Health Care Division Research Articles

The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

BackgroundTo date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care.MethodsRetrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias.ResultsInfluenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out.ConclusionInfluenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.

Using diversity, equity and inclusion to drive outcomes at CareerStaff unlimited

Study level/applicability This case was designed not only for MBA and executive education but also undergraduate courses in human resources (HR), leadership development, HR metrics and change management. It is ideal for introducing the concepts of diversity, equity and inclusion (DE&I), the balanced scorecard and talent retention. Subject area The case deals with initiating and integrating DE&I programs into a company. It highlights how and when to start, change management issues during roll-out and convincing senior leadership why a program such as the one the protagonist started adds value to an organization. Case Overview In early 2018, Kate McKinnon, AVP of HR for CareerStaff Unlimited (CSU), a temporary staffing company and division of Genesis HealthCare, reflected on the late 2016 decision to develop women for leadership roles at the company. With a rather unconventional implementation of the Women’s Leadership Group (WLG), Kate successfully developed fifteen female individual contributors, many of whom were promoted to leadership roles by early 2018. Kate was concerned about maintaining the momentum necessary to continue (and expand) the program of identifying, developing, promoting, and retaining women and other diverse employees across the company. She also wanted to measure a clear correlation between the WLG and CSU’s financial and customer outcomes. It was time to plan phase two of the program, including further improvement of the DE&I efforts at CSU. Expected learning outcomes The learning outcome of this paper are as follows: focused programs, led by courageous and committed leaders, improve gender equity. DE&I is a business imperative, as much as a legal/risk challenge. To be understood, approved and communicated, HR Initiatives must add value and be aligned with the company strategy along with financial and customer outcomes. People development and growth contribute to top talent retention. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes. Social implications Given the issues the USA is encountering after the George Floyd death and protests, this is a good way to demonstrate how courageous leadership can start to facilitate change in organizations. Subject code CSS 6: Human Resources.

Medical leadership in transformation: new ideas and practices at a crossroads in social sciences

Medical leadership in transformation: new ideas and practices at a crossroads in social sciences This BMJ Leader special section comprises four distinct contributions presented during a healthcare division panel symposium...

Professionals and Volunteers: The Importance of Recognising Diversification in the Healthcare Division of Labour

In sociological research on relationships between professionals and volunteers, professionals are often contrasted with volunteers as abstracted, distinct and homogeneous groups. Focusing on healthcare in selected modern societies, and adopting a neo-Weberian and complementary boundary work perspective, this essay argues the landscape is more complex than between paid groups with exclusionary social closure and the unwaged in the market. First, diversification exists within health professions themselves based on social closure, with hierarchies and differential scopes of practice. Second, unpaid volunteers vary in responsibility depending on factors like employment sector and social background, including qualifications and experience. Third, in the paid workforce, there are interstitial non-professionalised health occupations, such as the neglected, lower educated health support workers, forming the largest, most heterogeneous healthcare labour force. Drawing on studies of healthcare, it is argued that recognising the diversification and interplay between professionals, volunteers and support workers is vital for enhancing health policy.

Cultural Considerations in Palliative Care Provision: A Scoping Review of Canadian Literature.

Background: Palliative care, a division of health care that provides treatment to patients facing terminal or incurable illness, prioritizes maintaining quality of life for the patients it serves. Factors that influence quality of life are highly individualized, encompassing social, economic, or cultural determinants of health. In particular, cultural determinants remain an understudied element of palliative care.Objectives: The purpose of this article is to identify key concepts and issues arising from offering culturally relevant palliative care by reviewing how the concept of culture has been discussed in Canadian palliative care literature.Design: A scoping review of medical databases was conducted to identify recent Canadian literature connecting culture and palliative care provision. This review yielded 21 relevant results from the past 10 years.Results: Ideas frequently mentioned in Canadian palliative care literature include cultural competency in health care providers, cultural sensitivity of treatment options, and cultural accessibility of available services. Issues that arose from the literature included differing ideas of the meanings of life and death, visibility of cultural minority groups, spiritual care needs, desire to involve friends and family in care, and misunderstandings of language and communication styles.Conclusion: The results of this review provide a starting point from which health care providers can begin lending attention to cultural determinants of health, thus improving palliative care services for diverse populations.

A Cross-Sectional Study on Pharmacy Students' Career Choices in the Light of Saudi Vision 2030: Will Community Pharmacy Continue to Be the Most Promising, but Least Preferred, Sector?

