Delivery Of High-quality Care Research Articles

Engaging with the public on their views on the collection, use and sharing of personal health information: Development of a scenario-based survey instrument

Background Members of the public differ regarding their views on the use and sharing of personal health information. Objective This paper describes the methodology employed to develop a telephone-based survey tool to capture views of the public on the collection, use and sharing of personal health information. Method A rigorous methodology comprising multiple stages was undertaken to develop a vignette/scenario-based survey instrument. These steps included a review of instruments used in other jurisdictions, focus groups, engagement meetings with healthcare professionals, cognitive testing and piloting the final instrument. Informed by the findings of each survey development phase, draft scenarios and accompanying questions were developed. Results The following scenarios were developed: ‘Circle of care,’ ‘Use of information beyond your direct care’ and ‘Digital records.’ Conclusion The findings from this survey will inform national policy in relation to health information and will inform the development and implementation of eHealth initiatives. In turn, this should support the delivery of high-quality, effective health and social care. The learnings from the development of this survey will contribute to future health information policy and governance in countries or jurisdictions considering the development of a national electronic health record system. Moreover, this research will support public and population health management by encouraging public engagement to support successful implementation of new health information systems.

Identification of gaps in the delivery of high-quality care of patients with eosinophilic esophagitis.

Quality indicators (QIs) are standardized metrics that can be used to quantify health care delivery and identify important areas for practice improvement. Nine QIs pertaining to the diagnosis and management of eosinophilic esophagitis (EoE) were recently established. We therefore aimed to identify existing gaps in care using these QIs. This is a retrospective, multicenter study utilizing recently established EoE QIs to evaluate practice patterns among adult gastroenterologists in the diagnosis and management of EoE. Three patient cohorts of 30 patients each presenting with dysphagia, food impaction, and new diagnosis of EoE, respectively, were obtained, yielding 120 patients per site to assess for every QI. Summary statistics were reported across two main themes: diagnosis and management. Subsequent analysis of gaps in care was then performed. The domain of diagnosis of EoE (QI 1 and 2) had the most notable gap in care with only 55% of the presenting patients undergoing appropriate evaluation for EoE. The domain of management of EoE had overall higher QI fulfillment-however it also contained significant intra-category variation in care. Notably, while 79% of patients had clinical follow-up within 1year from remission, only 54% underwent surveillance endoscopy within 2years of remission. In contrast, 100% of patients with symptomatic strictures independent of histologic response underwent endoscopic dilation (QI 4). Management approaches for EoE are evolving and variation in care delivery exists. We identified significant gaps in both diagnosis of EoE especially amongst patients presenting with index food impaction and long term management of EoE, when retrospectively evaluating care patterns using newly established QIs. This is the first study of its kind to utilize these previously established QIs to objectively identify care gaps that exist in EoE amongst several institutions. These findings also highlight the importance of QIs and standardization of management of complex chronic diseases like EoE to help bridge these gaps and provide a framework to measure adherence to these best practices.

Healthcare Professionals’ Knowledge, Attitude, Practices of Assessment, and Management of Sickle-Cell Disease: A Meta-Aggregative Review

Abstract: Background: Sickle Cell Disease (SCD) presents significant health challenges globally. Despite its prevalence in diverse geographical regions, there is a paucity of literature synthesizing evidence on healthcare professionals’ knowledge, attitudes, and practices (KAP) toward SCD assessment and management. This meta-aggregative review systematically examined and synthesized existing qualitative research to elucidate healthcare professionals’ KAP regarding SCD assessment and management. Methods: This meta-aggregative review followed Aromataris and Pearson’s guidelines and the PRISMA framework for systematic review reporting. The search was conducted in Scopus, PubMed, Embase, CINAHL Web of Science, Google Scholar, Dimensions AI, and HINARI. Quality appraisal was performed using the Joanna Briggs Institute tool. Results: Healthcare professionals (HCPs) demonstrate varying levels of KAP toward SCD assessment and management. Studies reveal low-to-moderate levels of general knowledge among HCPs, with nurses often exhibiting poorer understanding than physicians. Deficiencies in awareness of specific interventions, such as chemoprophylaxis and prenatal diagnosis, are noted, along with gaps in SCD assessment and diagnosis, particularly in pain management and premarital screening. Attitudes toward SCD patients vary, and practices reveal inconsistencies and deficiencies, including inadequate nutritional counseling and barriers in emergency departments. However, interventions aimed at improving HCPs’ KAP show promise in enhancing understanding and attitudes toward SCD, suggesting potential avenues for improvement. Conclusions: Educational initiatives targeted at both student nurses and practicing healthcare providers, coupled with the implementation of standardized protocols and guidelines, can enhance knowledge acquisition and promote consistent, high-quality care delivery. Future studies should improve the quality of their methods in this area of study.

