Health Care Policy Development Research Articles

Barriers to National Surgical Healthcare Policy Development & Implementation in the Southern African Development Community

Barriers to National Surgical Healthcare Policy Development & Implementation in the Southern African Development Community

Collateral-based selection for endovascular treatment of acute ischaemic stroke in the late window (MR CLEAN-LATE): 2-year follow-up of a phase 3, multicentre, open-label, randomised controlled trial in the Netherlands

The MR CLEAN-LATE trial provided evidence for the safety and efficacy of endovascular treatment for acute ischaemic stroke within the late window (after 6-24 h) in patients who were preselected based on the presence of collateral flow on CT angiography. We aimed to evaluate clinical outcomes 2 years after randomisation. MR CLEAN-LATE was a phase 3, multicentre, open-label, blinded-endpoint, randomised controlled trial conducted at 18 stroke intervention centres in the Netherlands. If endovascular treatment could be initiated within 6-24 h of symptom onset or last seen well, patients (aged 18 years or older) with an acute ischaemic stroke due to a large vessel occlusion in the anterior circulation and at least some collateral flow in the affected middle cerebral artery territory on CT angiography were randomly assigned (1:1) to either endovascular treatment with best medical treatment (endovascular treatment group) or best medical treatment alone (control group). Web-based randomisation, stratified by centre, was performed with the use of permuted blocks (block size eight to 20). The researchers who collected clinical outcomes and analysed the results were masked to treatment allocation; treating physicians, local investigators, and patients were aware of the received treatment. The primary outcome of MR CLEAN-LATE was the modified Rankin Scale (mRS) score at 90 days after randomisation. For this 2-year prespecified analysis, the primary outcome was mRS score at 2 years (minus 3 months to plus 6 months). Primary and safety analyses were performed based on the modified intention-to-treat principle, and included patients who provided (deferred) consent or died before consent could be obtained. Missing data were handled with multiple imputation by chained equations. The trial is completed and is registered at ISRCTN, ISRCTN19922220. Between Feb 2, 2018, and Jan 27, 2022, 535 patients were randomly assigned in the MR CLEAN-LATE trial, of whom 502 (94%) gave deferred consent and comprised the modified intention-to-treat population (255 in the endovascular treatment group and 247 in the control group). 261 (52%) patients were female and 241 (48%) were male. Data for mRS score at 2 years were available for 226 (89%) patients in the endovascular treatment group and for 202 (82%) patients in the control group. The median mRS score at 2 years was 4 (IQR 2-6) in the endovascular treatment group and 6 (2-6) in the control group. The endovascular treatment group demonstrated a shift towards better functional outcomes on the mRS (adjusted common odds ratio 1·41 [95% CI 1·00-1·99]; p=0·049). All-cause mortality at 2 years was 34% (87 of 255) in the endovascular treatment group and 41% (101 of 247) in the control group (adjusted hazard ratio 0·81 [95% CI 0·60-1·08]; p=0·15). Major vascular events (ie, transient ischaemic attack, ischaemic stroke, haemorrhagic stroke, and cardiac events) were reported between 90 days and 2 years in 23 patients in the endovascular treatment group and 13 patients in the control group. Our results show that the effectiveness of late-window (after 6-24 h) endovascular treatment in improving clinical outcomes is sustained for up to 2 years in a population preselected based on the presence of collateral flow on CT angiography. This finding might be important for prompting further evaluations of cost-effectiveness, health-care policy development, and clinical decision making. The Dutch Organization for Health Research and Health Innovation (ZonMW), Collaboration for New Treatments of Acute Stroke Consortium, Dutch Heart Foundation, Stryker, Medtronic, Cerenovus, Health Holland Top Sector Life Sciences & Health, and the Netherlands Brain Foundation.

