Cost-effective Services Research Articles

Factors Influencing Smallholder Farmers’ Preference for Veterinary Service Providers in Zimbabwe

Animal diseases pose significant challenges to livestock production in Zimbabwe's smallholder sector. This study analyzed the variables influencing smallholder farmers' preferences for veterinary service providers. Data from a mixed-method approach, including a questionnaire (N=382), focus group discussions (N=8), interviews (N=16), and observations, were analyzed using descriptive statistics and multivariate probit regression. The findings revealed that access to veterinary services is complex and context-dependent, influenced by factors such as experiences, age, proximity to the provider, communication, remittances, satisfaction, repeat treatments, socioeconomic status, historical dynamics, and access to subsidized drugs. Government veterinary services, private sector entities, and Community Animal Health Workers played critical roles in the provision of veterinary services. Better coordination among the different service provides could enable provision of cost-effective services. The study highlights the multifaceted nature of smallholder farmers' decision-making, emphasizing the importance of situational factors and collaboration among service providers to meet their diverse needs effectively. These insights inform policymakers and stakeholders in developing strategies to enhance veterinary services in Zimbabwe's smallholder communities, ultimately improving livestock productivity and welfare.

T-cell large granular lymphocytic leukemia in Vietnam: Using microscope-to-screen videoconferencing to improve diagnosis.

Leukemia diagnosis in Vietnam is limited by a lack of hematopathology training and expert consultation as well as the cost of high-magnification digitization of hematology slides. Screen-sharing software allows international collaboration with experienced hematopathologists for improved diagnostic accuracy. A hematopathology education and consultation program was proposed for Vietnam hospitals. By appointment, pathologists in Vietnam with access to a microscope camera, imaging software, and high-speed internet were invited to review slides and data with a volunteer board-certified hematopathologist in the United States using secure videoconferencing software. A single hospital in southern Vietnam assigned a pathologist proficient in English to access this service. All consultations from this site with clinicopathologic information were logged. After a 2-year period of online consultation, case slides for selected diagnoses were reviewed under the microscope in Vietnam to assess concordance. In total, 135 consultations were logged, 53 of which were for blood and bone marrow. T-cell large granular lymphocytic leukemia (T-LGLL) was 1 of the most frequent bone marrow consultation-related diagnoses; all diagnoses of this entity were confirmed by in-person microscopy (100% concordance). A records search and physician surveys found no prior documented diagnoses of T-LGLL made in Vietnam before this education and consultation program. Our virtual consultation model has improved patient care in Vietnam by providing correct diagnoses to inform best practices in treatment. As a result of our program, the first Vietnam diagnoses of T-LGLL were made and may help expand on the literature in this area. This model could provide cost-effective, real-time consultation and education services for pathologists in underserved communities.

Robust Operation Scheme of EV Charging Facility With Uncertain User Behavior

With the widespread of electric vehicles (EV), the necessity of installing EV charging facility has rapidly increased. Since operating EV charging facility are costly and complex, choosing a proper power operation scheme is critical in implementing a cost-effective charging service. Therefore, this paper proposes an efficient power operation scheme for EV charging facility by jointly analyzing not only monetary issues with various power rate policies and battery wear-out costs of the energy storage system (ESS) but also the uncertainty issues caused by EV users' behavior under different charging requirements. By considering the issues, this paper analyzes and formulates the problem with robust optimization techniques. By using the real-world EV operation datasets, the effectiveness of the proposed scheme is analyzed in terms of daily peak power and total cost. In addition, by applying the proposed scheme in an actual power system, it is shown that the proposed scheme is able to reduce the overall cost by <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$20.5\%$</tex-math></inline-formula> and reduce peak power by <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$17.3\%$</tex-math></inline-formula> compared to other benchmark models.

Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India: A Randomized Controlled Trial.

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups (P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group (P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

Knowledge, Implementation, and Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan: A Survey Analysis.