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Changes in Registered Nurse Employment Plans and Workplace Assessments

The US registered nurse (RN) workforce is in flux, with high rates of burnout, intention to leave, and vacancies. Rapid, repeated assessments of the nursing workforce can help hospital executives and policymakers enact effective recruitment and retention strategies. To identify changes in practicing RNs' employment plans and workplace assessments between the 2022 and 2023 surveys. This survey study compared data collected from the Michigan Nurses' Study at 2 time points: February 22 to March 1, 2022, and May 17 to June 1, 2023. Practicing RNs with an active, unrestricted license in Michigan and a valid individual email address were included. The primary outcome was nurses' intention to leave their current position within 1 year. In the 2023 survey, nurses who planned to leave were queried on their next career step and the primary reason for their planned departure. Workplace assessments included questions about abusive or violent workplace events, emotional exhaustion, job satisfaction, the practice environment's delivery of high-quality care, and the clinical setting's safety rating. Regression analysis was used to examine workplace assessments and personal factors associated with planned departures. This study obtained data on 9150 nurses (6495 females [71.0%]) and 7059 nurses (5134 females [72.7%]) responding to the 2022 (response rate, 8.3%) and 2023 (response rate, 7.4%) surveys, respectively. In the 2023 survey, 32.0% (2259) of nurses planned to leave their position, compared with 39.1% (3576) in the 2022 survey. Of these nurses, 957 (41.8%) planned to leave their current employer but remain in nursing, with workloads as the most frequently cited reason (29.4% [672]). Compared with the 2022 cohort, nurses in the 2023 sample reported less workplace abuse or violence (4591 [50.2%] vs 3063 [43.4%]; P < .001), fewer understaffed shifts (4407 [48.2%] vs 2898 [41.0%]; P < .001), and less frequent use of mandatory overtime (1709 [18.7%] vs 824 [11.7%]; P < .001). Factors associated with increased likelihood for planned departures included workplace abuse or violence (odds ratio [OR], 1.39; 95% CI, 1.05-1.82) and higher emotional exhaustion scores (OR, 3.05; 95% CI, 2.38-3.91). Favorable practice environments (OR, 0.37; 95% CI, 0.22-0.62) and excellent clinical setting safety ratings (OR, 0.28; 95% CI, 0.14-0.56) were associated with lower likelihood of planned departure. Results of this study showed that nurses reported improved workplace conditions in the 2023 vs the 2022 survey; however, planned departure rates, abusive or violent events, and unsafe conditions remained high, and understaffing remained a primary concern for most nurses. Health system leaders and policymakers should prioritize initiatives that support nurse retention and reduce potential workforce instability.

The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study.

Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Exploration of Hospital Management and Organization Strategies: A Literature Review of Health Services

