japanese language and are thus relatively inaccessible to the rest of the world; for the first time, this study has provided an overview of the clinical use of telemedicine in Japan. The clinically related papers reflect the Japanese cultural focus on disease prevention.
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Oladimeji, Olawumi, Adeyinka Alabi, and Oladele Vincent Adeniyi. "Awareness, Knowledge and Perception of The National Health Insurance Scheme (NHIS) Among Health Professionals in Mthatha General Hospital, Eastern Cape, South Africa." Open Public Health Journal 10, no. 1 (October 24, 2017): 187–94. http://dx.doi.org/10.2174/1874944501710010187.
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Objective:This Eastern Cape study assessed the awareness, knowledge and perceptions of the healthcare professionals in Mthatha General Hospital on National Health Insurance Scheme (NHIS).Method:A descriptive cross-sectional study was conducted among health professionals at Mthatha General Hospital. A simple random sample of 100 participants drawn across the various categories of health professionals responded to a validated questionnaire on awareness, purpose and challenges of implementation of NHIS.Results:Of the total (N=100), 86 health professionals returned the questionnaire (response rate=87%); 54 female (63%) and 32 male (37%). The majority of the respondents were nurses (67%) and doctors (28%). Others were radiographers (n=2) and clinical associates (2). The majority of the respondents (89.5%) were aware of NHIS and their sources of information on NHIS were: seminars and meetings (n=32), television and radio (n=26), friends and family members (n=14), newspapers (n=10) and internet (n=4). Good understanding of the objectives of NHIS was demonstrated by 81.3% (n=70) of the respondents. The poor state of health facilities and inadequate staffing across the country were reported as the major impediments to the implementation of NHIS. However, the majority of the respondents (n=64) expected that the quality of healthcare service delivery would improve by increasing the staff strength in the various health facilities.Conclusion:The majority of the health professionals in this setting were aware of NHIS. Both the infrastructure and staff strength require the attention of the health authorities in order to effectively implement the scheme in the district.
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Macleod, Jana B. A., Sara Gravelin, Tait Jones, Alex Gololov, Michelle Thomas, Benson Omondi, and E. Bukusi. "Assessment of Acute Trauma Care Training in Kenya." American Surgeon 75, no. 11 (November 2009): 1118–23. http://dx.doi.org/10.1177/000313480907501119.
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An Acute Trauma Care (ATC) course was adapted for resource-limited healthcare systems based on the American model of initial care for injured patients. The course was taught to interested medical personnel in Kenya. This study undertook a survey of the participants’ healthcare facilities to maximize the applicability of ATC across healthcare settings. The ATC course was conducted three times in Kenya in 2006. A World Health Organization (WHO) Needs Assessment survey was administered to 128 participants. The data were analyzed qualitatively and quantitatively. Ninety-two per cent had a physician available in the emergency department and 63 per cent had a clinical officer. A total of 71.7 per cent reported having a designated trauma room. A total of 96.7 per cent reported running water, but access was uninterrupted more often in private hospitals as opposed to public facilities (92.5 vs 63.6%, P = 0.0005). Private and public employees equally had an oxygen cylinder (95.6 vs 98.5%, P > 0.05), oxygen concentrator (69.2 vs 54.2%, P = 0.12), and oxygen administration equipment (95.7 vs 91.4%, P > 0.05) at their facilities. However, private employees were more likely to report that “all” of their equipment was in working order (53 vs 7.9%, P < 0.0001). Private employees were also more likely to report that they had access to information on emergency procedures and equipment (64.4 vs 33.3%, P = 0.001) and that they had learned new procedures (54.8 vs 25.4%, P = 0.002). Despite a perception of public facility lack, this survey showed that public institutions and private institutions have similar basic equipment availability. Yet, problems with equipment malfunction, lack of repair, and availability of required information and training are far greater in the public sector. The content of the ATC course is valid for both private and public sector institutions, but refinements of the course should focus on varying facets of inexpensive and alternative equipment resources. Furthermore, the implementation of this course should create a setting that advocates, promotes, and investigates resources. The WHO survey can guide future research in understanding impediments to implementing essential trauma care courses for resource limited healthcare systems.
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Du Mont, Janice, Shilini Hemalal, Sarah Daisy Kosa, Lee Cameron, and Sheila Macdonald. "The promise of an intersectoral network in enhancing the response to transgender survivors of sexual assault." PLOS ONE 15, no. 11 (November 18, 2020): e0241563. http://dx.doi.org/10.1371/journal.pone.0241563.
