Different Levels Of Health Care Research Articles

Perceptions of health professionals on structure and process of stroke rehabilitation in Ghana.

Ensuring quality in the structure and process of stroke rehabilitation helps to attain a good outcome. However, knowledge on this is limited in resource-constrained settings such as Ghana. This study aimed to explore healthcare professionals' (HCPs) views and experiences of the structure and process of stroke rehabilitation in three selected hospitals in Ghana. A qualitative study was carried out involving 26 HCPs directly involved in stroke rehabilitation from three selected hospitals in the Greater Accra Region of Ghana representing the different levels of healthcare. Interviews were conducted using an interview guide to understand participants' views and experiences of the structure and process of stroke rehabilitation. Interview transcripts were analysed using thematic analysis. HCPs reported limitations with the structure of stroke rehabilitation with regards to the availability of rehabilitation units, bed capacity, approach to care, availability of protocol, staff capacity development and payment systems. With respect to the process of rehabilitation, the primary and secondary level hospitals were found not to have computed tomography (CT) and magnetic resonance imaging (MRI) scanning equipment. Participants also reported limitations with discharge planning, basis for discharge and post-discharge care across all three hospitals. This study found limitations in the current structure and process of stroke rehabilitation, which when given some considerations for improvement, can help improve the quality of care and thereby improve the outcome of stroke patients in Ghana. This study provided data which helps to assess the quality of stroke rehabilitation in Ghana.

Factors associated with hopelessness, depression and anxiety in the Honduran-Central America population during the COVID-19 pandemic.

IntroductionThe mental health of the population has been affected by COVID-19, reporting in many populations higher levels of depressive, anxious and stress symptoms, however, in Honduras there are no studies showing the impact of COVID-19 on the mental health of the population.AimTo determine the factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.MethodsCross-sectional analytical study. Three scales were used, Beck for hopelessness, Hamilton for depression and anxiety, through interviews with the population attending different levels of health care throughout the country. Descriptive and analytical statistics were obtained. For hopelessness, the Beck Hopelessness Scale was used; for depression and anxiety, the Hamilton Scale was used.ResultsOf the 8,125 participants, the population in general showed results of hopelessness 14.9%, depression 12.9% and anxiety 1.2%, there was less hopelessness among women (p = 0.004), university students (p < 0.001), but greater among those who had a family member deceased by COVID-19 (p < 0.001), among those who had diabetes mellitus (DM) (p < 0.001), history of mental illness (p < 0.001) or had consumed drugs in the last 6 months (p < 0.001). There was more depression among those with arterial hypertension (p = 0.002), obesity (p = 0.019), DM (p = 0.004), history of mental illness (p < 0.001) or had consumed drugs in the last 6 months (p < 0.001). There was more anxiety among those infected with COVID-19 (p = 0.023), according to having a family member deceased by COVID-19 (p = 0.045) and in those with a history of mental illness (p < 0.001).DiscussionThe Honduran population presented important differences in the socio-pathological, according to the loss of family members or having previous illnesses, this according to the presentation of problems in the mental sphere.ConclusionWe found factors associated with hopelessness, we found factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

Primenjivost i prognostička značajnost gerijatrijske procene

Aging implies a process during which changes occur in the function of all organic systems in the human body. For a detailed assessment of the health status of an elderly person, a comprehensive geriatric assessment (CGA) is recommended. CGA is defined as a multidisciplinary diagnostic and therapeutic approach that enables the identification of medical, psychosocial and functional limitations of an elderly person, all with the aim of developing a coordinated plan to improve the health of the elderly person. The aim of this review was to point out the significance, comprehensiveness, applicability and prognostic significance of geriatric assessment based on data from recent literature and by searching available electronic databases. Studies were collected from the electronic databases MEDLINE (via Ovid), Pubmed, COBSON database and Google Scholar database, as well as by manual search of relevant studies cited in the references of key articles. The search for papers as a whole is limited to the English language. All studies that used a comprehensive geriatric assessment in their methodology, in elderly people over 65 years of age, were included. CGA is very important for the elderly, for their families, health systems of countries, health professionals as well as the social community. Interventions resulting from a CGA are one way to improve the performance of activities of daily living in elderly patients. CGA has numerous advantages in practice, it is comprehensive, applicable, economically relatively acceptable and as such can be routinely implemented at different levels of health care. CGA has a high prognostic significance for the early detection of multimodal problems in the geriatric population.