The impact of mode of birth delivery on child health in India

Background: A skilled birth attendant and the place of delivery have significant effects on child growth. Aims: The present paper aims to examine the mode of delivery and its impact on child health among children (0 – 59 months) in India. Methods: The life table estimation of mortality and both bivariate and multivariate logistic regressions were used to identify the association between child health and mode of delivery using data from the National Family Health Survey conducted in 2015 – 2016. Results: After adjusting for socioeconomic and biodemographic factors, poor child growth (measured through Z-scores for stunting, wasting, and underweight categories) was more significant in cesarean delivery compared to normal delivery. In contrast, live birth for different groups of women was reportedly higher in normal vaginal delivery than in cesarean delivery. Neonatal and infant mortality rates were lower for normal delivery than cesarean delivery, particularly in public hospitals. The risk of child death was also higher in cesarean delivery, particularly in the neonatal period. Conclusion: The findings from this study could inform the development of health-care policies and the implementation of strategies aimed at improving the quality of painless labor and prompt delivery in health-care facilities, particularly public hospitals. Relevance for Patients: The present study may help pregnant women and their providers decide whether a cesarean delivery is appropriate.

Effects of governmental support on clinical nurse educators in South Korea: A repeated cross-sectional study.

To assess the effectiveness of the Clinical Nurse Educator Support Project and offer valuable insights for supporting nursing education. Allocating clinical nursing educators is crucial for supporting novice nurses' transition into the clinical setting and improving their performance. In 2019, the Ministry of Health and Welfare in South Korea implemented the Clinical Nurse Educator Support Project, which involves governmental financial support for the employment of clinical nurse educators. This study employed a repeated cross-sectional design to assess the project outcomes. Following the framework of the Kirkpatrick Evaluation Model, secondary data from annual self-program evaluation reports were analyzed to assess program satisfaction, clinical adaptation, and turnover rates of novice nurses. The "Strengthening the Reporting of Observational Studies in Epidemiology checklist" guided the reporting of the study. The project played a pivotal role in enhancing the quality of nursing education. Novice nurses' program satisfaction and clinical adaptation consistently remained high or exhibited an increase. The project led to a decrease in turnover rate among novice nurses, while the coronavirus 2019 pandemic resulted in increased turnover rates due to limited clinical practice opportunities for nursing students. Government support for clinical nurse educators has positively impacted the institutionalization of nursing education. The pressing need is to prioritize not only the enhancement of nursing education quality and the improvement of nurses' working conditions but also the development of healthcare policies and programs to effectively respond to unforeseen challenges and crises. Government and healthcare institutions must collaborate to strengthen clinical education, crucial for novice nurses' clinical adaptation. Prioritizing the improvement of nursing education quality and nurses' working conditions is essential. Continuous research and evaluation of the Clinical Nurse Educator Support Project is imperative to assess its impact and make necessary adjustments.

Evaluating the Prognostic Factors and Survival Rates of Endometrial Cancer Patients in a Tertiary Referral Hospital in Northeast Thailand.

This study aims to determine the 5-year and 10-year overall survival rates, mortality incidence, median survival time, and factors influencing the survival of endometrial cancer (EC) patients' post-diagnosis at the largest hospital in northeast Thailand. We particularly focus on the impact of access to health insurance schemes. We conducted a retrospective analysis of data from EC patients admitted to Srinagarind Hospital between 2010 and 2019. Overall survival was estimated using the Kaplan-Meier method. Multivariate Cox regression analysis identified factors associated with survival, with results expressed as adjusted hazard ratios (AHR) and 95% confidence intervals (CI). Among the 673 patients, the 5-year overall survival rate stood at 76.43% (95% CI: 72.72-79.70), and the 10-year rate at 67.86% (95% CI: 62.98-72.25). Notably, advanced age (≥60 years), stage III and IV cancer, and non-endometrioid histopathology were found to significantly increase post-diagnosis mortality risk (AHR = 2.39, 3.13, 4.62; 95% CI: 1.03-5.53, 2.07-4.74, 2.66-8.04; p-value <0.05, <0.001, <0.001). Surprisingly, we observed no significant correlation between health insurance schemes and mortality risk, suggesting that different insurance programs did not significantly affect EC patient survival in this study. health insurance schemes had no significant impact on endometrial cancer patient outcomes in Thailand, likely due to comprehensive coverage. Treatment modalities, notably surgery, showed no statistically significant differences, possibly due to early diagnosis. High-risk groups may benefit from adjuvant therapy. Early surgical intervention is crucial, with its association with disease stage emphasized. These findings inform cancer care decisions and healthcare policy development.<br />.