Background - Healthcare management strategy and organization encompasses the principles and practices used to operate healthcare facilities efficiently and effectively. It involves the planning, implementation, and coordination of various activities to ensure the delivery of high-quality patient care while optimising resource utilisation. The literature review in healthcare provides valuable insights into various aspects of hospital management strategy and organization. Objective - This article aims to find out the importance of management and organizational strategies in service businesses (hospitals) and related factors, so as to create improved human resource performance related to achieving effective and efficient organizational goals to face business competition and can be an organizational strategy in creating job satisfaction, can perform well and can create a competitive advantage for organizations in health services. Research Methode - The method used is the identification of previous articles with a total of 29 articles in the time span of 2000-2023. Search data for literature review was conducted in international journals to support the theory and take the topic of Management and Organizational articles, found 234,347 articles, scope Innovation, 2000-2023, Business, management and accounting, article, organization and management, English found 1,239 articles, Qualitative - 363 articles, Strategic - 134 articles, Performance - 95 articles, Effectiveness - 52 articles, Leadership, Health - 35 articles. Furthermore, articles that do not fit the topic will be ignored. Researchers only use data bases from Scopus and Web of Science because researchers only look for quality articles and the results are more accurate and very credible sources, because the results can be used as references and policies. Results - The importance of the role of management and organization in hospitals and can have a major impact on healthcare organizations. As explained in previous research that Management has a big role to improve hospital performance in an organization. The importance of management and organizational performance as they relate to each other. Human resources (HR) provide special attention in personal development and impact on performance in creating a health service. Conclusion - Management and organization are important in the hospital business because human resources are the driving force of the service business. Good management and organization can create professional and talented human resources results that can improve performance and will have an impact on organizational goals, and services to patients can run well which has an impact on the main objectives of the hospital. Management can be seen from several things including training and development, management practices, organizational climate, and other things that have a relationship in creating effective and efficient management so as to provide optimal results for the organization. Managerial Implications - The healthcare management needs to pay more attention to the evaluation of healthcare operational activities and feedback provided by patient families, the hospital management needs to increase the frequency of its discussions with employees to maintain excellent service quality for patient families, and the hospital management leaders need to set an example and encourage their employees to maintain a good organizational culture in order to maintain their service image.

Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations.

Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation. This study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA). The sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (n=3,547) and masculinizing (n=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of guideline concordant veterans on six VHA guidelines on feminizing and masculinizing GAHT initiation were determined. Compared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values<0.001) than veterans receiving feminizing GAHT. Among veterans who started feminizing GAHT with estrogen, 97.0% were guideline concordant due to no documentation of contraindication, including venous thromboembolism, breast cancer, stroke, or myocardial infarction. Among veterans who started spironolactone as part of feminizing GAHT, 98.1% were guideline concordant as they had no documentation of contraindication, including hyperkalemia or acute renal failure. Among veterans starting masculinizing GAHT, 90.1% were guideline concordant due to no documentation of contraindications, such as breast or prostate cancer. Hematocrit had been measured in 91.8% of veterans before initiating masculinizing GAHT, with 96.5% not having an elevated hematocrit (>50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation. We observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.

It's a jungle out there: Understanding physician payment and its role in group dynamics

Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians' behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians' payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians’ view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.

Development of an assessment tool for designated medical institutions in China--Based on the application of an online assessment system.

Due to the expanding coverage of medical insurance and the growth of medical expenses, the ability to assess the performance of designated medical institutions (DMIs) in supporting the delivery of high-quality patient care and the standardized use of funds represents a priority in China. Despite such interest, there has yet to be an operable standard and labor-saving method for assessing DMIs in China. The main objectives include two aspects: (1) establishing an evaluation index system for DMIs based on contracts; (2) designing and developing an online evaluation platform. A group of 20 experts with theoretical and practical expertise in medical insurance regulation and performance evaluation were invited to select available indicators. A combination weighting method based on analytic hierarchy process and entropy method was used to determine the weight coefficient. Shanghai was taken as the sample area, and 760 DMIs were included in the empirical research. The test-retest reliability method and criterion-related validity method was used to test the reliability and the validity of the evaluation result. An assessment index system that included 6 domains and 56 indicators was established in this study. Furthermore, we developed an online platform to assist in the implementation of the assessment. The results showed that the average score of assessment was 94.39, the median was 96.92. The test-retest reliability value was 0.96 (P ≤ 0.01), which indicated high stability of the assessment. In addition, there was a significant negative relationship between assessment score and the penalty amount of DMIs (R = -0.133, P < 0.001). After adjusting for the basic characteristics of medical institutions, the number of visits and revenue, the negative relationship was still significant (B = -0.080, P < 0.05). These results are consistent with expectations, indicating that the assessment had good criterion-related validity. This study established an operable assessment measure and developed an online platform to assess the performance of DMIs. The results showed good feasibility and reliability in empirical research. Our research findings provided an operable Chinese solution for DMI assessment that saves manpower and time, which would have good enlightening significance in other regions of China and in low-income and middle-income countries internationally.