The impact of the COVID-19 pandemic in Brazil: a study in tertiary dental care.

The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.

Вирусные циррозы печени: клинический профиль современного пациента, танатогенез и патоморфология

Objective. To analyze the profile of a patient with virus-related liver cirrhosis examined at different levels of healthcare, to identify the main causes of death, and describe morphological changes in liver tissue. Patients and methods. This study included 921 patients with chronic viral hepatitis (CVH) treated in day hospitals, 844 patients treated in inpatient facilities, and 455 CVH patients who died. We analyzed autopsy results of 97 patients with clinical signs of liver cirrhosis and described morphological characteristics of liver tissue depending on the Child–Turcotte–Pugh score. Results. Chronic hepatitis C is the most prevalent form of hepatitis in both inpatient and outpatient units. The highest incidence of latent hepatitis B was observed among inpatients. The majority of outpatients with virus-related liver cirrhosis were employable (or employed), socially adapted, not addicted to alcohol, and had compensated disease (class A in 97%) with minimal clinical manifestations, and were motivated for treatment and examination. The mean age of inpatients was 50 years; 100% of them had some comorbidities; 90% of them had subcompensated or decompensated cirrhosis; 60% of them systematically abused alcohol. Conclusion. The majority of deceased patients were employable, abused alcohol, and were not systematically followed-up by a specialist. Almost one-third of them (30%) had subcompensated disease and incomplete cirrhotic transformation of hepatic tissue; they died due to other reasons. This affects the course of chronic virus-related hepatitis and comorbidities and necessitates the creation of integrated comprehensive models of healthcare. Key words: virus-related liver cirrhosis, comorbidity, morphological examination, latent hepatitis, chronic viral hepatitis

HPB P13 Does Socioeconomic deprivation affect outcomes in patients undergoing liver resection for Colorectal Liver metastases?

Abstract Background It is well documented that socioeconomic deprivation (SED) has an overall negative impact on health outcomes. Many studies have shown this in primary cancers. The effect of SED on outcomes in patients undergoing liver resection for colorectal liver metastases (CRLM) is not well documented. As these patients are already under follow up, it is likely that the impact of SED on outcomes will be diminished. It was our aim to evaluate the effect of SED on overall survival (OS) in patients undergoing liver resection for CRLM. Methods The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. The tertiary centre treats patients over a wide geographical area with a population of 2.2 million. All consecutive patients undergoing liver resection for CRLM between January 2013 and December 2020 were eligible for inclusion. Demographics, prognostic variables for CRLM, operative variables, pathological variables and overall survival was recorded. Data was censored at 31 December 2021. Follow up was complete and checked with the Clinical Portal electronic database and by contacting General practitioners. The Multiple Deprivation score, that is nationally recorded was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan–Meier survival statistics and stepwise Cox proportional-hazards regression model. Results A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Both cohorts were comparable in terms of baseline characteristics except for age (69 most deprived vs 72 Least deprived, P=0.004). Kaplan–Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23–1.95; Logrank test: P=0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, 95% CI 1.23–1.98, P=0.0003) alongside the following variables: ASA status 1 (HR: 0.43, 95% CI 0.19–0.94, P=0.0349), presence of extrahepatic disease (HR: 1.51, 95% CI 1.12–2.03, P=0.0075), number of tumours (HR: 1.07, 95% CI 1.01–1.13, P=0.0221), size of largest tumour (HR: 1.01, 95% CI 1.00–1.01, P=0.0003), extended hemihepatectomy (HR: 3.24, 95% CI 1.56–6.76, P=0.0018), and absence of recurrence (HR: 0.55, 95% CI 0.43–0.70, P&amp;lt;0.0001). Conclusions Socioeconomic deprivation reduces the probability of OS following liver resection for CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment, and allocation of resources. Our study shows that the deleterious effects of SED extends to patients who are already in the healthcare system and therefore factors other than access to healthcare need further exploration.

