Effective Provision Research Articles

Factor Influencing Unmet Healthcare Needs among the disabled

Abstract Background The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled. Methods We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs. Results Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs. Conclusions Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642) Key messages • The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation. • Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.

Performance as Truth in the LIS Classroom

Library and Information Science instructors are including art in their teaching. Ibekwe (2020) asked students “to produce artworks that illustrated how chosen information and communication theories operated in plausible, real-life, or historic contexts” (p. 427). Dali et al. (2015) describe substituting an “academically informed creative writing” option for what would typically be an academic writing assignment, “in other words, a short story that would read like fiction while touching upon the essential issues involved in dissecting and understanding the experience of reading” (p. 302). Hartel et al. (2017) proposed reinventing conventional essay assignments as a “creative deliverable,” a more spacious translation of course content into any format of the arts, including non-material manifestations such as dance or musical composition. In the LIS field, performance is most commonly associated with children’s librarianship. McDowell and Cooke (2022), discussing storytelling, note “those skills and practices have not been readily available to or understood as important for everyday libraries and librarians” (p. 373). Worthington (2017), analyzing LIS syllabi, found that the “vast majority of courses that included storytelling, puppetry, and read-alouds were childrens’ courses” (pp. 211-212). Even these courses are typically elective rather than required, and performance is often ungraded (p. 210). Vardell and Nelson’s (2020) adventurous “Teaching Reference Interview Skills with Improv” reports on the benefits of improvisation activities, which can enhance communication, empathy, and teamwork–all essential to a librarian’s interactions with the public. Our panel will share how we incorporate performance into our LIS classrooms. We discuss performance for children’s librarians as well as for students entering other areas of the LIS profession. We examine how performance gets at Truth that can be difficult or impossible to access through other means. And, we consider the ethics of requiring student performance in a course. Exploring Soft Skills through the Fundamentals of Improv Comedy Emily Vardell will discuss how she uses improv comedy exercises to discuss and practice the soft skills necessary for successful reference service interactions. She uses the exercises as an active learning activity in a required reference services course to help LIS graduate students more organically explore soft skills. In addition to outlining the improv exercises, Emily will explore how she leads class discussions on the connections between improv and the soft skills needed to be an effective and responsive librarian. Students report that the opportunity to explore the provision of reference services through an improv lens helped them connect to many of the soft skills inherent in effective reference provision such as being flexible, meeting someone where they are at, making connections, and affirming patron needs. These soft skills are key to effective reference interviews but can be difficult to convey in a standard practice the reference interview exercise. By marrying discussions of improv comedy with reference skills, students are able to engage and explore these soft skills from a different lens. The Price of Stories is Sometimes Too High: Learning from Students’ Personal Narrative Performance Brian Sturm will share his experience in a Storytelling for Social Justice course for first year undergraduates. Designed to help them develop their own voices, the class was a bit too successful when one student used the opportunity for revenge on another student. He’ll cover lessons learned and changes made to the course to avoid this “misuse” of storytelling in the classroom. Breathing Life into Read-Alouds Sarah Beth Nelson will discuss the read-aloud assignment in her Library Materials for Children course. She prepares students for this assignment with a workshop on “breathing life into read-alouds,” which includes recognizing the reader’s creative contribution to the story. She will also share student thoughts on authenticity and authority as they relate to reading books aloud. What if a librarian wants to share a book with children, but isn’t sure they are the right person to read it aloud? By practicing a read-aloud and giving each other feedback, students experiment with stepping into the authority that the reader role asks of them. Sarah Beth has had students perform in person during face to face class, and more recently online by recording their performance. Storytelling for Social Justice and Advocacy Nicole Cooke will discuss the creation and implementation of her Storytelling for Social Justice and Advocacy course. Incorporating a mixture of public speaking, storytelling, personal narrative, and current social justice issues, students learn and practice the processes and skills needed to orally advocate for themselves, the profession, and the issues they care about most passionately. Grounding their passion with ethics and cultural competence, Cooke, and her students, place special emphasis on the question “Is this my story to tell?” Using data and self-reflection, instead of props, puppets, and picture books, student tellers learn how to lend their voices to amplify the social justice issues in their communities.