Microbiological perspectives in healthcare policy development: Bridging administration and infection control

Microbiological perspectives in healthcare policy development: Bridging administration and infection control

TB NOTIFICATION IN CHILDREN: THE EXPERIENCE OF TARGETED COMMUNITY DEMAND CREATION AMIDST INSECURITY IN IMO STATE, NIGERIA

This paper explores the challenges and successes of tuberculosis (TB) notification in children amidst a backdrop of insecurity in Imo State, Nigeria. Emphasizing targeted community demand creation strategies, the study investigates the intricate relationship between insecurity, community engagement, and pediatric TB detection. Drawing upon a comprehensive literature review, this research delves into the epidemiology, diagnosis, and treatment of TB in children, the ramifications of insecurity on healthcare access in Imo State, and effective community engagement strategies in healthcare initiatives. The literature findings underscore the substantial burden of TB among children and the distinct hurdles faced in environments characterized by insecurity. The prevailing insecurity in Imo State significantly disrupts healthcare services, leading to delays in TB diagnosis and treatment initiation. Nevertheless, the review identifies community engagement approaches as a promising avenue for bolstering TB notification rates in pediatric populations. These approaches empower local communities to actively participate in the identification and management of TB cases, ultimately contributing to the enhancement of pediatric TB notification. A conceptual framework, derived from amalgamated literature, elucidates the intricate interplay between insecurity, community engagement, and TB notification. This study highlights the pivotal role of community-driven interventions in mitigating the challenges posed by insecurity in Imo State, Nigeria, and presents actionable recommendations for the development of healthcare policies and programs tailored to the region. This research not only augments our comprehension of TB notification among children within insecure contexts but also provides valuable insights into the broader domain of community-based healthcare interventions. It underscores the exigency for customized strategies to address TB in pediatric populations in regions marked by insecurity, ultimately contributing to the amelioration of health outcomes for children in Imo State, Nigeria, and analogous settings&#x0D; Keywords: TB, Children, Community, Nigeria.

National Surgical Healthcare Policy Development and Implementation: Where Do We Stand in Africa?

National Surgical Healthcare Policy Development and Implementation: Where Do We Stand in Africa?

The inter-prefectural regional disparity of healthcare resources and representative surgical procedures in orthopaedics and general surgery: a nationwide study in Japan during 2015–2019

BackgroundFew reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan.MethodsThe number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables.ResultsThe annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05).ConclusionsInter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community.Level of evidenceIII.

Budgetary impact of new label indications after initial drug registration in Brazil: A case study of pembrolizumab and trastuzumab deruxtecan