THEORETICAL FOUNDATIONS OF COMPETITIVENESS MANAGEMENT OF HEALTH CARE INSTITUTIONS

Increasing the competitiveness of health care institutions is an urgent issue for health care in the new funding environment. The purpose of this work is to analyze the existing tools for competitiveness management in the healthcare sector. The problems of competitiveness management development are investigated. State regulation, political dynamics, changing socio-demographic characteristics and constant technological development cause significant changes in the healthcare sector, but despite this, state restrictions, conservatism of Ukrainian healthcare and lack of management specialists are the main problems of Ukrainian healthcare. This necessitates the use of the principles of competitiveness management of modern health care institutions. The main methodological approach used in the work is a review of literature sources. The analysis of scientific literature revealed the absence of unified methodological approaches to measuring competitiveness, and many of the proposed methods do not take into account the specifics of the health care system, as well as the areas of activity of the medical organization. The existing models of competitiveness management tools differ from each other, and their use is conditioned by many factors. The role and impact of competition in the healthcare sector is considered separately. The theoretical basis of the study is a systematic approach to understanding the relationship between different levels of health care. Important conceptual issues of measuring competition in healthcare, including S.W.O.T. analysis, competitive advantages, human resources assessment, benchmarking, etc. are considered. The results of this study form the methodological and practical basis for improving the competitiveness management system of health care institutions in Ukraine, which operate in difficult socio-economic conditions.

Impact of Artificial Intelligence on the Automation of Digital Health System

Automating digital systems in healthcare plays a significant role in transforming the quality-of-care services delivered to patients across the board. This role is anticipated to be accomplished by the development and implementation of artificial intelligence in healthcare which has the potential to impact the provision of healthcare services. This paper sought to investigate the impact of adopting and implementing artificial intelligence on the automation of digital health systems within the different levels of healthcare. The general objective of the research study was to investigate the impact of artificial intelligence in the automation of digital health systems. The specific goals were to understand the concept of artificial intelligence and how it automates digital strategies, to determine the AI systems that have been developed and implemented in the healthcare systems, to establish the factors that influence the adoption of AI in healthcare, and to find out the outcomes of implementing AI in digital health systems. The research employed the descriptive research design. The study population included healthcare workers, policymakers, IT specialists, and management teams in the healthcare sector in the State of Kentucky. The sampling technique for the study was the purposive sampling technique. The study collected data using semi-structured interviews administered through Google Teams and Zoom. Data analysis was analyzed using the computer-assisted software for analyzing qualitative data, NVivo. The findings were that AI as a technological concept has the potential to impact the automation of digital health systems and is key to automating health services such as the diagnosis and treatment of illnesses and management of claims and payments. The study recommended that policy supports the application of artificial intelligence in healthcare, thus enabling the automation of several healthcare services and thus improving the delivery of care.

Identification of patient-related, healthcare-related and knowledge-related factors associated with inadequate blood pressure control in outpatients: a cross-sectional study in Serbia

ObjectivesTo determine rate of blood pressure (BP) control and to analyse patient-related, medication-related and healthcare system-related factors associated with poor BP control in outpatients with hypertension (HT).DesignCross-sectional study.SettingTwo study sites...