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Objectives This study explores the promise of an intersectoral network in enhancing the response to transgender (trans) survivors of sexual assault. Methods One hundred and three representatives of healthcare and community organizations across Ontario, Canada were invited to participate in a survey. Respondents were asked to: 1) identify systemic challenges to supporting trans survivors, 2) determine barriers to collaborating across sectors, and 3) indicate how an intersectoral network might address these challenges and barriers. Descriptive statistics were used to summarize quantitative data and qualitative data were collated thematically. Results Sixty-seven representatives responded to the survey, for a response rate of 65%. Several themes capturing the challenges organizations face in supporting trans survivors were identified: Lack of knowledge and training among providers, Inadequate resources across organizations and institutions, and Limited access to and availability of appropriate services. Barriers to collaborating across sectors considered important by the overwhelming majority of respondents were: Lack of trans-positive service professionals (e.g., a paucity of sensitivity training), lack of resources (e.g., staff, staff time and workload, spaces to meet), and Institutional structures (e.g., oppressive policies, funding mandates). Four ways in which a network could address these challenges and barriers emerged from the data: Center the voices of trans communities in advocacy; Support competence of professionals to provide trans-affirming care; Provide the platform, strategies, and tools to aid in organizational change; and Create space for organizations to share ideas, goals, and resources. Conclusion Our findings deepen our understanding of important impediments to enhancing the response to trans survivors of sexual assault and the role networks of healthcare and community organizations can play in comprehensively responding to complex health and social problems.
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Kisembo, Harriet Nalubega, Ritah Nassanga, Faith Ameda Ameda, Moses Ocan, Alison A. Kinengyere, Sahal Omal Abdirahaman, Richard Malumba, Dina Husseiny Salama, and Michael Grace Kawooya. "Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol." BJR|Open 3, no. 1 (January 2021): 20210004. http://dx.doi.org/10.1259/bjro.20210004.
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Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).
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Bahati, Felix, Salome Kairu-Wanyoike, and Japheth Mativo Nzioki. "Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study." Wellcome Open Research 6 (July 5, 2021): 80. http://dx.doi.org/10.12688/wellcomeopenres.16699.2.
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Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.
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Bahati, Felix, Salome Kairu-Wanyoike, and Japheth Mativo Nzioki. "Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study." Wellcome Open Research 6 (April 12, 2021): 80. http://dx.doi.org/10.12688/wellcomeopenres.16699.1.
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Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.
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Harris, Carol, Asqual Getaneh, and José M. Zuniga. "Global Antiretroviral Therapy: The Hope Within Pandora’s Box?" Einstein Journal of Biology and Medicine 22, no. 1 (March 2, 2016): 25. http://dx.doi.org/10.23861/ejbm2006228.
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The vast numbers of individuals now infected with the HIV-1 virus and its spread to all corners of the globe have been well chronicled. It is difficult to convey, however, the desperation and hopelessness of the majority of those HIV-1-infected individuals that live in regions where resources are sparse. Pursuit of the unique and complex medical and societal issues relating to the HIV pandemic is globally creating a discrete area within the field of infectious disease. The consequences of the severe immunologic compromise resulting from HIV-1 infection vary from those seen in the West, both in terms of entities and their frequency. While a number of antiretroviral distribution programs are in place, the development of guidelines that simplify antiretroviral regimens, enrollment in treatment programs, and monitoring remain difficult. Furthermore, the epidemiology, response to antiretroviral therapy, and resistance patterns of non-B sybtypes await further elucidation. The goals that have been set may be compromised by concomitant endemic diseases (such as tuberculosis and malaria), unpreventable mother-to-child transmission, malnutrition, poor sanitation, inadequate public health systems, and, especially, the lack of an adequate healthcare workforce. However, awareness of these impediments is growing. The understanding of the complex and diverse economic, political and cultural forces entwined with and driving the epidemic is evolving. Finally, the need for a long-term, multifaceted response to the broad crisis in underdeveloped nations where AIDS is but one of a number of critical elements is becoming appreciated.
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Mundy, Linda, Rebecca Trowman, and Brendon Kearney. "OVERCOMING THE BARRIERS TO ACHIEVING UNIVERSAL HEALTH CARE IN THE ASIAN REGION." International Journal of Technology Assessment in Health Care 34, no. 4 (2018): 352–59. http://dx.doi.org/10.1017/s0266462318000417.