Introduction: The Saudi Arabian healthcare divisions that recruit and hire pharmacists include hospital pharmacy, community pharmacies, universities, and research centres. Local studies showed that hospital pharmacy is the most preferred sector, while community pharmacy is the least preferred. However, jobs in hospital pharmacy are limited compared to community pharmacy. Hence, to accommodate the increasing numbers of pharmacy graduates and to facilitate the implementation of Saudi Vision 2030, which promotes primary healthcare and the participation of both private and non-governmental organisations in healthcare delivery, community pharmacy ought to be Saudised. This study was conducted to assess the career choices made by Saudi pharmacy students and the enablers that influence their career choice, especially in community pharmacy. Methods: A prospective cross-sectional approach was used. A total of 437 final year pharmacy students were recruited from 15 pharmacy schools around the country. Results: Salary and advancement opportunities as well as geographical location, benefits, and work environment were found to be “very important” enablers when making career decisions. Hospital pharmacy was selected as the most preferred sector by 242 (55.4%) of the participants, while community pharmacy was the least favoured pharmacy sector (17% or 6.2%). The enablers that might influence the consideration of a job in community pharmacy included career aspiration and social accountability. On the other hand, the barriers were personal beliefs about the sector and the nature of the work. Conclusions: The community pharmacy sector was found to be the least preferred sector to work in. The study revealed a list of enablers that the participants found to be relevant or of high relevance when choosing community pharmacy as a career pathway. Some of the enablers contribute to the role of the pharmacist towards the local community, social accountability, and towards the country’s Vision, such as interaction with the general public and educating them. Other enablers are related to the pharmacists’ career aspirations, such as owning a business. Some of the barriers that were found relevant include high workload, inflexible working hours, and limited opportunities for professional development. Localisation of community pharmacies would help to create more jobs for national pharmacists, increase the participation of female pharmacists in the workforce and support the achievement of Vision 2030. The barriers should be tackled on several levels: undergraduate curriculum, regulatory, and actual practice. Undergraduate education needs to include primary pharmaceutical care services in its curriculum. Regulatory changes include enforcing the renationalisation of the community pharmacy sector and permitting females to work in community pharmacies without location restrictions.

Does the packaging of health information affect the assessment of its reliability? A randomized controlled trial protocol

Background Wikipedia is frequently used as a source of health information. However, the quality of its content varies widely across articles. The DISCERN tool is a brief questionnaire developed in 1996 by the Division of Public Health and Primary Health Care of the Institute of Health Sciences of the University of Oxford. They claim it provides users with a valid and reliable way of assessing the quality of written information. However, the DISCERN instrument’s reliability in measuring the quality of online health information, particularly whether or not its scores are affected by reader biases about specific publication sources, has not yet been explored. Methods This study is a double-blind randomized assessment of a Wikipedia article versus a BMJ literature review using a modified version of the DISCERN tool. Participants will include physicians and medical residents from four university campuses in Ontario and British Columbia and will be randomized into one of four study arms. Inferential statistics tests (paired t-test, multi-level ordinal regression, and one-way ANOVA) will be conducted with the data collected from the study. Outcomes The primary outcome of this study will be to determine whether a statistically significant difference in DISCERN scores exists, which could suggest whether or not how health information is packaged influences how it is assessed for quality. Plain Language Summary The internet, and in particular Wikipedia, is an important way for professionals, students and the public to obtain health information. For this reason, the DISCERN tool was developed in 1996 to help users assess the quality of the health information they find. The ability of DISCERN to measure the quality of online health information has been supported with research, but the role of bias has not necessarily been accounted for. Does how the information is packaged influence how the information itself is evaluated? This study will compare the scores assigned to articles in their original format to the same articles in a modified format in order to determine whether the DISCERN tool is able to overcome bias. A significant difference in ratings between original and inverted articles will suggest that the DISCERN tool lacks the ability to overcome bias related to how health information is packaged.

