Health Quality Improvement Research Articles

Quality indicators in health care systems: National Resources Focus on Results, Processes and Productivity

Introduction. Measuring the quality of health care in a country is one of the essential features of health quality improvement systems.The Aim of the Study. Studying the experience of countries with strong economies in monitoring and evaluating the quality of health care, comparing with domestic experience in this area.
 Materials and methods. The results of a review of English-language sites with data on measuring clinical indicators in the UK, Canada and the USA and websites of the national healthcare system (Ministry of Health of Ukraine, Center for Medical Statistics of the Ministry of Health of Ukraine, State Expert Center of the Ministry of Health of Ukraine, National Health Service of Ukraine) are given.
 Results and discussion. It was found that in all countries with the data analyzed in our work, the tasks of continuous improvement of the quality of health care are solved due to the connection with clinical recommendations, state support for the processes of measuring the health care quality, the provision of software for calculations and the transparency of the definition of indicators.
 Since 2018, parallel processes have been going on in the domestic healthcare system: а) clinical quality indicators are approved as part of industry standards in healthcare; b) indicators demonstrating the volumes of medical care are collected and processed by the Center for Medical Statistics of the Ministry of Health of Ukraine, c) The National Health Service of Ukraine generates special indicators based on the data of providers and users of medical services, processes, analyzes and publishes anonymized open data in the Unified State Open Data Web Portal in the form of special dashboards; these indicators are partly relevant to clinical indicators of quality.
 Сonclusions: Based on a comparison of the indicators used by different countries, the connection of quality indicators with evidence-based data, further steps of a systematic approach in the field of improving the quality of medical care are determined, since the main tool for monitoring and evaluating medical care are special indicators - quality indicators. These indicators are calculated retrospectively according to standardized methods defined at the national level, which contributes to the transparency and accountability of health care. At the same time, the connection with evidence and clinical guidelines, software, templates and calculation formulas, scope and limitations, etc. are clearly defined and easily accessible, the number and types of indicators vary from country to country. In healthcare institutions, indicators are calculated using information technology based on patient data, focusing on aspects of the quality of care such as effectiveness and productivity. A systematic improvement in the quality of health care in practice can be achieved due to the relevance of the indicators calculated in the electronic health system with the evidence-based provisions of national clinical recommendations and the requirements of industry standards in the field of healthcare.

Does quality matter to you? Ward accreditation and improving patient care.

British Journal of NursingVol. 31, No. 3 CommentDoes quality matter to you? Ward accreditation and improving patient careMichelle HopeMichelle Hope(E-mail Address: [email protected])Associate Chief Nurse, West Hertfordshire Hospitals NHS TrustSearch for more papers by this authorMichelle HopePublished Online:12 Feb 2022https://doi.org/10.12968/bjon.2022.31.3.176AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Allen T, Walshe K, Proudlove N, Sutton M. Using quality indicators to predict inspection ratings: cross-sectional study of general practices in England. Br J Gen Pract. 2019;70(690):e55-e63. https://doi.org/10.3399/bjgp19X707141 Crossref, Medline, Google ScholarCare Quality Commission. A new strategy for the changing world of health and social care—CQC's new strategy, 2021. 2021. https://tinyurl.com/4masr2us (accessed 1 February 2022) Google ScholarDarzi AW, Department of Health. Quality at the heart of everything we do. In: High quality care for all. NHS next stage review final report. 2008: 47. https://tinyurl.com/2p82ah3t (accessed 1 February 2022) Google ScholarGottwald M, Lansdown G. Clinical governance: improving the quality of healthcare for patients and service users. Maidenhead: Open University Press/McGraw Hill; 2014. Google ScholarHanefeld J, Powell-Jackson T, Balabanova D. Understanding and measuring quality of care: dealing with complexity. Bull World Health Organ. 2017;95(5):368-374. https://doi.org/10.2471/BLT.16.179309 Crossref, Medline, Google ScholarIngelsby-Burke E. Example 2: Salford Royal NHS Foundation Trust. In: May RNHS Improvement. Guide to developing and implementing ward and unit accreditation programmes. March 2019: 20-22. https://tinyurl.com/mrymj79r (accessed 1 February 2022) Google ScholarLee, F. If Disney ran your hospital. Boseman (MT): Second River Healthcare Press; 2004. Google ScholarMay R; NHS Improvement. Guide to developing and implementing ward and unit accreditation programmes. March 2019. https://tinyurl.com/mrymj79r (accessed 1 February 2022) Google ScholarPeters, T. The problem is never the problem. The response to the problem is almost always the real problem. 7 April 2012. YouTube video. https://tinyurl.com/3j7a5yx3 (accessed 1 February 2022) Google ScholarUnited Kingdom Accreditation Service, British Standards Institution Health Quality Improvement Partnership. UKAS, BSI and HQIP: joint statement of intent regarding clinical service accreditation and health Executive summary Executive summary. 2019. https://tinyurl.com/4ezdh7ze (accessed 1 February 2022) Google ScholarWhat matters to you? A global movement to improve outcomes. 2020. https://wmty.world/ (accessed 1 February 2022) Google Scholar FiguresReferencesRelatedDetails 10 February 2022Volume 31Issue 3ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 12 February 2022 Published in print 10 February 2022 Information© MA Healthcare LimitedAcknowledgement:I would like to thank Polly Pascoe, my supervisor during my recent MBA dissertation ‘The impact of ward accreditation on the quality of patient care. A realist literature review.’, on which this article is basedPDF download