3.A. Round table: Evidence-informed decision-making in patient care, public health, and health policy: the road ahead

Abstract This year marks the fiftieth anniversary of Archie Cochrane's seminal report “Effectiveness and Efficiency: random reflections on health services”, which spurred a paradigm shift in basing health policy and practice on robust empirical evidence. Indeed, evidence-informed decision- and policy-making has since permeated different levels of healthcare, public health, and health systems. More recently, the notion of “evidence-based” medicine has seen a shift towards “evidence-informed” health policy and practice, explicitly acknowledging that research evidence is but one of several factors influencing decision-making. In patient care, clinical expertise and a patient's own values and beliefs influence treatment and care; while in health policy-making, political and social factors, financial concerns, timing, and stakeholder relationships are decisive to successful implementation. Nonetheless, evidence-informed decision-making in health revolves around several core tenets, including a clear and well-communicated definition of objectives, using best-available, empirical evidence sourced from multiple sources, excellence and interdisciplinarity in the methods of analysis, and active collaboration across sectors and stakeholders to drive change. Across healthcare, public health, health systems and global health, actors continue to adapt these core principles into increasingly sophisticated strategies of evidence-informed decision-making. In the shadow of the global COVID-19 pandemic, exchanging best practices across these areas of application within the complex evidence ecosystem is a key driver for building more sustainable capacities in evidence-informed decision-making and partnerships to accelerate progress towards strengthening health systems and achieving global health equity. This panel aims to bring together major actors in knowledge translation and evidence-to-policy processes, highlighting latest resources and their relevance to public health, and stimulating collaboration and future action. With brief inputs from knowledge brokers, such as the European Observatory on Health Systems and Policies and the World Health Organization's (WHO) Evidence-informed Policy Network (EVIPNet), the panel will reflect on the current state of evidence-informed policy- and decision-making, showcase latest tools and resources, and discuss them from the specific perspectives of public health, coverage (with a focus on Health Technology Assessment), and patient and citizen involvement (with a focus on shared decision-making). Contributions from the audience will be sought in an open discussion round following initial inputs from panelists, with the objective of further shaping collaboration with involved stakeholders towards improving population health. Key messages • Building on current best practices in evidence-informed decision-making is crucial to achieving better outcomes in healthcare, public health and health systems. • Leveraging synergies and collaborating between different areas of application of evidence-informed decision-making can help ensure maximum impact and strengthen the evidence ecosystem. Speakers/Panellists Suszy Lessof European Observatory On Health Systems and Policies, Brussels, Belgium Tanja Kuchenmueller WHO, Geneva, Switzerland Elena Petelos CSFM &amp; HSR-PH Lab, Faculty of Medicine, University of Crete, Iraklion, Greece Ansgar Gerhardus German Public Health Association - DGPH, Bremen, Germany Isabelle Scholl University Clinic Hamburg-Eppendorf, Hamburg, Germany

Diagnosis of vascular cognitive impairment: recommendations of the scientific department of cognitive neurology and aging of the Brazilian Academy of Neurology.

Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.

Diagnóstico do comprometimento cognitivo vascular: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

ABSTRACT Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.

Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey

BackgroundNon-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya.MethodsA cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services.ResultsOf the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide.ConclusionsImportant gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