The pharmaceutical landscape has undergone a transformative shift due to emerging technologies, leading to a projected value of USD 405.52 billion for the global pharmaceutical manufacturing market in 2020. Brazil, representing 2% of the global pharmaceutical market, boasts a comprehensive public health system called Sistema &amp;Uacute;nico de Sa&amp;uacute;de (SUS), ensuring universal health coverage. However, the public and private health sectors in Brazil operate independently, with 23% of Brazilians possessing private health insurance plans. Regulated by the Brazilian Drug Market Regulation Chamber (CMED), which controls drug prices based on international retail prices and other factors, the pharmaceutical market in Brazil faces significant challenges in maintaining the sustainability of the Brazilian health-care system, particularly due to the high costs of cancer medications, such as pembrolizumab and trastuzumab deruxtecan. This study aims to assess the budgetary impact of expanding indications for pembrolizumab and trastuzumab deruxtecan in Brazil after their initial registration by the Brazilian Health Regulatory Agency. Utilizing epidemiological data from the National Cancer Institute (INCA) and clinical trial data, we estimated the eligible patient populations and associated costs for these medications. Trastuzumab deruxtecan&amp;rsquo;s eligible patient population increased from 383 to 23,000 across various indications, resulting in a total cost increase from USD 90.6 million to USD 5.0 billion. Similarly, pembrolizumab&amp;rsquo;s eligible patient population expanded from 1796 to 99,544 for multiple indications, causing the total cost increase from USD 121.1 million to USD 6.7 billion. The study highlights the substantial expansions in indications and patient eligibility for trastuzumab deruxtecan and pembrolizumab in Brazil, with significant budgetary implications potentially jeopardizing the health-care system&amp;rsquo;s sustainability. To ensure the long-term sustainability of health-care systems and to provide equitable access to optimal treatments, it is crucial for policymakers to monitor and adjust drug prices following their initial registration. Policymakers must be aware of these challenges and consider them in health-care policy development and decision-making processes.

National Surgical Healthcare Policy Development and Implementation: Where do We Stand in Africa?

National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational learning. Through a desk review of available African national surgical healthcare plans and written contributions from a committee comprising six African surgical policy development experts, a few key lessons from five healthcare plans were outlined and iteratively reviewed. The current state of national surgical healthcare policies across Africa was visually mapped, and lessons from a few compelling examples are highlighted. These include the power of initiative from Senegal; regional leadership from Zambia; contextualization, and renewal of commitment from Ethiopia; multidisciplinary focus and creation of multiple implementation entry points from Nigeria; partnerships and involvement of multiple stakeholders from Rwanda; and the challenge of surgical policy financing from Tanzania. The availability of global expertise, the power of global partnerships, and the critical role of health ministries and Ministers of Health in planning and implementation have also been highlighted. Strategic planning for surgical healthcare improvement is at various stages across the continent, with potential for countries to learn from one another. Convenings of stakeholders and Ministers of Health from countries at various stages of strategic surgical plan development, execution, and evaluation can enhance African surgical policy development through the exchange of ideas, lessons, and experiences.

Doing primary care integration: a qualitative study of meso-level collaborative practices

BackgroundThe integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems.Methods11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities.ResultsAs Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels.ConclusionsAchieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.

COVID-19, State Intervention, and Confucian Paternalism

For many in the West, paternalism manifest as state interference carries a pejorative connotation, as it is often taken to entail unjustified restrictions on autonomy and self-determination and frequently believed to precipitate bureaucracy, corruption, and inefficiency. Meanwhile, uncritical deference to policies in which individual liberties remain essentially unchecked by state oversight has faced renewed scrutiny since the outbreak of the COVID-19 pandemic, as many across the globe are now coming to believe that we must accept greater governmental intervention in our lives, particularly during times of widespread health crises. This paper explores normative considerations justifying state intervention with respect to public health policies in response to the COVID-19 pandemic through the lens of Confucian paternalism, which is distinguished from a more general concept of paternalism widely used in contemporary philosophical discourse. It argues that the “soft” paternalism apropos to Confucianism has pragmatic benefits for the development of healthcare policies due to which it is not only morally warranted but even preferable to alternatives in terms of safeguarding population health.