Navigating privacy and security in telemedicine for primary care.

To examine patient and provider perspectives on privacy and security considerations in telemedicine during the COVID-19 pandemic. Qualitative study with patients and providers from primary care practices in 3 National Patient-Centered Clinical Research Network sites in New York, New York; North Carolina; and Florida. Semistructured interviews were conducted, audio recorded, transcribed verbatim, and coded using an inductive process. Data related to privacy and information security were analyzed. Sixty-five patients and 21 providers participated. Patients and providers faced technology-related security concerns as well as difficulties ensuring privacy in the transformed shared space of telemedicine. Patients expressed increased comfort doing telemedicine from home but often did not like their providers to offer virtual visits from outside an office setting. Providers initially struggled to find secure and Health Insurance Portability and Accountability Act-compliant platforms and devices to host the software. Whereas some patients preferred familiar platforms such as FaceTime, others recognized potential security concerns. Audio-only encounters sometimes raised patient concerns that they would not be able to confirm the identity of the provider. Telemedicine led to novel concerns about privacy because patients and providers were often at home or in public spaces, and they shared concerns about software and hardware security. In addition to technological safeguards, our study emphasizes the critical role of physical infrastructure in ensuring privacy and security. As telemedicine continues to evolve, it is important to address and mitigate concerns around privacy and security to ensure high-quality and safe delivery of care to patients in remote settings.

Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers

ObjectivesHealthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative...

Decision support framework for home health caregiver allocation using optimally tuned spectral clustering and genetic algorithm

Population aging is a global challenge, leading to increased demand for health care and social services for the elderly. Home Health Care (HHC) is a vital solution to serve this segment of the population. Given the increasing demand for HHC, it is essential to coordinate and regulate caregiver allocation efficiently. This is crucial for both budget-optimized planning and ensuring the delivery of high-quality care. This research addresses a fundamental question in home health agencies (HHAs): “How can caregiver allocation be optimized, especially when caregivers prefer flexibility in their visit sequences?”. While earlier studies proposed rigid visiting sequences, our study introduces a decision support framework that allocates caregivers through a hybrid method that considers the flexibility in visiting sequences and aims to reduce travel mileage, increase the number of visits per planning period, and maintain the continuity of care – a critical metric for patient satisfaction. Utilizing data from an HHA in Tennessee, United States, our approach led to an impressive reduction in average travel mileage (up to 42%, depending on discipline) without imposing restrictions on caregivers. Furthermore, the proposed framework is used for caregivers’ supply analysis to provide valuable insights into caregiver resource management.

IMPLEMENTING LEAN MANAGEMENT PRINCIPLES TO OPTIMIZE HEALTHCARE FACILITY OPERATIONS

This article explores the implementation of Lean management principles to optimize operations in healthcare facilities. Lean management, a philosophy made famous by the Toyota Motor Company, focuses on continuous improvement and the elimination of waste to maximize quality and safety for patients. The primary objective of this paper is to examine how Lean tools and techniques can be adapted to the unique environment of healthcare institutions to enhance their productivity and service quality. The article begins by outlining the core principles of Lean management, emphasizing the importance of value stream mapping, Kaizen, and the 5S methodology. Value stream mapping helps identify and visualize the flow of materials and information required to bring a product or service to a consumer, which in healthcare translates to patient care processes. Kaizen, a practice of continuous improvement, encourages small, incremental changes that collectively lead to significant enhancements in efficiency and quality. The 5S methodology—Sort, Set in order, Shine, Standardize, and Sustain—ensures a clean, organized, and efficient work environment. The paper then delves into specific Lean practices that can be applied within healthcare settings, such as reducing patient wait times, improving the flow of patients and information, and minimizing unnecessary movements and processes. By focusing on these areas, healthcare facilities can reduce bottlenecks, streamline operations, and enhance patient care delivery. For instance, implementing Lean techniques in patient scheduling can lead to more efficient use of clinical resources and reduce the time patients spend waiting for services. Furthermore, the paper provides a critical review of existing literature and studies on the application of Lean management in healthcare, highlighting successful implementations and the challenges faced during the process. It discusses real-world examples where Lean management has significantly improved operational efficiency, patient satisfaction, and overall healthcare outcomes. For example, a hospital that adopted Lean principles reported reduced patient wait times, lower operational costs, and improved staff morale. The article also addresses the potential obstacles and resistance to change that healthcare facilities might encounter when adopting Lean principles. It offers strategic recommendations for overcoming these barriers, including leadership commitment, staff training, and fostering a culture of continuous improvement. Leadership commitment is crucial as it sets the tone for organizational change and ensures that the necessary resources are allocated for Lean initiatives. Staff training is essential to equip employees with the skills and knowledge required to implement Lean practices effectively. Fostering a culture of continuous improvement involves engaging staff at all levels, encouraging open communication, and recognizing and rewarding contributions to Lean projects. In conclusion, the paper argues that Lean management principles, when effectively implemented, can lead to substantial improvements in the operational performance of healthcare facilities. It calls for further research and collaboration between healthcare professionals and Lean management experts to tailor these practices to the specific needs of the healthcare sector. The successful integration of Lean management into healthcare operations not only enhances efficiency and reduces waste but also improves patient care quality and safety. By adopting Lean principles, healthcare facilities can create a more efficient, patient-centered environment that supports high-quality care delivery. This article highlights the importance of a systematic approach to implementing Lean management, considering the unique challenges and opportunities within the healthcare sector. It underscores the need for ongoing evaluation and adaptation of Lean practices to ensure sustained improvements and long-term success.