Access to surgical care in Ethiopia: a cross-sectional retrospective data review

BackgroundAccess to emergency and essential surgical care is still unmet and accessibility is disproportionately inequitable in Ethiopia and other low-and middle-income countries. The aim of this study was to assess surgical care access in terms of capability, capacity, and timeliness of care in different levels of health care in Ethiopia.MethodsA cross-sectional study with retrospective data review was conducted in 172 health facilities from December 30, 2020 to June 10, 2021. Descriptive statistics such as median with interquartile range and proportion were computed using STATA Version 15 statistical software.ResultsWithin a 90-day interval of the study period, 69,717 major and minor surgeries, and 33,052 bellwether procedures were performed, and major surgeries accounted for 58% of the surgeries. About 1.6%, 23.56%, 25.34%, and 32.2% of both major and minor, and 3.1%, 12.8%, 27.6%, and 45.3% of bellwether procedures were performed in health center OR blocks, primary, general, and specialized hospitals, respectively. Private hospitals performed 17.33% of major and minor and 11.2% of bellwether procedures for the period. The average pre-admission waiting time for surgical patients in primary, general, and specialized hospitals was 9.68, 37.6, and 35.9 days, respectively, whereas, in private hospitals, the average pre-admission waiting time was 1.42 days. On average, surgical patients traveled 5 Hrs, 11 Hrs, 28.4 Hrs, and 21.3 Hrs to access surgical services in primary, general, specialized, and private hospitals, respectively. The surgical workforce to the population served ratio was 7.5, 1.15, and 1.31/100.000 population in primary, specialized and general hospitals, respectively.ConclusionMost surgical procedures were performed in specialized hospitals, indicating that there is a burden in these health facilities. The pre-admission waiting time for surgical patients was long in higher-level public hospitals. Surgical patients traveled a long distance to access surgical service in higher level hospitals. The ratio of surgical workforce per 100,000 population served was low in all levels of public health facilities in general, and in higher level hospitals in particular. Efforts should therefore be made to strengthen all levels of the health system and improve surgical care access in terms of capacity, capability, and timeliness in the country.

Relationship Between Psychopathological Symptoms, Coping Strategies and Sexual Orientation of Nursing Professionals in Pandemic COVID-19

The aim of this study is to identify the relationship between psychopathological symptoms, coping strategies, and the sexual orientation of Brazilian nursing professionals in the context of the COVID-19 pandemic. A cross-sectional and analytical study with 1737 nurses, midwives, nursing assistants, and technicians, working at different levels of health care, direct assistance and/or administrative/managerial assistance, and linked to teaching and research. These included socio-demographic data, Psychopathological Symptom Assessment Scale, and coping strategies inventory. For data analysis, descriptive statistics and Wilcoxon, Mann–Whitney, and Kruskal Wallis tests were used, with a significance level of 0.05. Statistically significant differences were evidenced between psychoticism; obsessiveness-compulsivity; somatization and anxiety, indicating mental suffering. Bisexual professionals showed greater severity of psychopathological symptoms. As for the coping strategy, there is a statistically significant difference in the mean scores of Withdrawal, Responsibility, Escape from Fear, and Self-Control, according to sexual orientation. The factors Withdrawal, Self-control, and Responsibility had higher means in bisexuals (p < 0.05) and lower means in confrontation (p > 0.05). In homosexuals, the highest mean scores were for the problem solving and social support factors (p > 0.05) and lowest in the Withdrawal factor (p < 0.05). Among heterosexuals, the highest mean score was in confrontation (p > 0.05) and the lowest in avoidance (p < 0.05). This study reinforces the importance of reflecting on the life context and work settings of nursing professionals, especially bisexual women, through the influence of the effects of the Covid-19 pandemic on their mental health. The data can guide actions that minimize the impacts on mental health, in addition to recognizing, based on the findings, a collective complaint from the professional category to the health authorities and competent bodies, as a way of explaining the context experienced in the locus of their work.

Clinical Recommendations of the Northwest Society for Enteral and Parenteral Nutrition, Interregional Association for Emergency Surgery, Russian Gastroenterological Association, Union of Rehabilitation Therapists of Russia and Russian Transplantation Society on Diagnosis and Treatment of Short Bowel Syndrome-Associated Intestinal Failure in Adults