Gender equality in family relations: legal aspects of protecting the rights of women and men in marriage

Gender equality in family legal relations is one of the main foundations of modern legal and social development. The article is devoted to the systematic analysis of the principle of gender equality in family relations as one of the fundamental tasks of the state and society. This study acquires special importance in the context of global political processes, international obligations of Ukraine and its European choice. The theoretical and practical importance of this issue is decisive for legal principles and the development of national society. Implementation of the principles of gender equality in family relations is important not only from the point of view of justice, but also for ensuring the harmonious development of society in general. The article examines the concept of gender equality in detail and determines its impact on the realization of property rights of participants in family relationships. On the basis of an in-depth analysis of scientific provisions, the legal nature of economic relations of spouses and their importance in the science of family law have been clarified. It is emphasized that family legislation reflects the concept of gender, taking into account all aspects of gender issues. Its purpose is to strengthen the principles of egalitarian democracy in the family, to ensure equal opportunities for the realization of constitutional rights, freedoms and duties of both an individual and a citizen. Legal awareness is defined as the basis of the mechanism for ensuring gender equality in Ukraine. The importance of gender equality for achieving stability and harmony in the family and society in general is emphasized. It has been established that there are problems of low legal awareness of citizens in general and specific problems of gender inequality in the country. It has been studied that gender equality in family relations is becoming more and more relevant and necessary in modern society. The meaning of gender equality as equal recognition of rights and opportunities for men and women in all aspects of family life is considered. Through the analysis of the legal aspects of the protection of the rights of women and men in marriage, highlighting the practical aspects of the realization of these rights and the analysis of socio-cultural influences, the formation and application of gender equality in modern family relations has been studied. It was noted that achieving gender equality in family relationships is a complex process that includes both legal and socio-cultural aspects. In particular, this issue is closely related to the fight against gender stereotypes, which can still affect attitudes towards the roles of men and women in the family. Therefore, the effective provision of gender equality in family legal relations requires not only the improvement of legislation, but also a change in public consciousness.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.

Proposed categories for reporting of service organization in rehabilitation in clinical trials: a discussion paper.

The lack of standardized reporting for crucial organizational factors in rehabilitation poses a significant barrier to understanding their impact on patient outcomes in clinical trials and meta-analyses. Based on the categories in the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), we aimed to develop reporting standards specifically for organizational factors in clinical trials. A comprehensive two-step process was conducted. In Step 1, important categories were identified. The identification was based on previous results from a Delphi survey with international stakeholder participation, two systematic literature reviews and results from focus groups with users in Germany, Indonesia and Norway. Step 2 involved the necessary reduction of categories and the proposal of reporting specifications, achieved through two voting rounds among key researchers, stakeholders and users. The suggested minimum reporting set comprises Context and Setting as well as Quality assurance and management. The Context and Setting is proposed to include whether the intervention is delivered by Hospital, Community or Other service providers. The Mode of delivery is proposed to be specified as Inpatient, Outpatient, In-home, or Tele-rehabilitation. Furthermore, the Level of specialization (Primary/Secondary) and the Phase of service delivery Acute, Subacute or Long-term rehabilitation services should be reported. The Quality assurance and management should be reported as Yes or No, with the option Yes requiring description of the quality assurance applied in the methods section. This study proposed a compulsory and standardized reporting of organizational factors in clinical trials to facilitate the generation of scientific evidence regarding effective service provision and delivery in rehabilitation medicine. Authors are encouraged to consider the proposed reporting set to testing, criticism, and modification to enhance its applicability and robustness.

Современные принципы и методы оказания первой помощи при утоплении

Summary. The aim of the study — to review and analyze the scientific literature and current recommendations on first aid (FA) for drowning; based on the results of the analysis, to develop a draft universal algorithm for providing FA in drowning. Study materials and methods. The material for the study comprised international and national guidelines on FA in drowning and articles on the topic of FA in drowning published in peer-reviewed scientific journals. The information search was carried out in January 2024 using the Google search engine and bibliographic databases Google Scholar, PubMed, and eLIBRARY.RU. Results of the study and their analysis. Being one of the most common causes of accidental death, drowning is a serious public health problem. Timely and correct provision of FA by incident witnesses significantly reduces the risk of death and disability for the victims. At the same time, the topic of providing FA for drowning has been little touched upon in the domestic scientific literature. There are no uniform guidelines for the Russian Federation on the provision of FA in drowning. Improvement of the organizational basis in Russia for effective provision of FA for drowning requires the development and approval of a unified formal procedure for providing FA for drowning and the establishment of the practice of mass training of the population in modern principles and methods of providing FA for drowning. Based on the results of the analysis of current international guidelines on FA, the proposed universal algorithm for providing FA for drowning, after discussion and agreement by the scientific community, may act as a basic element for creating the formal procedure for providing FA and developing appropriate educational and awareness-raising materials on FA for drowning.

