Context Of Health Care System Research Articles

Somatropin for Short Stature


 For children with short stature who were born small for gestational age, 1 guideline suggests increasing human growth hormone dose when treatment response is unsatisfactory, while aiming for normal insulin-like growth factor 1 levels.
 For children with idiopathic short stature, 1 guideline recommends against the routine use of growth hormone. It suggests initiating growth hormone therapy on a case-by-case basis, with a starting dose ranging from 0.24 mg/kg/week to 0.47 mg/kg/week, as well as conducting an assessment 12 months after initiation to optimize dosage.
 The development of recommendations from guidelines included in this report was challenged by limited relevant evidence, as well as heterogeneity of growth hormone dose and frequency and treatment response found in available literature. Future guidelines should also consider patient perspectives, resource implications, and the facilitators of and barriers to therapy within the context of health care systems in Canada.

Understanding Impacts of Online Dual Practice on Health System Performance: A Qualitative Study in China

ABSTRACT The outbreak of the COVID-19 pandemic has boosted the global development of online healthcare platforms. An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice—online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. Following a purposive sampling, we interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. The benefits include improved accessibility due to increased labor supply of public hospital doctors, better remote access to high-quality services, and lower privacy concerns. It can improve efficiency and quality by optimizing patient flows, reducing repetitive tasks, and improving the continuity of care. However, the potential distraction from designated work at public hospitals, inappropriate use of virtual care, and opportunistic physician behaviors may undermine overall accessibility, efficiency, and quality. Countries should mitigate these adverse consequences via regulations that are appropriate to their healthcare system context, policy priority, and governance capacity.

Observation, Aspiration, or Tube Thoracostomy for Primary Spontaneous Pneumothorax: A Systematic Review, Meta-Analysis, and Cost-Utility Analysis

Primary spontaneous pneumothorax (PSP) has several commonly used management strategies: observation, aspiration, and chest tube placement. Economic modelling of pooled data comparing techniques has not been performed. Based on studies from the past 20 years, which approach to management of PSP delivers the highest utility? A systematic review of PSP management strategies (observation, aspiration, or chest tube placement) included in the Medline and EMBASE databases from January 1, 2000, through April 10, 2020, was conducted. Text screening, bias assessment, and data extraction were performed by two authors (G. E. and C. A. P.). Inclusion and exclusion criteria were defined a priori. The primary outcome was PSP resolution after the initial intervention. Secondary outcomes were PSP recurrence, length of stay, rate of surgical management, and complications. The meta-analysis compared treatment arms; dichotomous outcomes were reported as relative risk (RRs) and continuous outcomes were reported as mean differences. A cost-utility analysis within the Canadian health care system context with deterministic and probabilistic sensitivity analyses was performed. Five thousand one hundred seventy-nine articles were identified; after screening, 22 articles were included. Most trials showed a high risk of bias, but randomized trials showed a lower risk. Compared with chest tube placement, observation (mean difference, 5.17; 95%CI, 3.75-6.59; P< .01; I2= 62%) and aspiration (mean difference, 2.72; 95%CI, 2.39-3.04; P< .01; I2= 0%) showed a shorter length of stay. Compared with observation, chest tube placement (RR, 0.81; 95%CI, 0.71-0.91; P< .01; I2= 62%) and aspiration (RR, 0.73; 95%CI, 0.61-0.88; P< .01; I2= 67%) showed higher resolution without additional intervention. Two-year recurrence rates did not differ between management strategies. Observation showed the best utility (0.82) and lowest cost; observation was the optimal strategy in 98.2%of Monte Carlo simulations. Observation is the dominant choice compared with aspiration and chest tube placement for PSP. It should be considered as the first-line therapy in appropriately selected patients.

Association of Cumulative Viral Load With the Incidence of Hypertension and Diabetes in People With HIV.