Participation of Nurses in National Politics and Health Policy Development at Meru Level 5 General Hospital

The nurses in Kenya have the numerical power because they form the highest population of the health care system in Kenya. Despite this, they have been unable to have a strong voice to champion their rights and influence health policy formulation at policy tables. In the hospital management and at national level, the nurses hold mostly subordinate roles compared to medical counterparts. No record exists for nurses who have made it to the Kenyan National Parliament and Senate. Literature on the participation of Nurses in national politics and health policy in Kenya is scanty. This makes the situation wanting because without nurses’ participation at legislative arena the nursing profession will retrogress. The purpose of the study therefore aims at determining the participation of nurses in national politics and health care policy development. The specific focus was to find out the knowledge, perception and participation in health policy development and national politics and health policy development. The study adopted a descriptive cross- sectional study design. Self-administered questionnaires were used to collect data. The sample size was 49 registered nurses. Simple random sampling was used to select the respondents. Knowledge and perception were assessed using a set of questions that were scored on a Likert scale. Data was analyzed using Microsoft Excel 2007. The findings revealed that nurses at Meru Level 5 General Hospital had limited participation in national politics and healthcare policy development, with political participation majorly limited to voting in the general elections and health policy implementation respectively. Very few nurses were engaged in agenda setting, policy formulation and policy evaluation stages. 92% reported that politics was good for the profession, with 65% expressing that political discussions have a direct impact on their salaries and working conditions. All participants (100%) reported that nurses have a responsibility to engage in health policy development because they are knowledgeable and direct healthcare providers. Keywords: Advocacy, Health care policy, Health policy development process, Participation, Politics, Policy.

Enjeux et controverses quant à la participation d’activistes intersexes au Consensus de Chicago (2005)

For the first time, two intersex activists were invited to participate in an international medical conference in Chicago in 2005. As a result of this conference, recommendations for the medical management of intersex patients were updated. In addition, a new terminology has been adopted to refer to intersex people, namely disorders of sex development. This qualitative research aims to understand the implication of patient expertise in the development of new models of care. The article takes as a case study a controversy between the Intersex Society of North America (ISNA) and the Organisation internationale des intersexes (OII), during the 2000's. The analysis of the controversy between ISNA and OII reveals that the participation of patients in the Chicago conference raises the epistemic injustice. That is, the knowledge of those affected is not given the same credibility as that of other participants. In addition, intersex people do not have access to the same information as health professionals, especially since the medical protocols used to recommend secrecy. It also reveals that the strategies adopted by some organizations may prove to be a failure or safeguard positions contrary to the interests of the people concerned. This paper calls for reflection on the strategies implemented, here in the dialogue with the medical profession. This research contributes more widely to the scientific debates on the epistemological and political stakes of a participation of the concerned persons in the development of healthcare policies.

Revisiting COVID-19 and Occupational Mental Health.

This cross-sectional study aimed to describe the frequency of psychological sequelae of COVID-19 in healthcare workers (HCWs) conducted at The Aga University Hospital, from May to July 2020. The data collection was done online using a demographics questionnaire, concern of COVID-19 scale, Generalised Anxiety Disorder, and Impact of event scale. A total of 560 responses were received. Nearly 25% of participants had moderate to severe anxiety or psychological distress due to COVID-19. Female responders reported more anxiety compared to males. (p= 0.001. The doctors and nurses reported significant psychological distress (p=0.046). The participants with moderate to severe anxiety and psychological distress reported statistically significant high levels of concern of the following: inadequate protective measures, contracting and spreading COVID-19, medical violence, and deteriorating quality of patient interaction due to COVID-19. The COVID-19 pandemic has highlighted areas of development for occupational healthcare policy development in Pakistan. Implementation of contextualised solutions, especially psychosocial determinants is necessary to mitigate the invisible mental health burden and its impact on HCWs in Pakistan. Key Words: Occupational mental health, Pakistan, Anxiety, Depression.