Emotional-Behavioural Development in Children with Below Average Cognitive Ability

Background: Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenges. This study examines the longitudinal relationship between cognitive ability and emotional-behavioural development between age 3-9 years. Methods: Participants consist of 7,134 children from the Growing Up in Ireland study. Cognitive ability was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was defined as below average cognitive ability (n=767), and scores above this as average/above (n=6418). Emotional-behavioural difficulties (EBDs) were measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9 years. Generalised linear mixed models were used to examine the predictive significance of cognitive ability for longitudinal SDQ scores and change in SDQ score during childhood. The independent association between cognitive ability and clinically significant EBDs was examined using logistic regression. Findings: Cognitive ability was an independent predictor of longitudinal SDQ scores and of change in SDQ score during childhood. Between age 5-9 years, those with below average cognitive ability experienced a significant increase of 0·56 points in SDQ score (95% CI 0·10 – 1·01), whereas those with average/above ability had relatively unchanged scores. After adjustment, children with below average cognitive ability were 1.31 times (AOR 1.31, 95% CI 1.05-1.62, p=0.014), and 1.33 times (AOR 1.33, 95% CI 1.04-1.67, p=0.019) more likely to experience a clinically significant EBD at age 5 and 9 years respectively. Interpretation: Children with below average cognitive ability are at higher risk of EBDs in childhood. A scalable method of early identification should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes. Funding Statement: This work was performed within the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive, National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: Ethical approval for the GUI study was obtained from the Research Ethics Committee, Department of Children and Youth Affairs Ireland. Written consent was collected from parents/guardians prior to data collection. Secondary analysis of the Anonymised Microdata Files of the GUI study does not require additional ethical approval.

Knowledge and attitude of undergraduate students on oral cancer

Introduction: Oral cancer is considered s one of the commonest cancers affecting the Indian population. In our study we studied this knowledge in the healthcare system to evaluate their knowledge regarding oral cancer. In India most often the common man seeks help of a known person or a relative in the medical field than the doctor for an initial opinion, this is possibly due to the fear and the social stigma associated with the disease. Therefore the authors of this study felt the need to educate the students well early in the course of the disease about oral cancer. So decided in the present study we decided to study the knowledge attitude and practices of undergraduate students of various health care divisions regarding oral cancer at the level of interns before they finish internship. Materials and Methods: This was a prospective cross-sectional study conducted at the medical colleges of Karnataka. The second year students of the medical, paramedical and nursing colleges were the target population of the study. The study was conducted between 2014 December and 2017 December. There was a questionnaire consisting of various questions in regard to oral cancer which participants who were willing to part-take in the study had to fill before and after being taught regarding the disease. The data was analyzed. Results: Among the participants the nursing professionals had a better understanding of oral cancers than the medical and paramedical students before they taught. Conclusion: In conclusion, the lack of knowledge amongst the participants’ is indicative of the fact that only a few people have effective the disease early decrease the morbidity of oral cancer. Keywords: Oral cancer, Indian population, Undergraduate, Students, Knowledge, Attitude.

Dynamic monitoring of the effects of adherence to medication on survival in heart failure patients: A joint modeling approach exploiting time-varying covariates.

Adherence to medication is the process by which patients take their drugs as prescribed, and represents an issue in pharmacoepidemiological studies. Poor adherence is often associated with adverse health conditions and outcomes, especially in case of chronic diseases such as heart failure (HF). This turns out in an increased request for health care services, and in a greater burden for the health care system. In recent years, there has been a substantial growth in pharmacotherapy research, aimed at studying effects and consequences of proper/improper adherence to medication both for the increasing awareness of the problem and for the pervasiveness of poor adherence among patients. However, the way adherence is computed and accounted for into predictive models is far from being informative as it may be. In fact, it is usually analyzed as a fixed baseline covariate, without considering its time-varying behavior. The purpose and novelty of this study is to define a new personalized monitoring tool exploiting time-varying definition of adherence to medication, within a joint modeling approach. In doing so, we are able to capture and quantify the association between the longitudinal process of dynamic adherence to medication with the long-term survival outcome. Another novelty of this approach consists of exploiting the potential of health care administrative databases in order to reconstruct the dynamics of drugs consumption through pharmaceutical administrative registries. In particular, we analyzed administrative data provided by Regione Lombardia - Healthcare Division related to patients hospitalized for HF between 2000 and2012.