HIV induces several metabolic derangements that contribute to cardiovascular disease, but it is unclear if HIV increases diabetes or hypertension risk. Refining longitudinal relationships between HIV-specific factors and cardiovascular disease risk factors across different care settings may help inform cardiovascular disease prevention among people with HIV (PWH). We tested the hypothesis that long-term higher cumulative viral load (viremia-copy-year) is associated with higher risk of diabetes and hypertension by analyzing electronic records of PWH from 2 distinct health systems in Chicago (Northwestern Medicine and Howard Brown Health Care) receiving care in 2004 to 2019. We used joint longitudinal-survival models to assess multivariable-adjusted associations. Subgroup analyses per site were also conducted. We observed 230 (3.0%) incident diabetes cases in 7628 PWH without baseline diabetes and 496 (6.7%) hypertension cases in 7450 PWH without baseline hypertension. Pooled analysis showed a direct association of viremia-copy-year with incident hypertension (hazards ratio, 1.20 [95% CI, 1.14-1.26]) but not with diabetes (hazards ratio, 1.03 [95% CI, 0.96-1.10]). However, site-specific differences existed whereby the Northwestern-only analysis demonstrated a significant association of viremia-copy-year with hypertension (hazards ratio, 1.29 [95% CI, 1.08-1.32]). Additionally, higher social deprivation index (both sites) and diagnosis of mental health disorder (Howard Brown Health only) was associated with higher diabetes and hypertension risk. Cumulative viral load may be associated with incident hypertension among PWH. Associations of HIV control with cardiovascular disease risk factors among PWH may differ by health care system context.

Gardens of Historic Mental Health Hospitals and Their Potential Use for Green Therapy Purposes

Gardens of historic psychiatric institutions represent a special type of heritage garden that possess both aesthetic and therapeutic purposes. Their existence and current state are affected by changes in the organisation of mental treatment. The article focuses on the possible use of these gardens as places of modern green therapies carried out in, and connected with, nature. Taking into account the state of the art on the beneficial influence of nature on human health and well-being, the paper provides an overview of historic and modern nature-based activities considered therapeutic. Subsequently, three case studies of contemporary psychiatric facilities operating in historic mental hospital sites are examined. Many activities linked to nature exercised historically in those gardens bear similarities to a contemporary spectrum of ecotherapies. An analysis of historic and contemporary plans of the sites and gardens and a description of the therapeutic activities carried out in nature are provided. Results prove that their potential is promising, but not yet used to its full extent because of organisation and financing within the context of health care systems. Using those gardens for the spectrum of green therapies may bring benefits for patients and the historic substance alike.

The Relation Between Organizational Justice and Counter-Productive Work Behavior Among Health Care Professionals in Jimma Zone Public Health Institutions.

BackgroundCounterproductive behavior costs organizations and their members which will ultimately affect work-related outcomes and organizational success. Organizational justice has the potential to affect the level of counter productive behavior. However, there is a paucity of studies to show the link between counterproductive behavior and organizational justice dimensions in the Ethiopian health care system context. Therefore, the purpose of this research was to look into the link between organizational justice, and counterproductive work behavior among health care professionals.MethodsThe 395 study participants were chosen using a facility-based cross-sectional study methodology. A proportionate stratified systematic random sampling technique was deployed to select study participants from health facilities. Data was gathered using a structured self-report questionnaire by CWB Scale that was developed by Spector and Fox (2005) with Cronbach’s alpha of an average of (0.84–0.87). Data was obtained, cleaned, and entered by Epidata3.1. Finally, for descriptive and inferential statistical analysis, the data was exported to SPSS version 23.0.ResultsAccording to the findings, 159 (40.3%) of the study participants engaged in counterproductive job activities. Organizational justice was assumed to be fair by about half of the respondents, 202 (52.2%). Distributive Justice (=−0.141, p.05) was found to be a significant and negative predictor of counterproductive work behavior in the regression analysis. Age (β=−0.014, p< 0.05), the average number of hours worked every week (β=−0.009, p< 0.05), and experience (β=0.016, p< 0.05) were found to be significant predictors of the counterproductive work behaviors.Conclusion and RecommendationThis study indicated that distributive justice show significant contribution in reduction of counterproductive work behaviour.As a result, improving organizational justice can aid to reduce counterproductive work behavior which in turn increases the facility’s productivity.