Aim. Current clinical recommendations address the epidemiology, causes, clinical manifestations and pathogenesis of possible immediate and long-term complications, as well as the problematic issues related to treatment and rehabilitation of adult short bowel syndrome patients.Key points. Short bowel syndrome (SBS) is a symptom complex of impaired digestion caused by the reduction of small intestine absorptive surface and manifested by intestinal failure (IF) of various severity (maldigestion and malabsorption) developing into malnutrition and systemic somatogenic disorders. The vital strategic aspects of its treatment are the personalisation of liquid, macro- and micronutrients consumption as well as avoidance of intestinal failure- and parenteral nutrition-associated complications. Various nutritional support regimes and the indications for infusion therapy and maintenance parenteral nutrition are considered in this patient category, also in outpatient settings. To mitigate the dependence on intravenous fluid- and nutrient administration and attain enteral autonomy in SBS-IF patients, the use of recombinant glucagon-like peptide-2 (GLP-2) is justified as exerting a pronounced trophic effect on the epithelial regenerative potential as well as structural and functional adaptation of intestinal mucosa. The SBS-IF patients prescribed with home parenteral nutrition and/or their caregivers should be trained in a special programme that covers the catheter care, preparation of infusion solutions and nutrient mixture container, infusion pump operation as well as the prevention, recognition and management of complications. The main referral indications for small bowel transplantation (SBT) are: fast-progressing cholestatic liver disease-complicated irreversible intestinal failure; thrombosis of two or more central venous conduits used for parenteral nutrition; recurrent catheter-associated bloodstream infection.Conclusion. Current recommendations on diagnosis and treatment as well as the developed criteria of medical aid quality assessment are applicable at different levels of healthcare.

Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study.

BackgroundSymptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts.ObjectiveWe aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs.MethodsQuantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark.ResultsStudy phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023.ConclusionsThe possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications.Trial RegistrationGerman Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67International Registered Report Identifier (IRRID)DERR1-10.2196/34026

Experiencing an extensionist action of the academic leagues in the itinerary of the student of Medicine

An Academic League is formed, primarily, by students and professors of a certain course (or courses), united by the common interest of developing activities of teaching, research, extension, culture and / or affirmative policies in several areas of academic formation. This study aims to report the importance of health leagues in the construction of the formative itinerary, especially, based on an experience report from the construction of the 1st Academic League Symposium of Recôncavo of Bahia, with the main theme “Interconnecting the Children's Health” highlighting childhood as a stage of the life cycle that requires socio-cultural, political-economic and individual transformations. For this purpose, 15 Academic Leagues, mostly with medical students, were divided into groups to coordinate the event's activities: conferences, courses, practical stations and presentations of scientific papers. Providing students with the competence of an autonomous and critical-reflexive professional with the capacity to meet the population's health demands, striving for the articulation of attitudinal knowledge and skills to act at different levels of health care. The result of this experience shows that developing activities that enable student protagonism where students can exercise skills such as leadership, management, communication and teamwork are fundamental for both the growth of the university and the development of students, in order to deal with future challenges, making the Leagues tools of important value in the academic itinerary of the student in the health field.

Patient safety attitude among healthcare workers at different levels of healthcare in Sharqia Governorate, Egypt.

BackgroundPatient safety (PS) has been identified as a significant healthcare challenge. A good safety attitude helps healthcare workers (HCWs) to decrease medical errors.AimThis study aimed to assess the PS attitude and identify its determinants among HCWs.SettingThis study was conducted in Sharqia Governorate at different levels of health care.MethodsThis was a comparative cross-sectional study that involved240 HCWs selected after using a multistage cluster sampling technique from Sharqia Governorate.In ordertto assess the respondents’ attitudes towards PS, the modified Chinese Safety Attitudes Questionnaire (CSAQ) was used.ResultsThe scale with the highest percentage of positive responses, on average, was safety climate (49.59%). The study found a statistically significant association between the level of health care and mean scores of ‘teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition’ and the overall CSAQ score. In regression analysis, the highest degree of education and job type were significant predictors of PS attitude among the HCWs under study (p = 0.031 and 0.011, respectively).ConclusionAccording to the study’s findings, PS is low among HCWs in both healthcare units and hospitals, with a significantly higher score among hospital workers than among primary care workers. All PS composites need improvement starting with regular assessment of PS culture along with continuous monitoring.

Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study.

BackgroundIncreasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented.ObjectiveThe aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ.MethodsThis study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities.ResultsImplementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender.ConclusionsPerceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.