Hospital/Home Medical Assistant Robot

Now a day’s health-care facilities increasingly depend on health-care staffs. By aging populace, there is an upsurge in number of old people present in the labor force and even in health-care division. It is significant to take care of aging workforce present in healthcare sector. So, for this process hospitals are providing an opportunity to mobile robots because of rapid technological progress accomplished of working and cooperating with humans and surroundings. This paper presents a design of Hospital/home medical assistant robot that consist of both combination of network system and robotics system for transmitting, receiving and sending information to care taker or doctor. As the robot gets a distress signal which is obtained from the patient, it tries to contact the care taker or doctor. If the robot is unable to contact, it will try to find out the location of doctor or the care taker and then display the condition of the patient so that the doctor can act as early as possible. Doctor or caretaker can access the robot at any time and get the live video feed of the patient at any time.

Parental perceptions of paediatric rehabilitation services using the Malay Measure of Processes of Care

Neurodevelopmental disabilities are amongst the main conditions encountered in our paediatric rehabilitation centre. To identify the necessary actions to achieve family-centred care in the tertiary healthcare division, we explored the perceptions of parents on the paediatric rehabilitation services received by their children with neurodevelopmental disabilities. A cross-sectional study involving 200 parents of children with neurodevelopmental disabilities aged 1-18 years was carried out. The Malay version of the Measure of Process of Care (MPOC-20) questionnaire was used to measure the perceptions of parents on the services. Descriptive statistical analysis was done to describe the mean score of each MPOC-20 scale. Univariate and bivariate analyses were used to examine the associations between the characteristics of parents and children as well as the sociodemographic and environmental factors with the MPOC-20 scales. The mean score of the MPOC-20 scales ranged from 4.50 to 5.65 (SD 0.93-1.51). Amongst the MPOC-20 scales, parents ranked enabling, having good partnership and being comprehensive (EP) the highest, whereas the provision of specific information (PS) received the lowest score. Amongst all the MPOC-20 scales, significant differences were shown in parent's employment, between children's age groups and between ethnic groups. The Malay MPOC-20 is a validated tool that can be used in evaluation of services among the Malay-speaking community, and therefore, it is recommended for our clinical use to improve family-centred practice in paediatric rehabilitation.

Dialysis for Undocumented Immigrants: Challenges and Solutions.

Undocumented immigrants with ESKD have traditionally had very limited options for dialysis care. They are not eligible for Medicare, they are typically not able to afford private insurance, and they are not eligible for assistance through the Affordable Care Act (ACA). A handful of states provide coverage through Medicaid programs. For patients in the state of Texas, this is not an option. Consequently, these patients have no options for scheduled dialysis care and must present to the emergency department (ED) for evaluation for emergent dialysis. As a result of federal policy, inpatient dialysis units are not able to provide scheduled dialysis, so these patients can only receive dialysis when a life-threatening indication develops. Such practice exposes these patients to adverse health outcomes (including increased mortality) and impaired quality of life, as well as creating a great deal of stress on all levels of the healthcare system and providers, including trainees. As the primary safety-net hospital for Dallas County, Parkland Hospital has cared for the vast majority of undocumented immigrants with ESKD in North Texas, and the expected array of problems has been observed. Over the past several years we have engaged in several ongoing team-based, multidisciplinary efforts to improve quality of care for this population. Through allocation of resources, collaboration with other healthcare divisions, development of educational materials, and the creation of partnerships with organizations outside our institution, we have observed improvements in the care of our patients, including increased access to scheduled dialysis, decreased catheter-related complications, and decreased mortality. Although much work remains, we have been gratified by the improvement in patient care and hope that our story can serve as an example for others faced with similar challenges and spark discussion for needed broader policy changes. Undocumented immigrants with ESKD have limited options for dialysis care. They are …

Patient Safety Culture Change over Time-Health Care Staffs’ Perceptions

Rationale and Aim: Patient safety is of great interest in health care organisations, worldwide. In Sweden, a national patient safety initiative was launched in 2011. The aim of this study was to examine and compare patient safety culture change over time from health care staffs’ perspective. A further aim was to examine factors that have had an effect on patient safety culture. Methods: Patient safety culture was assessed in 2009, 2011 and 2013 using the Swedish version of the Hospital Survey of Patient Safety Culture. Respondents in this study were registered nurses (n = 2149), enrolled nurses (n = 959), physicians (n = 355) and managers (n = 159) working in three health care divisions in a Swedish county council. Results: Patient safety culture decreased significantly over time for all but two dimensions. The dimension “Information to Patients/Relatives” was the only dimension to increase significantly over time. Health care staffs’ profession and health care division belonging had significant main effects on 14 and 8 dimensions, respectively. Managers and enrolled nurses scored patient safety culture significantly higher than registered nurses and physicians. Health care staff working in a mixed medical-surgical health care division scored significantly higher than those working in medical or surgical divisions did. Conclusions: Despite efforts for patient safety work in the county council, health care staffs’ perceptions of patient safety culture decreased over time. To improve hospital patient safety culture, managers and staff groups must meet and communicate with each other in order to create a common view of patient safety.