A comparison of the content taught in critical care transportation modules across South African bachelor's degrees in emergency medical care.

Background and objective Critical care transport (CCT) involves the movement of critically ill patients between healthcare facilities. South Africa (SA), like other low- to middle-income countries, has a relative shortage of ICU beds, making CCT an inevitability. In SA, CCTs are mostly done by emergency care practitioners; however, it is unclear how universities offering Bachelor in Emergency Medical Care (BEMC) courses approach their teaching in critical care and whether the content taught is consistent between institutions. In our study we formally evaluate and compare the intensive and critical care transport modules offered at SA universities in their BEMC programmes. Methods The electronic version of curricula of the critical care transport modules from higher education institutes in SA offering the BEMC were subjected to document analysis. Qualitative (inductive content analysis) and quantitative (descriptive analysis) methods were used to describe and compare the different components of the curriculum. Curricula were assigned into components and sub-components according to accepted definitions of curricula. The components included: aims, goals, composition and objectives of the course; content or teaching material and work-integrated learning. Results The four universities that offer BEMC programmes were invited to participate, and three (75%) consented and provided data. The duration of the modules ranged from 6 to 12 months, corresponding with notional hours of 120 - 150. A total of 83 learning domains were generated from the coding process. These domains included content on mechanical ventilation, patient monitoring, arterial blood gases, infusions and fluid balance, and patient preparation and transfer. Two universities had identical structures and learning outcomes, while one had a different structure and outcomes; it corresponded with a 58% similarity. Clinical placements were in critical and emergency care units, operating theatres and prehospital clinical services. Conclusion In all components compared, the universities offering BEMC were more similar than they were different. It is unclear whether the components taught are relevant to the SA patient population and healthcare system context, or whether students are adequately prepared for clinical practice. Postgraduate educational programmes might need to be developed to equip emergency care practitioners to function in this environment safely. Contributions of the study Owing to the limited availability of ICU beds in South Africa, optimising and standardising critical care transport is an important consideration. This study identifies important elements for improving emergency medical care training in South Africa, as well as areas needing further research.

Of Blindness, Elephants, and Multidisciplinary Collaboration.

Of Blindness, Elephants, and Multidisciplinary Collaboration.

Understanding the evaluation of mHealth app features based on a cross-country Kano analysis

While mobile health (mHealth) apps play an increasingly important role in digitalized health care, little is known regarding the effects of specific mHealth app features on user satisfaction across different healthcare system contexts. Using personal health record (PHR) apps as an example, this study identifies how potential users in Germany and Denmark evaluate a set of 26 app features, and whether evaluation differences can be explained by the differences in four pertinent user characteristics, namely privacy concerns, mHealth literacy, mHealth self-efficacy, and adult playfulness. Based on survey data from both countries, we employed the Kano method to evaluate PHR features and applied a quartile-based sample-split approach to understand the underlying relationships between user characteristics and their perceptions of features. Our results not only reveal significant differences in 14 of the features between Germans and Danes, they also demonstrate which of the user characteristics best explain each of these differences. Our two key contributions are, first, to explain the evaluation of specific PHR app features on user satisfaction in two different healthcare contexts and, second, to demonstrate how to extend the Kano method in terms of explaining subgroup differences through user characteristic antecedents. The implications for app providers and policymakers are discussed.

Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries.

In low- and middle-income countries (LMICs) striving to achieve universal health coverage, the involvement of different stakeholders in formal or informal ways in health technology assessment (HTA) must be culturally and socially relevant and acceptable. Challenges may be different from those seen in high-income countries. In this article, we aimed to pilot a questionnaire for uncovering the context-related aspects of patient and citizen involvement (PCI) in LMICs, collecting experiences encountered with PCI, and identifying opportunities for patients and citizens toward contributing to local decision- and policy-making processes related to health technologies. Through a collaborative, international multi-stakeholder initiative, a questionnaire was developed for describing each LMIC's healthcare system context and the emergence of opportunities for PCI relating to HTA. The questionnaire was piloted in the first set of countries (Brazil, Indonesia, Nigeria, and South Africa). The questionnaire was successfully applied across four diverse LMICs, which are at different stages of using HTA to inform decision making. Only in Brazil, formal ways of PCI have been defined. In the other countries, there is informal influence that is contingent upon the engagement level of patient and citizen advocacy groups (PCAGs), usually strongest in areas such as HIV/AIDS, TB, oncology, or rare diseases. The questionnaire can be used to analyze the options for patients and citizens to participate in HTA or healthcare decision making. It will be rolled out to more LMICs to describe the requirements and opportunities for PCI in the context of LMICs and to identify possible routes and methodologies for devising a more systematic and formalized PCI in LMICs.