Assessment of the readiness of the medical and preventive facility for actions in an extraordinary situation of a military character with combined radiation injury to the population

Background. In emergency situations of a military nature, medical institutions at all levels, especially specialized (radiological) medical facilities, are tasked with providing qualified assistance to the affected population. The effectiveness of these measures depends not only on the promptness, equipment, and training of operational teams but also on adherence to radiation safety standards, which differ from peacetime norms in terms of the scale of combined radiation injuries, injury criteria, and the methods of implementing measures. At the same time, against the backdrop of the multi-criteria uncertainty of possible radiological scenarios, there is no scientific justification for the necessary connections between the features of radiation safety and specific organizational and technical tasks within the system of overall readiness of medical institutions. Purpose – scientifically justify the potential readiness of a medical institution to act during a special period to provide qualified assistance to the population with combined radiation injuries, based on a systematic analysis of the features of the radiation safety system during military emergencies. Materials and Methods. In this paper, an attempt is made to assess the readiness of a medical and preventive institution to take action in emergency situations of a military nature by applying the method of analysis of hierarchies by T. Saati, adapted for the relevant tasks. Results. The conducted analysis of generalized weight coefficients and priorities in percentages (%) for each element of the hierarchical structure (Fig. 3) shows that more than 50% of «actions» are related to the effective provision of personnel safety and the effective delivery of medical care («Dia-1» and «Dia-2»). These components should receive key attention in the practical training of healthcare facility personnel and involved individuals through special training for emergency actions during special periods. Conclusions. This work attempts to assess the readiness of a medical institution to act in military emergencies by applying the Analytic Hierarchy Process (AHP) method by T. Saaty, adapted for the relevant tasks.

Educator perceptions of the complex needs of young people in Pupil Referral Units: An exploratory qualitative analysis

Background Alternative education provision such as Pupil Referral Units support young people who have been excluded from mainstream school settings and often from disadvantaged backgrounds. However, there is limited research to date exploring educators’ perceptions of the complex needs of young people in PRUs, and the extent to which PRUs as currently configured can meet such needs. Methods Between March 2019 and October 2020 twenty-two participants holding various educational roles from five different Pupil Referral Units across London and Southeast England were interviewed. The interviews aimed to explore the participants’ experiences of working with students in PRU’s and examine some of the challenges that they might encounter. Semi-structured interviews were analysed using Reflexive thematic analysis. Results The three identified themes and their sub-themes highlighted the complex needs of these young people and identified significant barriers to effective service provision. The first theme ‘Complexities of PRU population’ highlighted the challenges that young people in PRUs face and perceived systemic short falls in addressing such complexity. The second theme ‘Challenges of the PRU environment’ highlights the frustrations that educators experience when it comes to providing adequate support to young people in PRU’s, the absence of agency support, and the uncertainty that these educational settings can bring. The third theme ‘Peer Group Influences’ highlights the impact of peer groups from beyond the classroom on engagement within the classroom. Conclusions Despite the clear complex needs of young people in PRUs, staff reported feeling ill-equipped to support these individuals and lacked access to effective inter-agency support. Participants reported that pupils’ mental health difficulties were exacerbated by exclusion and reintegration practices, an over-zealous focus on educational outcomes and the impact of gang influences on their school lives. Implications include more specific mental health training for staff working in PRU’s, improved inter-agency working and the incorporation of trauma-informed approaches in educational practice.

CROWDFUNDING AND FUNDRAISING AS INNOVATIVE FINANCIAL TOOLS IN PROVIDING ALTERNATIVE ENERGY SOURCES

Objectives. Search and substantiation of directions for investing investment resources in alternative energy sources using crowdfunding and fundraising mechanisms. Method. Research methods in this scientific article are statistical, logical, historical, graphic, as well as general methods of scientific thinking: analysis, synthesis, induction, deduction. The results. The existence of the problem of insufficient financial instruments for building a system of alternative regenerative energy sources is substantiated. The necessity of an in-depth study and analysis of the financial tools of crowdfunding and fundraising for more effective provision of financial resources for the production of alternative renewable energy sources has been proven. Scientific novelty. The need for innovative financial instruments for "green" projects of renewable sources of energy resources has been identified. It is proposed and justified to use fundraising and crowdfunding start-up projects for the most optimal financing of social, so-called "green" investments in renewable energy sources at the current stage of the military crisis. Practical significance. The practical implementation of the proposed measures for the development of innovative projects based on fundraising and crowdfunding in the system of alternative renewable energy sources in the conditions of a crisis state of the economy will save financial resources and increase the profitability of domestic enterprises in the energy sector, which will have a positive effect on the general macroeconomic situation in the state.