Factors Associated with Evidence-Based Practice Competencies among Taiwanese Nurses: A Cross-Sectional Study.

Evidence-based practice (EBP) is an essential component of healthcare practice that ensures the delivery of high-quality care by integrating the best available evidence. This study aimed to explore factors influencing EBP among nursing professionals in Taiwan. A cross-sectional survey study was conducted with 752 registered nurses and nurse practitioners recruited from a regional teaching hospital in southern Taiwan. EBP competency was evaluated using the Taipei Evidence-Based Practice Questionnaire (TEBPQ). The results showed that participation in evidence-based courses or training within the past year had the strongest association with EBP competencies (Std. B = 0.157, p < 0.001). Holding a graduate degree (Std. B = 0.151, p < 0.001), working in gynecology or pediatrics (Std. B = 0.126, p < 0.001), searching the literature in electronic databases (Std. B = 0.072, p = 0.039), and able to read academic articles in English (Std. B = 0.088, p = 0.005) were significantly associated with higher TEBPQ scores. Younger age (Std. B = -0.105, p = 0.005) and male gender (Std. B = 0.089, p = 0.010) were also identified as factors contributing to higher EBP competencies. The study highlights the importance of ongoing professional development, including EBP training and language proficiency, in enhancing EBP competencies among nursing professionals in Taiwan.

Blockchain-based resale and leasing of pre-owned medical equipment

Medical equipment plays a crucial role in the global healthcare industry, towards the delivery of high-quality medical care and contributing to positive patient outcomes. The traditional method of handling pre-owned medical equipment often leads to improper disposal of functional devices in landfills, compelling healthcare providers to invest in costly brand-new equipment. Several proposals have been put forth to establish trading platforms that facilitate the resale of pre-owned medical equipment. However, existing solutions are characterized by a centralized approach, and face challenges related to traceability, certification, system se-curity, and equipment reliability. In this paper, we propose a blockchain-based solution that is capable of orchestrating the resale, leasing, and auctioning of pre-owned medical equipment. Blockchain smart contracts are utilized to automate the resale and leasing process, register stakeholders with authenticity, transfer and verify ownership, and maintain public reputation scores of entities. A comprehensive overview of the architectural components, sequence diagrams, and algorithms that define the operations of our solution is provided. In addition, we develop and test a working implementation of the smart contracts to verify the feasibility of our proposed solution in terms of execution cost and code security. Through a discussion of the proposed solution's key components and concepts, we showcase our solution's ability to fulfill the specified requirements and attain the main objectives. Moreover, we evaluate and compare our solution with existing works in terms of capabilities and robustness, and explore potential adaptations and extensions of our architecture to allow for a wide range of additional use cases. Our smart contract code has been made publicly available on GitHub.