Volunteering in Health Care Context: A Concept Analysis Using Rodger’s Evolutionary Approach

Background: Volunteering is a common concept used in various disciplines including in the health care context. Nursing plays a role in volunteering concept development. However, the use of volunteering concept is still interchangeable. The clear definition concept about volunteering will promote the improvement in healthcare system quality.Purpose: This study aimed to clarify the volunteering concept in the health care context using Rodger’s evolutionary concept analysis.Methods: This study used a literature review for collecting the exemplars. Researchers used articles published in 2010-2020 in ScienceDirect, PubMed, Web of Science, and Google Scholar. Articles were searched using OR and AND. The keywords and MeSH used were “Volunteering OR Volunteerism OR volunteers AND Health OR Care OR Nursing” in the title, abstract, and keyword articles. Inclusion criteria were full articles in English. Rodger’s evolutionary concept analysis was implemented in this study with six steps.Results: This study used 39 eligible articles analyzed by providing codes of each article and then classified them in attributes, antecedents, and consequences of concept. Five attributes of volunteering, namely, giving help freely, as long-term planned, as giving a benefit to another individual, group, or organization, as working at a formal organization, and as a long-life activity were found. Antecedents of volunteering include motivation, social demographic, and philanthropic behavior. The consequences of volunteering were consequences for volunteers, patients, and the health care system.Conclusion: Volunteering is a complex concept and many surrogate concepts have similar definitions. The attributes are still debatable and need to be explored. Also, the consequences of volunteering are still rarely discussed in a particular health care system context. Further studies need to analyze the measurement of volunteering development based on the nursing theory framework and explore the consequences of volunteering in the health care system related to the nursing care context.

WEB-BASED 5-DIMENSIONAL ELECTRONIC PORTFOLIO (5DEP) AS A COMPETENCY-BASED ASSESSMENT TOOL IN POST-GRADUATE MEDICAL TRAINING

Background. New challenges of permanently changing context of healthcare system requires new methods of medical education and new assessment tools, as well. Competency-based Medical Education (CBME), framework which has been adopted as a new approach in medical education, needs appropriate assessment tool such as portfolio. Portfolio is learner-centered assessment instrument which evaluates learner’s progression towards outcomes and enables both residents and teachers to engage in a process of learning through assessment.&#x0D; Objective. In this paper we aim to share our successful experience of an effective use of web-based 5-Dimensional Electronic Portfolio (5DeP) as an assessment tool in the Pilot Group.&#x0D; Methods. Pilot Group of sixteen residents (six first year residents of Obstetrics/Gynecology and ten first year residents of Internal Medicine. Tbilisi State Medical University Institute of Postgraduate Medical Education and Continuous Professional Development) and twelve mentors (four Obstetrics/Gynecology mentor and eight Internal Medicine mentors) reported some feedback about 5-Dimensional Electronic Portfolio (5DeP) as a new assessment tool.&#x0D; Results. Feedback about 5-Dimensional Electronic Portfolio (5DeP) as a new assessment tool from mentors and students demonstrated efficiency of the program. It enables assessment within a framework of transparent and declared criteria and learning objectives; provides a model for lifelong learning and continuing professional development; increases competence in a wider context with benefits to both professional and personal roles; improves organizing skills.&#x0D; Conclusions. 5DeP have been recognized as an extremely effective assessment tool.