An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs), such as Pakistan, has driven the need for implementing Enhanced Recovery After Surgery (ERAS), a safe and cost-effective surgical service aimed at improving patient recovery and reducing post-operative complications. Despite countless benefits, there are few ERAS programs throughout Pakistan andsparse literature on healthcare professionals' views regarding ERAS. Without a deep understanding of healthcare professionals' perspectives on ERAS, underlying barriers and facilitators to a long-term ERAS implementation cannot be addressed and improved upon.Therefore, the purpose of this study is to better understand the knowledge, implementation, and perception of ERAS from the perspective of healthcare professionals across Pakistan. Upon receiving ethical approval from the McGill University Health Center (MUHC), a previously validated questionnaire was modified and a 29-question survey was developed and disseminated to healthcare professionals practising in Pakistan. Quantitative data was analyzed using descriptive statistics and potential correlations that exist between the implementation of ERAS and the participants' gender, employment setting, and surgical specialty were investigated using the chi-squared analysiswith a p-value of 0.05 as the cutoff. A total of 49 participants responded to this survey of whom 34 (69%) worked at a tertiary care teaching hospital whereas 15 (31%) worked at a private hospital. Surprisingly, 42 (85%) participants expressed being aware of the ERAS guidelines with only 30 (61%) either strongly agreeing or agreeing to successfully implementing ERAS into practice. The largest discrepancies in implementation were seen when discussing specific elements of the ERAS guidelines such as preoperative carbohydrate loading, practicing prolonged preoperative fasting, performing mechanical bowel preparation, performing active patient warming, and early postoperative removal of Foley's catheter. Surgeons employed at a private institution were more likely to discuss postoperative pain management and control, less likely to utilize prolonged fasting, more likely to perform regular body temperature monitoring, more likely to practice providing chewing gum to patients postoperatively, and more likely to perform early removal of the Foley's catheter. An understanding of ERAS, the implementation of various elements, and a positive attitude toward its benefits definitely seem to be prevalent among healthcare professionals in Pakistan. However, key barriers and enablers specific to the underlying healthcare environment seem to be hindering the long-term successful implementation of ERAS across Pakistan. It is crucial for future studies to explore these barriers in further detail and involve theperspective of these key stakeholders to help enhance long-term ERAS adoption.

Effectiveness of peer assisted learning in improving HIV knowledge, attitude, and perception among community health workers

Background: Community health workers (CHWs) act as a bridge between community and clinical care in caring for HIV patients. This study aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and perception of CHWs in Babol, Iran in 2019. Methods: This was a quasi-experimental study conducted among CHWs in the health centers of Babol, Iran. The city was divided into two areas of the North and the South according to the geographical map. Then, based on the list of the health centers in each of the areas, one health center was randomly selected and assigned to either the experimental or the control group. Results: Following peer education, all study variables including knowledge score, attitude, and perception about HIV-related issues significantly improved in the experimental group compared to the pre-intervention phase (P=0.002, P=0.02, and P=0.00 respectively). The most significant change was in misconception score with a approximately large effect size (0.78), presenting an increase of 95.53% from 15 to 29.33 after the intervention, while attitude and knowledge respectively presented 85.04% and 81.07% increase with a smaller effect size of 0.57 and 0.52. Conclusion: In the study peer education proved to be an effective strategy in improving the knowledge, attitudes, and perception of CHWs concerning HIV/AIDS. Therefore, the peer-to-peer training model can fill a critical gap in the training of CHW based on the idea that not only do the CHWs themselves need to enhance their knowledge of related topics but they also need to train others. In turn, this will result in providing cost-effective health promotion and prevention services in a more culturally appropriate manner.

Using data to develop cost-effective battery-swap networks for electric vehicles

Electric vehicle (EV) development faces the challenges of range anxiety and the high construction and operating costs of charging and battery-swap infrastructure. To address these issues, this paper describes a proposed battery-swap network (BSN) comprising battery-swapping van service points and battery-swap stations to provide local, fast and cost-effective battery-swapping services. A data-driven approach was developed to analyse and model vehicle trajectory data to obtain realistic battery-swap demand distributions. An optimisation model based on location cover was then developed to minimise the cost of a BSN using a greedy algorithm. Real traffic network driving distance was adopted to improve authenticity and accuracy. In a case study, a BSN used a 1 week trajectory data set of taxis in Beijing, China and tested the effects in eight scenarios. The results showed that the mesh size of service points, service radius and coverage rate all had an impact on service quality and cost. It is concluded that a BSN could be cost-effectively deployed by adjusting these parameters to suit the needs of EVs at different development stages. This paper provides a useful reference for decision makers and operators to formulate policies and strategies.