Legal integrity of public authorities

This article is devoted to the study of the state of management activity of public authorities in Ukraine, as well as to the disclosure of such a social and legal phenomenon as the term “integrity of public authorities”, providing its legal definition, and revealing its meaning. It was noted that the first steps on the way to fundamentally reforming the old system of public power with the support of our European allies, starting in 2014, were carried out in Ukraine through the initiation of relevant reforms, of which 18 are key reforms. In order to implement the aforementioned, appropriate amendments to the Constitution of Ukraine and relevant laws were drafted. Thus, the movement towards the specified goal, the implementation of the aforementioned reforms by the public authorities of Ukraine depends entirely on its capacity, integrity, primarily in the field of law, in the spheres of lawmaking and law application, i.e. ensuring the supremacy of law over state arbitrariness. The article reveals the concept of “integrity” as a psychological factor, which is based on the tendency to be organized, responsible and hardworking, and also notes its connection with the law, and the legal category “legal integrity”, which is closely related to professional ethics. Related to legal integrity is legal ethics, which plays a certain role and importance of moral principles in the sphere of justice and law enforcement, as well as in other human activities related to law. Attention is focused on the fact that the analysis of the state of implementation of the planned reforms by the public authorities of Ukraine indicates a very slow progress in the fulfillment of the corresponding obligations regarding democratic transformations in the state, since a certain part of them have not been implemented so far. At the same time, new challenges have appeared during the wartime period, the implementation of which largely depends on the “legal integrity of the public authorities”, which, in turn, can affect the speed of military aid to Ukraine from our allies. First of all, this concerns the need to complete the planned reforms. It is emphasized that one of the negative dynamics, which is surprisingly important for Ukraine, is the slowing down of reforms in the security and defense sector. This is one of the most important public administration reforms, the purpose of which is to strengthen the quality of security sector management (SSC) by means of effective and efficient security provision under conditions of democratic supervision and control. In parallel with it, the reform of the defense industry should be carried out. One of the reasons for the mentioned shortcomings is the absence of a state personnel policy, which leads to the occurrence of grave consequences for national security, to the occurrence of acts of corruption, theft of state funds, and state treason. It was established that the confirmation of the above is only a fragmentary involvement of public authorities of civil society in the normative regulation of public life, regarding the regulation of social relations in the relevant spheres of life, as well as the involvement of citizens in the development and adoption of management decisions, which does not correspond to the provisions of Article 25 of the International Covenant on Civil and Political Rights. Evidence of ignoring the rights and interests of citizens on the part of the public authorities is the legislative, regulatory “deterioration” of the pension legislation in 2018 regarding persons released from military service, which was performed without involving citizens in the discussion; the veteran movement of the security and defense sector was split by the authorities. A significant shortcoming of the functioning of public authorities is that in their activities they often do not perceive the modern European democratic principle of orienting authorities to the fulfillment of social requests of society regarding its further development, but instead act on the contrary – offer and lobby their personal vision of directions for the further development of society, which often does not coincide with society’s aspirations and leads to the emergence of social conflicts. And therefore, only in the case of sharpening attention to emerging social problems, in compliance with the obligations assumed to adhere to European democratic principles, the public authorities have the opportunity to jointly solve existing problems with civil society, thereby consolidating society and increasing the efficiency of public administration.

Assessing Consumer Perception of Effective Health Service Delivery: A Study of The Perspectives of Users of Diocesan Health Services in Sunyani

Background: The standard of the healthcare provided predicts a population's health. The purpose of this study is to comprehend how consumers perceive the effective management and provision of health services at the Diocesan Health Services in Sunyani, Ghana. Materials and Methods: The study used a mixed methodology in which both quantitative and qualitative data were utilized. Semi-structured interviews and a questionnaire were used to collect the data. The nested case study design approach was used for this investigation. The study was carried out in a few chosen facilities of Diocesan Health Services Sunyani. The sample included 331 people from the facilities. Respondents’ data were subjected to descriptive and inferential data analysis. Results: The findings revealed focused primary healthcare delivery, good management and leadership, community engagement, and integration of traditional and complementary medicine into the national health systems as quality healthcare. Conclusion: Users view increased accessibility, acceptability, availability, and good service outcomes as quality health service planning and delivery.