Budgetary bias in the Finnish public hospital system

PurposeThe purpose of this paper is to analyze the dynamics of budgetary biasing in the context of public hospitals.Design/methodology/approachThe study applies theories of accounting and budgeting behaviors in the specific institutional context of health care systems. Based on the theoretical framework, data from interviews with hospital budget officers were analyzed using qualitative content analysis.FindingsA typology of biases is provided. It proved to be useful and highlighted the central empirical assumptions and preliminary results of biasing dynamics.Practical implicationsUnderstanding the logic of budgeting actors and the drivers of bias may help explain why bias so often appears in health care budgeting. It further contributes to understanding whether the bias is functional or dysfunctional.Originality/valueThe concepts of budgetary bias are rarely used in the context of health care budgeting, so the study fills a gap in research knowledge.

Psychometric Evaluation of a Feedback Conception Scale: Building Positive Feedback Practises of Charge Nurses in Public Hospitals

Charge nurses who have a good level of understanding on feedback conceptions will be able to practise feedback effectively towards their staffs. The purpose of this pilot study was to provide the evidence of psychometric evaluation of ‘Teachers’ Conceptions of Feedback (TCoF) scale of charge nurses using the Rasch Measurement Model. There are 9 constructs with 37 items altogether. One hundred and sixty-three (N=163) charge nurses from three states had completed the questionnaire. The content validity was checked by three experts in the field of measurement and medical health. The findings revealed that most items fit the model as their MNSQ values are between 0.60 and 1.40 except for four items. PMC value for all items are more than 0.20 except for three items. Two items showed a negative value of PMC. Most items are in a same direction so the item discrimination is good. Item reliability and item separation is 0.87 and 7.29 respectively, while person reliability and person separation is 0.81 and 2.81 respectively. The reliability value for item and person is high and acceptable. The separation index for item and person are also acceptable. In total, five items were deleted. The statistical analysis provides strong evidence to support the validity and reliability of the scale. The findings show that sample selection is appropriate. Hence, this instrument could be adapted or adopted by other researchers in the Malaysian health care system context

Problems and challenges: development of blood transfusion services in Mainland China within the context of health-care system reform.

To evaluate the development of blood transfusion services in Mainland China within the context of health-care system reform. China launched a health-care reform program in 2009 to redistribute health-care resources, which are currently over-concentrated in well-developed cities. A geographically equitable blood transfusion service is key to achieving this goal. Based on the national survey of blood establishments in July 2015, total blood collection, whole-blood donations per 1000 population and the supply and demand relationship were analysed at the administrative region level. Areas at different developmental levels were compared in terms of total blood collection and human resources. In 2014, Mainland China's 31 provinces showed wide variation, with total blood collection in blood facilities ranging from about 1000 units to over 600 000 units (each 200 mL), and the whole-blood donation rate per 1000 population, ranging from 1·48 to 17·09. 69% of the country's total collection, was concentrated in 29 provincial capitals, and 31% was in 311 non-capital cities. Of 97 personnel with doctorates, 74 worked in 32 provincial blood establishments, whereas the remaining 23 worked at the other 318 blood stations. In most provinces, per permanent resident donation was within 2-4mL, and blood volume per inpatient was 10-35 mL regardless of the development of the transfusion service. In 2014, China had an imbalanced development and insufficient access to blood transfusion services. This service must be redeployed at the national level to facilitate health-care reform in China.

That Look That Makes You Not Really Want to be There: How Neoliberalism and the War on Drugs Compromise Nursing Care of People Who Use Substances

Abstract Research conducted in 2016 explored the health care experiences of people who use illicit opioids in small Ontario urban and rural communities. Perspectives of participants who used opioids and of nurse participants were interpreted using Friere’s critical social theory framework to explore sociopolitical, economic and ideological influences. Findings describe pervasive experiences of stigma, discrimination and inappropriate care. Exploration of why such negative experiences with nursing care might be so pervasive led to a consideration of the context of health care systems and in particular of the influences of neoliberalism and the impact of the global War on Drugs. Mitigation strategies to support contextualized nursing practice are outlined. Nurses are called upon to actively resist the pressures of these political forces by advocating for policy change including decriminalization.