Rising through the pandemic: a scoping review of quality improvement in public health during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear.MethodsWe conducted a scoping review of literature published January 2020 – February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted using four bibliographic databases, in addition to a supplementary grey literature search through custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review.ResultsRecords were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators.ConclusionsThe literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization’s management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.

Preventing the spread of COVID-19: Participation in the mass vaccination movement in Magelang Regency

This community service aims to aid in the prevention of Covid-19 transmission and the success of the vaccination acceleration program for residents of the Magelang Regency. The Subdistricts of Pakis, Tegalrejo, Mertoyudan, Mungkid, Muntilan, Dukun, Sawangan, and Tempuran are some of the areas that are supported in the administration of mass vaccination. Furthermore, this vaccination program has the potential to improve health quality while also restoring community productivity. The service team has been involved in assisting and facilitating health workers, beginning as a vaccine administrator, inputting vaccine data, and finally recording vaccine recipients.

An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities.

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways. To address these deficiencies, the field of pediatrics, along with other specialties, has been on a journey toward a more competency-based approach to education and assessment, and the framework created for the future is built on entrustable professional activities (EPAs). Competency-based medical education is one approach to addressing the deficiencies within graduate medical education and across the continuum by allowing educators to focus on the desired equitable patient outcomes and then develop an approach to teaching and assessing the tasks, knowledge, skills, and attitudes needed to achieve the goal of optimal, equitable patient care. To that end, we describe the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. We also highlight the ways in which this EPA can be used to inform curricula, assessments, professional development, organizational systems, and culture change.

Interventions for Early-Stage Pericoronitis: Systematic Review of Randomized Clinical Trials.

Background: To investigate the efficacy and safety of interventions for early stage pericoronitis. Methods: We searched for randomized controlled trials (RCTs) in databases from inception to July 2020, without language restriction. RCTs assessing adolescents and adults were included. Results: Seven RCT with clinical diversity were included, so, it was not possible to conduct meta-analyses. Individual study data showed an improvement in oral health quality of life in favor of topical benzydamine versus diclofenac capsule (Mean difference (MD) −1.10, 95% Confidence interval (CI) −1.85 to −0.35), and no difference between topical benzydamine and flurbiprofen capsule (MD −0.55 95% CI −1.18 to 0.0). There was no difference between diclofenac and flurbiprofen capsules (MD 0.55, 95% CI −0.29 to 1.39). An imprecise estimate of effects was found for all outcomes, considering (i) oral versus topic pharmacological treatment, (ii) different oral pharmacological treatments, (iii) pharmacological treatment associated with laser versus placebo laser, (iv) pharmacological treatment associated with different mouthwashes, and (v) conventional treatment associated to antimicrobial photodynamic therapy versus conventional treatment, with low to very low certainty of evidence. Conclusions: Until future well-designed studies can be conducted, the clinical decision for early stage pericoronitis should be guided by individual characteristics, settings and financial aspects.