Ethical and legal aspects in anesthesiology, ethical and legal issues, an overview

Introduction: The practice of anesthesiology plays a crucial role in medicine, ensuring the comfort and safety of patients during medical and surgical procedures. However, this specialty faces a series of ethical and legal challenges. This article provides an overview of these issues, considering the importance of respecting patient autonomy and compliance with legal standards. Methods: To conduct this review, the following descriptors were used to search the PubMed and MEDLINE databases: "Anesthesiology", "Ethical", "Questions", "Aspects", "Legal". These descriptors were combined using the boolean operator AND to ensure search accuracy. Initially, 165 relevant studies were identified. After excluding duplicates, editorials, and incomplete articles, 122 articles were considered for analysis. The final selection included the full reading of 24 articles, of which 13 were considered relevant to compose this review. Results: Anesthesiologists face complex ethical dilemmas, from obtaining informed consent to making decisions in emergency situations. Additionally, there are concerns about fair resource allocation and balancing risks and benefits. In the legal realm, there are comprehensive regulations related to professional liability, documentation of procedures, and the use of medications and equipment. Conclusion: The practice of anesthesiology requires a solid understanding of the ethical and legal aspects involved. It is essential to respect patient autonomy by obtaining their informed consent. Constant ethical reflection and compliance with legal regulations are fundamental to ensuring the delivery of high-quality care.

An integrated multiple-criteria decision-making and data envelopment analysis framework for efficiency assessment in sustainable healthcare systems

Efficiency is critical in allocating sustainable healthcare resources to ensure that hospitals can effectively care for patients while maintaining high-quality care delivery. Hence, it is necessary to monitor efficiency carefully. This study aims to assess hospital unit effectiveness through a novel comprehensive approach integrating Multiple-Criteria Decision Making (MCDM) with Data Envelopment Analysis (DEA). The proposed MCDM-DEA framework involves allocating varying weights to distinct data categories. It harnesses the capabilities of the q-rung orthopair fuzzy (q-ROF) methodology to address the inherent uncertainties in healthcare performance assessment. The experimental results provide a comprehensively structured ranking system for specific hospital departments. This ranking system allows decision-makers to identify the strengths and weaknesses of each department, enabling them to make informed decisions regarding resource allocation and improvement strategies. Furthermore, the integration of MCDM-DEA provides a robust and objective assessment tool for monitoring and evaluating the performance of hospital departments over time. These rankings offer invaluable insights to decision-makers, equipping them with the strategic information needed to enhance the overall performance of hospital units.

The Prevalence of Violence Against Healthcare Workers in Trinidad and Tobago.

Abuse of healthcare workers (HCWs) and lack of public trust threaten the foundation of the physician-patient relationship. This growing global problem creates an even more difficult professional environment and hinders the delivery of high-quality clinical care. The primary aim was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers. A cross-sectional analysis of 434 HCWs in the public sector of Trinidad and Tobago was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from communities. Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past two years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients' relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had two to five years of work experience (24.9%), specialized in emergency and internal medicine (48.6%), and cared for psychiatric and physically disabled patients (p-value < 0.001). HCWs believed the threat of violence negatively impacted performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians' altruism and competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence. Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.

NURSES' ATTITUDE TOWARDS PATIENTS WITH MENTAL ILLNESS IN A TERTIARYCARE HOSPITAL

Nurses play a crucial role in the care of patients with mental illness, yet their attitudes towards these patients can significantly impact the quality of care provided. This study aimed to assess nurses' attitudes towards patients with mental illness in a general hospital setting. A cross-sectional survey was conducted among 150 nurses working in various hospital departments. The Attitudes Towards Mental Illness (ATMI) scale was utilized to measure nurses' attitudes. Results revealed that most nurses held positive attitudes towards patients with mental illness, with a mean ATMI score of 75.4 (SD=6.8) out of 100. However, a subgroup analysis identified variations in attitudes based on nurses' years of experience and department of work. Nurses with more years of experience tended to exhibit more positive attitudes toward mental illness. At the same time, those working in acute care settings showed slightly more negative attitudes compared to those in psychiatric units. These findings underscore the importance of addressing nurses' attitudes towards mental illness to ensure the delivery of high-quality and stigma-free care to patients with mental health conditions.