The ‘wicked problem’ of telerehabilitation: Considerations for planning the way forward

Telerehabilitation offers great promise to improved access to rehabilitation care. The rising use of technology, the increased expansion of data networks worldwide, and the growing confidence and interest of the general population to incorporate technology into their day-to-day lives via the Internet, smartphones and wearables provide fertile ground for many rehabilitation interventions. Despite this opportunity, telerehabilitation is not integrated into existing health care systems today. Most research is focused on the efficacy of the intervention without addressing the complexity of introducing a system of care that is starkly different from the current health care system in most countries. As such, implementation of telerehabilitation may be considered a ‘wicked problem’ in that it is extremely complex and challenging situation that is intricately linked with the social, economic and political contexts. This paper discusses telerehabilitation implementation while considering the intervention, patient, and health care system contexts in which it occurs.

The role of communication in healthcare systems and community resilience

Communication failures often contribute to emergency medicine breakdowns during crises like Ebola, Superstorm Sandy, and 9/11. For example, the misidentification of Ebola in Dallas in 2015 was blamed on ineffective communication between hospital departments and ineffective hospital communication systems. Yet, existing research rarely examines how communication breakdowns can contribute to such failures. This paper provides a systematic research review to introduce emergency medicine providers to research-based best practices in risk and crisis communication. This paper also extends these best practices based on the unique healthcare system context. Understanding these best practices can improve how emergency medicine providers prepare for and respond to crises. In addition, awareness of critical research gaps such as message crafting techniques, family communication, and empowering nurses can inform strategic priorities for mitigating common communication failure points.

PHP187 - Marketing Authorization of Medicines Approved In Eu Via “Adaptive Pathway”: Consequences on The Egyptian Public Health

This paper aims to discuss the consequences of the broadened use of the “adaptive pathways” in the EU countries, the availability of adequate measures in the current regulatory framework and healthcare system to ensure public health benefit and reduce hazards. Finally, this paper will draw policy recommendations on how to manage the entrance of these kind of products to the Egyptian Market. Literature review is done to set a list of measurements and prerequisites in the regulatory and healthcare system to ensure and monitor the benefit-risk balance across the product life cycle. A focus group of medicines regulators and healthcare system experts was established to discuss the existence of these measurements within the Egyptian regulatory framework and healthcare system context. Finally a list of policy recommendations will be set for the safe introduction of medicines approved by “adaptive pathway” to the Egyptian market. Health system decision makers and the Egyptian Drug Authority should ensure that the following measurements will be in place before starting the introduction of “Adaptive licensing” medicines: Vigilance regulation is fulfilled; Regulatory bodies closely monitor the promotion practice and prescribing practice to prevent off-label use; The Egyptian Drug Authority should revisit the definition of unmet medical need; Payers and health insurance organization should reconsider their reimbursement mechanisms and shift to payment-for- performance scheme; The MOH should ensure the availability of unbiased clear information for patients; Patient Registry systems in MOH and University tertiary hospitals should be strengthened and there should be a mechanism in place to compensate patients for any resulted harms from the therapy. Medicines approved by “adaptive pathway” should get a market authorization in Egypt only if there is an unmet medical need.

Implementation of HIV and Tuberculosis Diagnostics: The Importance of Context.

Novel diagnostics have been widely applied across human immunodeficiency virus (HIV) and tuberculosis prevention and treatment programs. To achieve the greatest impact, HIV and tuberculosis diagnostic programs must carefully plan and implement within the context of a specific healthcare system and the laboratory capacity. A workshop was convened in Cape Town in September 2014. Participants included experts from laboratory and clinical practices, officials from ministries of health, and representatives from industry. The article summarizes best practices, challenges, and lessons learned from implementation experiences across sub-Saharan Africa for (1) building laboratory programs within the context of a healthcare system; (2) utilizing experience of clinicians and healthcare partners in planning and implementing the right diagnostic; and (3) evaluating the effects of new diagnostics on the healthcare system and on patient health outcomes. The successful implementation of HIV and tuberculosis diagnostics in resource-limited settings relies on careful consideration of each specific context.