The Framework of Zakat Managing Organization (OPZ) Synergy in Achieving SDGs Target

The target of SDGs cannot be achieved without all stakeholders’ participation, including zakat institutions. Zakat Managing Organization (OPZ), as the one serving to manage zakat, plays an important role in achieving the target of SDGs, particularly related to poverty. It is inseparable from Indonesia as the largest Muslim country in the world with great zakat potency. The objective of the research is to propose a framework of OPZ synergy in achieving the target of SDGs, particularly in poverty alleviation. The research method used was document analysis conducted on both online and offline documents of OPZ. This study was also conducted by interviewing the manager of OPZ. The result of the research shows that OPZ indirectly contributes to achieving the target of SDGs, particularly in the zero-poverty sector, overcoming starvation, realizing quality education, and improving health quality. Nevertheless, the spirit of synergy and coordination with the enactment of (Abdoeh, 2020) has not been realized yet. Each of OPZs has its own program and target.

Home working at a public university due to the COVID-19 pandemic: challenges and opportunities.

Introduction:The COVID-19 pandemic made it necessary to rapidly adapt ways of working, forcing adoption of home working, and public higher education institutions were no exception to this trend.Objectives:To analyze the initial phase of implementation of emergency teleworking at a public university, including its ramifications and repercussions for workers.Methods:This article constitutes a narrative account of the university’s experience with teleworking, evaluated by analysis of a report produced by the institution after a survey of the needs of workers assigned to emergency teleworking because of the health crisis. Report of the experience: The analysis identified both opportunities and challenges created by the experience, which involved 50% of the institution’s workers who were assigned to this modality of working. The most important opportunities were a perception of increased productivity compared to on-site working and improvements in quality of life and mental health. In counterpoint, barriers observed included worsening of mental health symptoms in the majority of workers who already had some type of mental disorder before the pandemic, work overload, difficulties with reconciling work routines with domestic activities, and a lack of the conditions and training needed to work from home.Conclusions:It should be emphasized that the various characteristics observed are related to the initial stages of adaptation to pandemic conditions and the new working routine. In counterpoint, some of the characteristics identified could offer important clues for continuation of teleworking and support for the university administration’s planning for the future.

Lessons from studies in South Asia and Sub-Saharan Africa on improvement of basic medical education and related health services

South Asia and Sub-Saharan Africa are facing rapid proliferation of medical schools especially in the private sector stimulated by demand for doctors in the mainly curative private health sector. Accreditation has failed to stem declining standards of basic medical education and its increasing irrelevance to national health care needs. Medical graduates tend to opt for careers in high paying specialties and frequently migrate to Western countries for career progression and a better organized lifestyle. However, some recent developments hold promise for improvement and are potential solutions to the problem: (a) the trend towards decentralization of health systems favours strengthening of district health services that hold the key to serve populations equitably, with district hospitals as hubs for integrating clinical care and Primary Health Care; (b) the trend towards diversification of basic medical education to district health services is potentially beneficial for both as they are interdependent; and (c) the realization that accreditation of health professional education must influence health outcomes through practice provides the impetus to improve related health services. The aim of the present review was to find evidence of successful implementation of these measures in South Asia and Sub-Saharan Africa. Evidence of improvements in performance and health outcomes from decentralization of health systems and strengthening of district health services is forthcoming, although provision and management of human and financial resources are challenging. Similarly, there is growing evidence from Sub-Saharan Africa that improvement of health professional education and quality of health care occurs when experiential learning is based at district level hospitals and its related health services; albeit the evidence is presently limited to externally supported projects. Accreditation based on successful integration of medical education and health services, is the weakest link. Although there is growing pressure for national accreditation agencies to implement global standards of basic medical education, without the context of professional development associated with coordinated improvement in related health services the notion that global standards will improve health care lacks credibility. Eventually, effective convergence of these measures is required if the daunting health challenges in South Asia and Sub-Saharan Africa are to be addressed sustainably.

Combining an experiential learning model and interprofessional peer-mentoring to improve maternal and neonatal health: Lessons learned from Indonesia.