Re-visioning Zimbabwe’s Science, Technology, Engineering and Mathematics for Secondary Schools through the Science Teacher Education Programme

The study highlights the necessity of developing innovation, creativity, and scientific competencies among Zimbabwean secondary school learners for their future social and economic engagement and participation. It explored the government’s efforts to enhance access to STEM education through the Science Teaching Education Programme (STEP) for secondary schools. Five STEM lecturers and ten STEM student teachers were purposefully selected to participate in the study. Focus group discussions with respect to student teachers, in-depth interviews with lecturers and on-site observation of the infrastructure were the data collection instruments. The research, employing a phenomenological framework, identified challenges such as resource constraints, inadequate infrastructure, and lecturer turnover as factors threatening the successful implementation of the programme. The study recommended that the government and other educational stakeholders provide additional support and resources for STEM lecturers, such as professional development opportunities, mentorship programmes, and access to cutting-edge technology and tools to produce teachers who can make a difference through the STEP programme. Thus, the study expands knowledge on discourses regarding growing challenges related to the effective institutional provision of STEM education in Zimbabwe. Keywords: College of Education, Science Teaching Education Programme (STEP), Science, Technology, Engineering and Mathematics (STEM), Secondary Schools, Student Teachers, Technology

Signposting services in the UK: enhanced support or service diversion for people with health and social care needs: a rapid realist synthesis

PurposeIn the UK signposting services can be developed as enhanced support for people with health and social care needs or service diversion to help primary and urgent care services manage their workload. This review considers these two conflicting purposes.Design/methodology/approachThe review used a realist approach, initial searches to identify theory; we then selected 22 publications and extracted programme theories, from which we developed questions from three viewpoints: the service user, the front-line service provider and the commissioner. A rich sample of studies were found from purposive searching. To optimise the applicability of synthesis findings predominantly UK studies were included.FindingsUsers value signposting service that understand their needs, suggest a range of options and summarise potential actions. People with complex health and social care needs generally require extended time/input from signposting services. Front-line providers require initial and ongoing training, support/supervision, good knowledge of available services/resources and the ability to match users to them and a flexible response. Commissioned signposting services in England are diverse making evaluation difficult.Originality/valueMeaningful evaluation of signposting services requires greater clarity around roles and service expectations. Signposting services alone fulfil the needs of a small number of users due to the unreconciled tension between efficient (transactional) service provision and effective (relational) service provision. This is underpinned by competing narratives of whether signposting represents diversion of inappropriate demand from primary care and other urgent care services or improved quality of care through a joined-up response encompassing health, social care and community/voluntary services.

Some aspects of tactical medicine in service and combat activities of police officers under the conditions of the legal regime of martial state: problem issues in critical situations and combat conditions

The article highlights the problematic issues of tactical training of law enforcement officers in today’s conditions, considers the actual problems and challenges that law enforcement officers may face during the performance of official duties and the provision of first aid in combat conditions and emergency situations. The issue of the interaction of the National Police of Ukraine with other rescue services at the scene for the effective provision of first aid was considered. It is noted that the interaction of the police and other rescue services at the scene of the event in the conditions of martial law requires a special approach and careful planning. It is necessary to ensure a clear coordination of actions, an appropriate level of protection for the personnel of the rescue services, and to take into account the peculiarities of work in the conditions of hostilities. Effective interaction between different services will minimize the consequences of emergency situations and ensure the safety of the population in the conditions of martial law. The article highlights the algorithm of actions for providing assistance to injured persons by police officers under fire, considers the key issues of training law enforcement officers to provide effective first aid in conditions of martial law or extreme situations in general. The authors of the article emphasize the importance of unified training programs for police officers in tactical medicine, which should include both theoretical knowledge and practical skills. Special attention is paid to ensuring a high level of readiness of police officers for quick and effective response to emergency situations and saving lives in the conditions of an aggravated conflict. Service situations in which police officers may find themselves are often accompanied by conflicts and their escalation, up to “fire contact” with the offender. Therefore, for the training of police officers, the section of tactical medicine is the most relevant, which teaches the basic skills of providing self- and mutual aid in combat conditions, which are primarily aimed at eliminating the preventive causes of death, taking into account the threat from combat operations or an active shooter. Unfortunately, there are infamous cases of the death of police officers while performing law enforcement tasks, which indicates the need for mandatory integration of first aid standards into their training and operations in various tactical situations. In addition, it is important to note that training police officers in tactical medicine will not only help them provide effective care to victims, but will also increase their level of safety while performing their duties. Therefore, unified training programs for police officers in tactical medicine should be an integral part of the training of law enforcement officers.