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Objectives:The Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) met to discuss the challenges of achieving universal health care (UHC) in Asia.Methods:Group discussions and presentations at the 2017 HAPF, informed by a background paper, including a literature review and the results of pre-meeting surveys of health technology assessment (HTA) agencies and industry, formed the basis of this article.Results:Affordability was identified as the greatest barrier to establishing UHC; however, other impediments include the lack of political will to implement UHC, and the cultural issue of deference to expert opinion instead of evidence-based assessments. Although HTA was identified as an important prioritization tool when adding new technologies to benefit packages, it is used inconsistently in the region, resulting in a less transparent decision-making process for stakeholders. Although regional challenges exist around real-world data (RWD), including a lack of capacity to enable information and data sharing, most policy or funding decision makers in the region have access to data. However, there appears to be a disconnect with the experience of industry, whose representatives identify the lack of RWD as their primary issue. To overcome these issues, both HTA agencies and industry agree that collaboration and transparency should be fostered to support the development of robust evidence generation in the region.Conclusions:There is a willingness for HTA agencies and industry to collaborate to develop HTA methodology for the prioritization of technologies in the Asia region that support healthcare systems to achieve the ultimate outcome of UHC.
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Moshi, Magdalena Ruth, Rebecca Tooher, and Tracy Merlin. "Development of a health technology assessment module for evaluating mobile medical applications." International Journal of Technology Assessment in Health Care 36, no. 3 (May 18, 2020): 252–61. http://dx.doi.org/10.1017/s0266462320000288.
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ObjectiveThe aim of this study was to develop a module which could be used to facilitate the assessment of mobile medical applications (MMA) for regulatory and reimbursement purposes.MethodsIn-depth interviews were conducted with policymakers, healthcare practitioners, and application developers to determine possible pathways and impediments to MMA reimbursement. These findings were integrated with our previous research on MMA reimbursement and regulation to create a module that could be used with existing health technology assessment (HTA) methodological frameworks to guide the evaluation of MMAs.ResultsStakeholders indicated that they trust how traditional medical devices are currently appraised for reimbursement. They were concerned that there was a lack of clarity regarding which entity in the health system was responsible for determining app quality. They were also concerned about the digital health literacy of medical practitioners and patients. Concepts emerging from our previous research were reinforced by the interview findings, including that the connectivity and cybersecurity of apps need to be considered, along with an assessment of software reliability. It is also critical that the credibility of the information presented in apps is assessed as it could potentially mislead patients and clinicians.ConclusionAn MMA evaluation module was created that would enable an existing HTA process to be adapted for the assessment of MMA technology. These adaptations include making provisions for an assessment of app cybersecurity, the impact on MMA clinical utility of software updates, and compatibility issues. Items to address concerns around practitioner responsibility and app misinformation were also incorporated into the module.
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Wolf, Bruce L., and Michael Becker. "Pharmacy Deserts and Healthcare Impediment Zones." Journal of Allergy and Clinical Immunology 141, no. 2 (February 2018): AB166. http://dx.doi.org/10.1016/j.jaci.2017.12.531.
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Pizzo, Philip A. "Thoughts about Dying in America: Enhancing the impact of one’s life journey and legacy by also planning for the end of life." Proceedings of the National Academy of Sciences 113, no. 46 (November 8, 2016): 12908–12. http://dx.doi.org/10.1073/pnas.1614266113.
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This Perspective offers a summary of the recommendations in the Institute of Medicine report Dying in America. How we die is a deeply personal issue that each of us will face. However, the approach to end-of-life (EOL) care in the United States needs improvement. Too frequently, healthcare delivery is uncoordinated and has many providers who are not adequately prepared to have meaningful conversations about EOL planning. This is amplified by payment systems and policies that create impediments, misunderstanding, and sometimes misinformation. Dying in America made five recommendations to improve quality and honor individual preferences near the EOL beginning with making conversations with providers and families something that occurs during various phases of the life cycle and not just when one is facing serious illness or possible EOL. It was recommended (i) that public and private payers and care delivery organizations cover the provision of comprehensive care that is accessible and available to individuals on a 24/7 schedule; (ii) that professional societies and other entities establish standards for clinician patient communication and advance care planning and that payers and care delivery organizations adopt them; (iii) that educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and care delivery organizations establish palliative care training, certification, and/or licensure requirements; (iv) that public and private payers and care delivery organizations integrate the financing of health and social services; and (v) that public and private organizations should engage their constituents and provide fact-based information to encourage advance care planning and informed choice.