Corruption in Health Sector

Corruption has profound roots in each field in Pakistan. We are on the whole exceptionally mindful of the corruption that keeps running into billions of rupees; however it is the little scale defilement that we don't pay heed, which is gradually spreading its limbs in the public arena. There is expanding interest in health policymaker, organizer and contributors in how debasement influence human services survey and results and what should be possible to battle defilement in health care division. Attempts to explain the peril of abuse of depended control for private increment have reviewed the associations among debasement and various pieces of the board, financing and organization. Direct analysts and anthropologists moreover pointed the individual and social characteristics which sway the lead of government master and client this article present a comprehensives structure for depicting and assessing how openings, weight and legitimization sway defilement in medicinal services area. It is in like manner discusses execution for mediation. Keywords : corruption, health sector DOI : 10.7176/JHMN/68-14 Publication date: November 30 th 2019

The Individualized Treatment of Opioid Use Disorder.

No outside funding supported the writing of this commentary. Boyett is Chief Medical Officer and founder of the medical division of Pathway Healthcare, which provides treatment for opioid and other drug addictions.

Achieving IHI's Triple Aim by Utilizing Core Health Program With Community Health Workers in Rural Communities.

Utilizing a nurse/community health worker team model, a Midwest institution's community health care division developed a 12-month managed care program for underserved individuals diagnosed with heart failure and/or diabetes. A study of 277 patients was conducted to determine whether this model could be utilized in rural settings. The program was evaluated using the Institute for Healthcare Improvement's Triple Aim criteria; HEDIS measures and other health indicators quantified each patient's performance. Study participants showed improved outcomes and a reduction in the total cost of care. Hospital admissions decreased (203.4 inpatient days were saved), and the return-on-investment value realized was 1.37 for emergency department and inpatient visits in the rural communities.

Using Boundary Objects to Facilitate Culture Change and Integrate a Global Top Management Team

As business anthropologists, we are often called upon to work on organizational change initiatives as members of a change team. This article is the story of one organizational change initiative involving a global top management team in a healthcare division of a large multinational firm and the research that was used as the basis for implementing change in the top management team and subsequently in the division as a whole. Specifically, the article focuses on how the change team, of which I was a part, communicated the research results to the top management team and to employees of the company by presenting the results in a map that became a boundary object, that facilitating translation across diverse groups, joint sensemaking, and local action in the change process.

'I expected just to walk in, get my tablets and then walk out': on framing new community pharmacy services in the English healthcare system.

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed.

Mass gathering enhanced syndromic surveillance for the 8th Micronesian Games in 2014, Pohnpei State, Federated States of Micronesia.

Pohnpei State’s Division of Primary Health Care implemented enhanced surveillance for early warning and detection of disease to support the 8th Micronesian Games (the Games) in July 2014.The surveillance comprised 11 point-of-care sentinel sites around Pohnpei, Federated States of Micronesia, collecting data daily for eight syndromes using standard case definitions. Each sentinel site reported total acute care encounters, total syndrome cases and the total for each syndrome. A public health response, including epidemiological investigation and laboratory testing, followed when syndrome counts reached predetermined threshold levels.The surveillance was implemented using the web-based Suite for Automated Global Electronic bioSurveillance Open-ESSENCE (SAGES-OE) application that was customized for the Games. Data were summarized in daily situation reports (SitReps) issued to key stakeholders and posted on PacNet, a Pacific public health e-mail network.Influenza-like illness (ILI) was the most common syndrome reported (55%, n = 225). Most syndrome cases (75%) were among people from Pohnpei. Only 30 cases out of a total of 408 syndrome cases (7%) presented with acute fever and rash, despite the large and ongoing measles outbreak at the time. No new infectious disease outbreak was recorded during the Games. Peaks in diarrhoeal and ILI cases were followed up and did not result in widespread transmission.The technology was a key feature of the enhanced surveillance. The introduction of the web-based tool greatly improved the timeliness of data entry, analysis and SitRep dissemination, providing assurance to the Games organizers that communicable diseases would not adversely impact the Games.