Взаємодія інститутів громадянського суспільства та органів державної влади

The importance of effective interaction of public society institutions with state authorities is analyzed, because civil society institutions ensure the provision of high-quality and cost-effective social services, the organization of private individuals and legal entities under private law to independently satisfy their interests without additional financial or administrative costs from the state; spread of charity and provision of targeted and operational charitable assistance; participation in decision-making and thus ensuring greater effectiveness of decisions taking into account the interests of various social groups. It has been established that today this interaction is actively taking place in several legal forms, namely: the participation of civil society institutions in the rule-making activity of the state; participation of civil society institutions in law enforcement activities of the state; participation of civil society institutions in law enforcement activities of the state. The political and legal aspect of the right of citizens to association is defined, which is determined by the specificity of the subject of constitutional and legal regulation. It has been investigated that the activity of a public association or charitable organization in Ukraine before and after the start of a full-scale war is generally quite highly evaluated by representatives of the public sector. The role of the mass media, acting simultaneously as a channel for expressing the opinion of civil society, as a means of its formation, and as a tool for public control over power, is characterized. It was found that the essence and specificity of mass media is revealed through their functions. Determining the functions of the media means revealing the role played by the media as an element of the social system. The war caused the appearance in the media space of situations and legal dilemmas that were not relevant until now. In particular, not all information can be freely requested and used. After all, there is also information with limited access - secret, confidential, official. During martial law, it is especially important to follow the "letter of the law" and not to publish data that could directly or indirectly harm the security of the state and its citizens.

An appraisal of the National Health Insurance Scheme (NHIS) in public service organizations in Nigeria: A case study of Federal Polytechnic, Idah, Kogi State, Nigeria

The Formal Sector Social Health Insurance Programme (FSSHIP) is one of the cardinal programmes of the National Health Insurance Scheme (NHIS) targeted at providing qualitative and cost-effective health care services to employees in the public and organized private sectors, respectively. This study, therefore, empirically examines the level of awareness and the enrollment rate (rate of participation) of the staff of The Federal Polytechnic, Idah, Kogi State. North Central Nigeria, pertaining to the Formal Sector Health Insurance Programme (FSSHIP). The study also explores the extent to which staff of the institution are satisfied with the quality and cost-effectiveness of health services provided under the programme. The study adopts the descriptive cross-sectional survey research design which involves the administration of fixed-choice questionnaires to 162 randomly sampled staff of the institution. Consequently, the data elicited from the questionnaires were mainly analyzed using descriptive statistics. The study reveals that the awareness level about the Formal Sector Social Health Insurance Programme (FSSHIP) among staff of the institution is low. Also, the study shows that majority of the sampled staff of the institution are not enrolled in the FSSHIP. The study, therefore, concludes that the qualitative and cost-effective health services provided under the FSSHIP would be of little impact if a significant proportion of those covered by the programme do not actively participate in it due to low level of awareness and enlightenment about the programme. To this end, the study leveraged on the political systems theory, to recommend, among others, the need for major stake holders in the FSSHIP, to interface with staff of the institution through various interactive forums in order to raise their awareness levels, and enrollment rate in the programme.

An Assessment of Case Manager Experience on the Implementation of Case Management at Langsa City General Hospitals

Background: The responsibility of case managers is to facilitate and coordinate patient care. Their presence in the implementation of case management is expected to have a beneficial impact. The program is also expected to benefit the hospital in a variety of ways, specifically in terms of patient service management related to more cost-effective services. Objective: This research aims to explore the experience of case managers in carrying out case management at Langsa City General Hospital (RSUD), which has been operational since June 2019. Methods: This research adopted a qualitative design with a descriptive phenomenological approach. From a total of seven individuals on duty, five case managers from the nursing profession were included in the population. The remaining two are medical professionals and refused to participate. Data were collected by conducting interviews, observations, and documentation. Results: The results showed that case managers are still in the honeymoon phase, with their services focused on the collaboration gap and overlapping roles. Conclusion: Almost all case managers feel that their work experience has not been fully implemented in accordance with the work program. They have to adapt to new tasks and receive some training related to the implementation of case management in hospitals.

Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes.

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.

New trends in photonic switching and optical networking architectures for data centers and computing systems [Invited

The rapid increases in data traffic coupled with user preferences are driving the data center and computing system service providers to offer energy-efficient, intelligent, flexible, cost-effective, high-capacity, and low-latency data services without added complexity to the users. Disaggregated heterogeneous reconfigurable computing systems realized by photonic switching and interconnects can enhance throughput and energy efficiency for artificial intelligence/machine learning (AI/ML) workloads, especially when aided by the AI/ML-enhanced control plane. Photonic switching and new optical networking architectures are expected to solve many of these challenging problems. This paper discusses new trends in photonic switching and optical network architectures for future data centers and computing systems summarized as follows: (1) flat reconfigurable disaggregated computing enabled by high-radix photonic switching and interconnects in data centers; (2) chiplet-based computing architectures empowered by embedded photonics toward heterogeneous reconfigurable computing; (3) nanosecond-scale photonic switching in data centers and computing systems; (4) AI/ML in self-driving, application-aware, and situation-aware data centers; (5) the emergence of flexible networking for cloud computing, edge computing, and split computing, as well as flexible networking for 5G/6G RF-optical networks; and (6) the deployment of embedded co-designed silicon photonics being considered for future data centers.

Using the behaviour change wheel and person-based approach to develop a digital self-management intervention for patients with adrenal insufficiency: the Support AI study protocol.

Most patients with Adrenal insufficiency (AI) require lifelong glucocorticoid replacement. They need to increase glucocorticoids during physical illness or major stressful situations and require parenteral hydrocortisone in the event of an adrenal crisis. Patients with AI have impaired quality of life and high mortality; approximately 1 in 6-12 patients are hospitalised at least once/year from a potentially preventable adrenal crisis. Adoption of self-management behaviours are crucial; these include adherence to medication, following "sick day rules" and associated behaviours that aid prevention and treatment of adrenal crisis such as symptom monitoring, having extra tablets, carrying a medical-alert ID and injection kit, and self-injecting when necessary. Current patient education is ineffective at supporting self-management behaviour change or reducing adrenal crisis-related hospitalisations. This research study aims to gain an in-depth understanding of the barriers and enablers to self-management for patients with AI and to develop an evidence-based digital self-management behaviour change intervention. The study is conducted in accordance with the MRC Framework for developing complex interventions. Underpinned by the Behaviour Change Wheel (BCW), the Theoretical Domains Framework (TDF), and the Person-Based Approach, this research will be conducted in two phases: Phase 1 will involve a sequential qualitative/quantitative mixed-methods study involving focus group interviews followed by a cross-sectional survey with patients with AI recruited from patient advocacy groups and endocrine clinics in the UK. Phase 2 will develop the Support AI, a website-based digital behaviour change intervention (DBCI) informed by Phase 1 findings to support self-management for patients with AI. The most appropriate behaviour change techniques (BCTs) will be selected utilising a nominal group technique with an Expert Panel of 10-15 key stakeholders. The design of the Support AI website will be guided by the Person-Based Approach using an Agile iterative "think-aloud" technique with 12-15 participants over 3 usability testing iterations. A theory- and evidence-based digital behaviour change intervention will be developed which will be tested in a feasibility randomised trial following completion of this study. The projected benefit includes cost-effective health care service (reduced hospitalisations and demand for specialist services) and improved health outcomes and quality of life for patients with AI.

Digital service technologies, service robots, AI, and the strategic pathways to cost-effective service excellence

ABSTRACT Recent research has shown that the trade-off between customer satisfaction and productivity can be mitigated through three strategic pathways: the (1) operations management (OM) approach, (2) focused service factory, and (3) dual culture strategy, which allow firms to achieve cost-effective service excellence (CESE). We advance that these strategies are also excellent enablers for the development, implementation, and use of digital service technologies, service robots, and artificial intelligence (AI). First, the OM approach reduces process variations in service delivery, creating opportunities for leveraging technology to automate processes. Second, the focused service factory strategy enables high volumes of largely identical service transactions with minimized customer-induced variability, easing service automation. Third, the dual culture strategy ensures that digital automation is firmly customer-centric and achieves service excellence. We advance a set of propositions and research questions aimed at stimulating research at the intersection of the two streams of literature on digital service technologies and CESE.