Direct healthcare costs for people with cerebral palsy in the Brazilian unified health system between 2015 and 2019

ABSTRACT Background Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. Research design and methods Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. Results A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD ‘spastic quadriplegic CP’ received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. Conclusions Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

Does maternity care in Australia align with the national maternity Strategy? Findings from a national survey of women’s experiences

BackgroundWomen Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles. AimTo explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy’s values and principles. MethodsWomen who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women’s experiences according to the Strategy’s values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported. FindingsThe survey was completed by 1750 women. A proportion of women perceived the Strategy’s values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period. ConclusionDespite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women’s access to and experiences of care across the entire maternity episode.

2191 Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture

Abstract Introduction to investigate physiotherapists’ perspectives of effective community provision following hip fracture. Methods qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

2275 Enhancing delirium awareness among patients’ relatives: a quality improvement project in elderly care

Abstract Aim This Quality Improvement Project (QIP) addressed the pressing need for increased awareness of delirium among patients’ relatives. With a 26% rise in the elderly population in Cambridgeshire, surpassing the 18.6% national average, the project provides crucial information to enhance patients’ relatives access to information about delirium, a condition affecting up to 50% of older hospitalised patients. Method This prospective QIP was conducted across seven Cambridge University Hospital (CUH) geriatric wards. Qualitative surveys determined delirium awareness, understanding, interest and perception of information availability among patients’ relatives with delirium. Measurements included data on the views of online Trust delirium information. Interventions included designing a new eye-catching delirium information poster with a QR code linked to the Trust delirium information leaflet, strategically placing QR code-enabled posters in wards, awareness campaigns targeting healthcare professionals, liaison with the inpatient Dementia team, and targeted communication at Dementia and Delirium Champion training sessions for nursing and healthcare staff. Results Pre- and post-intervention questionnaires, involving 13 relatives visiting these wards, showed a 16%, 10% and 20% respective increase in respondents’ awareness, understanding, and interest in delirium. There was a 29% increase in awareness of location of delirium information post intervention. After the interventions, views of the Trust delirium website increased by 132%. Cycles of the QIP highlighted the importance of laminated posters to comply with infection control measures and the need liaison with ward teams about strategic poster placement. Conclusion this QIP successfully demonstrated the effectiveness of QR code enabled access to patient/relative information and that a multi-faceted approach is required to facilitate effective information provision. We also demonstrated these measures increased delirium awareness in relatives. Future recommendations include continuous monitoring of the availability of posters within clinical areas, content evaluation, and work with the Dementia team to roll this out to all wards with older people within Trust.

Identifying barriers and facilitators for the effective diagnosis and provision of primary health care for otitis media from the perspective of carers of Aboriginal children.

To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children. A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software. Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications. A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.

Digital Literacy Among Agricultural Extension Agents in North Maluku, Indonesia

This study assesses the digital literacy of agricultural extension agents in North Maluku Province, Indonesia, and its implications for service delivery. A survey of 252 extension agents, conducted from November 2022 to February 2023, employed a validated questionnaire based on five key indicators: Information and Communication Technology (ICT) usage, digital data and information literacy, digital communication and collaboration, digital learning and extension skills, and digital identity and security literacy. Descriptive statistical analysis revealed an overall digital literacy level of 54.3% (SD = 10.8), indicating moderate proficiency. While ICT skills proficiency was high (61%), proficiency in other areas was lower, ranging from 50.8% to 55%. Younger agents and those with higher educational levels demonstrated higher digital literacy. These findings underscore the need for targeted interventions by government and academic institutions to bolster the digital capabilities of agricultural extension agents, thereby enhancing their capacity to leverage digital technologies for effective service provision in North Maluku's agricultural sector.