Urip iku urup (life is lit) by service to others: a qualitative study of frontline healthcare workers’ lived experiences providing patient care in Indonesia’s COVID-19-designated hospital

BackgroundWhile COVID-19 affects every walk of human life, it especially implicates healthcare workers at the forefront of the pandemic due to their vulnerable involvement in providing first-line treatment. This study presents the lived experiences of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital, one of the severely afflicted healthcare settings wherein resource challenges, public health crisis, and political constraints intersect as policy conundrums.MethodsUsing a qualitative exploratory-descriptive approach, this study drew on thirteen in-depth, semi-structured interviews with frontline healthcare workers who have experiences providing first-line COVID-19 patient care in the COVID-19 hospital. The data analysis commenced with the verbatim transcription of the interview data, which was then subjected to a systematic thematic analysis employing hermeneutic phenomenological principles.ResultsThe exploration of the participants’ accounts reveals eight interconnected themes: facing resource scarcity and resignation; experiencing service-induced burnout due to occupational workload; encountering fears of being infected and infecting others; engaging in positivity through social connectedness; having dilemmas over healthcare rationing; developing negative emotions during patient interactions; coping through spirituality and religiosity; and embodying a life of service.ConclusionManaging healthcare in resource-limited, crisis settings presents multifaceted challenges that exceed mere structural modifications, requiring prioritized public health investment to ensure optimal patient care. Therefore, healthcare policy development and implementation should equally emphasize the well-being of frontline healthcare workers to foster sustainable healthcare delivery and achieve improved patient outcomes.

The Experiences of Patients Treated with Complete Removable Dentures: A Systematic Literature Review of Qualitative Research

Patient experience has been acknowledged as a critical dimension of healthcare quality alongside patient safety and clinical effectiveness. However, patient experiences in complete removable denture wearing have not been well established qualitatively. The purpose of this review was to synthesize qualitative studies that investigated the experiences of people wearing removable dentures in order to gain a deeper understanding of the issues and their causes. Databases of PubMed, SCOPUS, and CINAHL were searched to assess articles published in English from 2010 to 2021 globally. Qualitative studies that reported on experiences of people wearing removable dentures were included. A total of ten studies were included. People who wear dentures expressed diversified experiences (both negative and positive), including physical, social, psychological processes, and affective responses. Furthermore, experiences were related to emotions, maintenance of dentures, hygiene, access to care, and cost. Those wearing implant retained dentures reported more positive experiences than those who wear conventional complete dentures. Denture wearing experiences is a complex phenomenon involving the patient in wholeness including their environment. Healthcare professionals should be considering a holistic approach when providing denture rehabilitation. There is a need to further explore denture wearing experiences using qualitative approaches, as understanding of patient experiences can inform and provide clear directions on quality improvement initiatives and health-care policy development.

Digital Health Profile of South Korea: A Cross Sectional Study.

(1) Backgroud: For future national digital healthcare policy development, it is vital to collect baseline data on the infrastructure and services of medical institutions’ information and communication technology (ICT). To assess the state of medical ICT across the nation, we devised and administered a comprehensive digital healthcare survey to medical institutions across the nation. (2) Methods: From 16 November through 11 December 2020, this study targeted 42 tertiary hospitals, 311 general hospitals, and 1431 hospital locations countrywide. (3) Results: Since 2015, most hospitals have implemented electronic medical record (EMR) systems (90.5 percent of hospitals, which is the smallest unit, and 100 percent of tertiary hospitals). The rate of implementation of personal health records (PHRs) varied significantly between 61.9 percent and 2.4 percent, depending on the size of the hospital. Hospitals have implemented around three to seven government-sponsored information/data transmission and receiving systems for statistical or investigative objectives. For secondary usage of medical data, more than half of tertiary hospitals have implemented a clinical data warehouse or shared data model. However, new service establishments utilizing modern medical technologies such as artificial intelligence or lifelogging were scarce and in the planning stages. (4) Conclusion: This study shows that the level of digitalization in Korean medical institutions is significant, despite the fact that the development and spending in ICT infrastructure and services provided by individual institutions imposes a significant cost. This illustrates that, in the face of a pandemic, strong government backing and policymaking are essential to activate ICT-based medical services and efficiently use medical data.

Development Practices in Senior Nursing and Midwifery Leadership: Pathways to Improvement in South Pacific Health Policy.

The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.