Customer Service Combining Human Operators and Virtual Agents: A Call for Multidisciplinary AI Research

The use of virtual agents (bots) has become essential for providing online assistance to customers. However, even though a lot of effort has been dedicated to the research, development, and deployment of such virtual agents, customers are frequently frustrated with the interaction with the virtual agent and require a human instead. We suggest that a holistic approach, combining virtual agents and human operators working together, is the path to providing satisfactory service. However, implementing such a holistic customer service system will not, and cannot, be achieved using any single AI technology or branch. Rather, such a system will inevitably require the integration of multiple and diverse AI technologies, including natural language processing, multi-agent systems, machine learning, reinforcement learning, and behavioral cloning; in addition to integration with other disciplines such as psychology, business, sociology, economics, operation research, informatics, computer-human interaction, and more. As such, we believe this customer service application offers a rich domain for experimentation and application of multidisciplinary AI. In this paper, we introduce the holistic customer service application and discuss the key AI technologies and disciplines required for a successful AI solution for this setting. For each of these AI technologies, we outline the key scientific questions and research avenues stemming from this setting. We demonstrate that integrating technologies from different fields can lead to a cost-effective successful customer service center. The challenge is that there is a need for several communities, each with its own language and modeling techniques, different problem-solving methods, and different evaluation methodologies, all of which need to work together. Real cooperation will require the formation of joint methodologies and techniques that could improve the service to customers, but, more importantly, open new directions in cooperation of diverse communities toward solving joint difficult tasks.

Laparoscopy in Low- and Middle-Income Countries: A Survey Study.

An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs) has impelled the need for implementing laparoscopic surgery, a safe and cost-effective surgical service. However, despite countless benefits, laparoscopic surgery programs remain limited throughout LMICs, and limited understanding is known of healthcare professionals' views regarding the implementation of laparoscopic surgery in their local healthcare environments. Therefore, the purpose of this study is to better understand the perceived challenges and barriers to implementing long-term laparoscopic surgery programs from the perspective of healthcare professionals. Upon receiving ethical approval from the McGill University Health Center (MUHC), a nine-question survey (concerning attributes required to establish a successful laparoscopic program in LMICs and to gain insight into what surgeons from LMICs believed were the necessary next steps) was pilot tested amongst faculty members, and subsequently disseminated to healthcare professionals practicing in LMICs. Explicit consent was obtained from the participants before answering the survey. Results: Thirty-four participants representing a total of 35 countries participated in the survey with the majority having received laparoscopic surgery training. Overall, participant responses were characterized by two major themes. Highlighted in the first theme, Laparoscopic Experience and Training Curriculum, were responses concerning current laparoscopic training and education, improved career opportunities provided by laparoscopic training, and a particular existing potential to incorporate laparoscopic surgery into the current surgical curriculum at various levels of training. Emphasized in the second theme, Challenges and Next Steps, were responses concerning barriers to the implementation of laparoscopic surgery, current institutional capabilities, and the need for improving mentorship through existing surgical societies such as the College of Surgeons of East, Central, and Southern Africa (COSECSA), West African College of Surgeons (WACS), and The Pan-African Academy of Christian Surgeons (PAACS). A buy-in from the government, hospitals, staff, and industry is crucial for the long-term implementation of laparoscopic surgery in LMICs, which can only be accomplished through increased advocacy and the dissemination of the benefits of minimally invasive surgery both economically and socially.

Factors Influencing Smallholder Farmers’ Preference for Veterinary Services Providers in Zimbabwe

Animal diseases pose significant challenges to livestock production in Zimbabwe's smallholder sector. This study analyzed the variables influencing smallholder farmers' preferences for veterinary service providers. Data from a mixed-method approach, including a questionnaire (N=382), focus group discussions (N=106), interviews (N=16), and observations, were analyzed using descriptive statistics and multivariate probit regression. The findings revealed that access to veterinary services is complex and context-dependent, influenced by factors such as experiences, age, proximity to the provider, communication, remittances, satisfaction, repeat treatments, socioeconomic status, historical dynamics, and access to subsidized drugs. Government veterinary services, private sector entities, and Community Animal Health Workers played critical roles, with coordination enabling cost-effective services. The study highlights the multifaceted nature of smallholder farmers' decision-making, emphasizing the importance of situational factors and collaboration among service providers to meet their diverse needs effectively. These insights inform policymakers and stakeholders in developing strategies to enhance veterinary services in Zimbabwe's smallholder communities, ultimately improving livestock productivity and welfare.

Epidemiology of Hajj pilgrimage mortality: Analysis for potential intervention

BackgroundThe Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Little is known about the impact of the existing chronic diseases on morbidity and mortality during the Hajj. Furthermore, the quality of services provided by Hajj hospitals warrants further study. This study aims to describe patterns of inpatient, all-cause mortality during the Hajj and the relationship between mortality and preexisting chronic diseases as well as the services provided in Hajj hospitals. MethodsThe population included pilgrims who were admitted to Hajj hospitals in Makkah and sacred sites between 2012 and 2017, excluding 2015. A retrospective, matched, case-control study design was utilized. 2237 cases of mortality were matched to 4474 control cases based on age and gender. The data were extracted from hospital admissions offices and medical records. Hierarchical, logistic regression models were used to examine the medical services. The effect measure modification of the copresence of more than one chronic disease was also examined. ResultsThe rate of inpatient all-cause mortality was higher in Makkah hospitals compared to sacred site hospitals. Inpatient, all-cause mortality was significantly associated with diabetes, hypertension, and cardiovascular diseases. Effect measure modification was present between diabetes and cardiovascular diseases, hypertension, and cardiovascular diseases, but not between diabetes and hypertension. Patients who received medical services were more likely to die during their hospital stay compared to patients not receiving services. ConclusionThe current focus on public health issues during the Hajj should be equally distributed between communicable and non-communicable diseases. Although advanced services are provided by Hajj hospitals, interventions to address the increased risks, including mortality, faced by pilgrims with preexisting, chronic diseases should be further investigated and considered.

A current review of the digital component of cardiac rehabilitation via telemonitoring

The increasing availability of information technologies in modern society has created the opportunity to provide technology-based health care in both hospital and community settings. In this way, telemedicine has become a topic of debate; this can ensure the delivery of accessible, cost-effective and specific health care services at different times and at a distance. Communication technologies have also shown incredible promise in rehabilitation, encouraging the development of a fresh branch of telemedicine known as telerehabilitation. Extensive research has shown that telerehabilitation is equal to or more effective and less expensive compared to traditional rehabilitation in such areas as recovery post-myocardial infarction, post-coronary bypass and post-percutaneous coronary intervention. This literature synthesis aims to highlight the importance of the involvement of telemedicine on cardiac recovery in order to improve the quality of life, reduce the morbidity and mortality of patients in the context of the use of information and communication technologies that allow obtaining important parameters in quantifying the risk of heart failure and, respectively, of cardiovascular events. The comprehensive structure of knowledge, the evolutionary path and research strengths of telerehabilitation from the perspective of the cardiac patient in Moldova, is poorly visualized, thus, the final objective of the study is to study the effectiveness of telemedically monitored home rehabilitation versus the unsupervised one in order to improve the quality and prognosis of patients’ lives with ischemic heart disease after coronary revascularization.

Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.

The primary aim of our study was to assess the environmental impact of moving from a standard to a lean and green model for a carpal tunnel decompression. We objectively measured the clinical waste generated, the number of single use items and the number of sterile instruments required for a standard procedure, and then moved to smaller instrument trays, smaller drapes and fewer disposables. These two models were compared for waste generation, financial costs and carbon footprint. Information prospectively collected on seven patients in the standard model and 103 patients in the lean and green model in two hospitals over a 15-month period, demonstrated a reduction in CO2 emissions of 80%, clinical waste reduction of 65%, and an average aggregate cost saving of 66%. The lean and green model can deliver a safe, efficient, cost-effective and sustainable service for patients undergoing carpal tunnel decompression.Level of evidence: III.