High maternal-neonatal mortality rate in the East Nusa Tenggara Timur Province, Indonesia, has raised a concern about improving quality health care and prevention. A task force team consisting of the district health office and the corresponding hospital implemented an interprofessional peer mentoring for improving maternal-neonatal health initiative involving various health professionals and community members. This study assesses the effectiveness of the interprofessional peer-mentoring program in improving health-care workers' capacity and community members' awareness of maternal-neonatal health in the primary care setting. A mixed-methods action research was conducted to measure the effectiveness of the peer-mentoring program. The task force appointed 15 personnel to be trained as peer mentors for 60 mentees from various professions. Peer mentors' perceptions of knowledge and skills improvement were measured before and after the training program. A reflective logbook was then developed to document mentoring activities. Surveys and logbook observations were performed to measure the effectiveness of the 8-month peer-mentoring program. Mentees' capacity and perception were measured before and after the mentoring program. Quantitative data were analyzed using the descriptive statistics and Wilcoxon's paired-rank test, whereas open-ended responses and log-book reflection were analyzed using the content analysis. The peer-mentor training program improved peer mentors' knowledge and readiness from 3.64/5.00 to 4.23/5.00 (P < 0.001). Moreover, mentees viewed the program as effective in improving self-confidence and working capacity in maternal-neonatal health services from 3.47/5.00 to 3.98/5.00 (P < 0.001). Open-ended responses and a reflective logbook revealed that both mentees and peer mentors gained positive learning experiences. Seniority might become an obstacle to the mentoring process since peer mentors reported barriers in engaging elderly mentees due to seniority issues. The interprofessional peer-mentoring program was effective in improving both mentors' and mentees' knowledge, self-confidence, and working capacity in maternal-neonatal primary health services and experiential learning. Further observation of the long-term outcomes of the program should be undertaken.

A review on the Cost-Utility Analysis for the FELDA Residents in Malaysia with “Health Care Scheme (Skim Peduli Kesihatan) for the B40 Group” (PeKa B40) Coverage

Introduction: People with low socioeconomic status are always found to be one of the significant factors to determine their health status. The Malaysian government has initiated multiple programs to address the issues related to the health quality improvement of the population in line with the United Nations (UN) target for Universal Health Coverage (UHC). One of them is the “Health Care Scheme (Skim Peduli Kesihatan)” or PeKa B40 which was recently launched in 2019 to improve the target community's health status by offering several benefits obtained by the program including free health screening at private or public facilities concerning non-communicable diseases (NCDs). The cost-utility analysis study for the FELDA residents in Malaysia with “PeKA B40” coverage is needed to increase the understanding of the program's benefits and weaknesses during its implementation. It will help in identifying specific factors related to the utilization of the PeKa B40 program and will fill the gap in the economic evaluation of the government initiative. The policymaker may take into consideration of the discussion and recommendation to improve awareness among healthcare providers, especially at the primary care level. Concerning the Sustainable Development Goals (SDG), the study can give an impact on achieving good health and well-being (SDG 3.0). Conclusion: In the 12th Malaysia Plan, the Malaysian government showed commitment to combat NCDs in line with the international target by targeting to reduce the NCDs prevalence by focusing on non-communicable diseases (NCDs). Therefore, a health reform commission needs to be established to improve the effectiveness, efficiency and equity of healthcare access to all residents mostly among B40 group in Malaysia.

Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care.

Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

Connecting soil characteristics to edge-of-field water quality in Ohio.

Soil health and water quality improvement are major goals of sustainable agricultural management systems, yet the connections between soil health and water quality impacts remain unclear. In this study we conducted an initial exploratory assessment of the relationships between soil chemical, physical, and biological properties and edge-of-field water quality across a network of 40 fields in Ohio, USA. Discharge, dissolved reactive P (DRP), total P (TP), and nitrate (NO3 ) losses associated with precipitation events via surface runoff and tile drainage were monitored. Agronomic soil tests and a suite of soil health indicators were measured, then predictive relationships between the field average soil properties and tile drainage and surface runoff discharge and DRP, TP, and nitrate loads were explored with random forest and multiple linear regression approaches. Among the soil health indicators, water extractable C and N were consistently found to be positively related to tile nitrate loads, but other soil health indicators had little or inconsistent importance for water quality impacts. Several other soil properties were important predictors, particularly soil P pools for surface and tile DRP and TP losses as well as Mehlich-3 (M3) extractable Fe and Al for surface and tile discharge. Thus, we did not observe strong evidence that soil health was associated with improved edge-of-field water quality across the edge-of-field monitoring network. However, additional studies are needed to definitively test the relationships between a broader array of soil health metrics and water quality outcomes.

Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review.

Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

As cystic fibrosis transmembrane regulator (CFTR) modulator therapies offer greater longevity and improved health quality, women living with cystic fibrosis (CF) are increasingly pursuing pregnancy. Maternal risks for pregnant women with CF largely depend on a woman’s baseline pulmonary and pancreatic function, and the majority of CF pregnancies will successfully end in live births.Diabetes, either gestational or pre-existing cystic fibrosis-related diabetes (CFRD), is highly prevalent in women with CF, affecting 18 to 62% of pregnancies in recent CF center reports. In addition to the rising incidence of CFRD with age, gestational diabetes is also more common in women with CF due to lower insulin secretion, higher insulin resistance, and increased hepatic glucose production as compared to pregnant women without CF. Diabetes occurring during pregnancy has important implications for maternal and fetal health. It is well established in women without CF that glycemic control is directly associated with risks of fetal malformation, neonatal-perinatal mortality, cesarean delivery and need for neonatal intensive care. Small studies in women with CF suggest that pregnancies affected by diabetes have an increased risk of preterm delivery, lower gestational age, and lower fetal birth weight compared to those without diabetes.Women with CF preparing for pregnancy should be counseled on the risks of diabetes and should undergo routine screening for CFRD with oral glucose tolerance testing (OGTT) if not already completed in the past six months. Glycemic control in those with pre-gestational CFRD should be optimized prior to conception. Insulin is preferred for the management of diabetes in pregnant women with CF via multiple daily injections or insulin pump therapy, and continuous glucose monitors (CGM) can be useful in mitigating hypoglycemia risks. Women with CF face many unique challenges impacting diabetes care during pregnancy and would benefit from support by a multidisciplinary care team, including nutrition and endocrinology, to ensure healthy pregnancies.

Bioactive Phytochemicals with Anti-Aging and Lifespan Extending Potentials in Caenorhabditis elegans.

In the forms of either herbs or functional foods, plants and their products have attracted medicinal, culinary, and nutraceutical applications due to their abundance in bioactive phytochemicals. Human beings and other animals have employed those bioactive phytochemicals to improve health quality based on their broad potentials as antioxidant, anti-microbial, anti-carcinogenic, anti-inflammatory, neuroprotective, and anti-aging effects, amongst others. For the past decade and half, efforts to discover bioactive phytochemicals both in pure and crude forms have been intensified using the Caenorhabditis elegans aging model, in which various metabolic pathways in humans are highly conserved. In this review, we summarized the aging and longevity pathways that are common to C. elegans and humans and collated some of the bioactive phytochemicals with health benefits and lifespan extending effects that have been studied in C. elegans. This simple animal model is not only a perfect system for discovering bioactive compounds but is also a research shortcut for elucidating the amelioration mechanisms of aging risk factors and associated diseases.

Potentials of associated traditional knowledge on marine resources for economic and general well-being among coastal communities in Terengganu, Malaysia

This study was conducted to explore the potential of associated traditional knowledge on marine resources for the sustainability of economic and general well-being among coastal communities in Terengganu. Using a qualitative study, twenty-six interviews were conducted. The study used convenience and snowball sampling to identify the other potential participants who had knowledge and experience about the topic. The study used thematic analysis to identify the required themes according to the objectives. Drawing upon sustainable livelihood theory for data interpretation, the findings indicate that traditional knowledge of marine resources plays an essential role in achieving economic well-being for the coastal community in Terengganu. This is viewed from the aspect of increased living standards and improved health quality. Although exploration of traditional knowledge on marine resources is limited among the modern generation, the implications of this study highlight that identification of certain marine resources as traditional medicine for health problem solutions, selling fresh marine resources, and production of processed food from marine resources could offer ways to improve the economy of coastal communities. The study was carried out during the Covid-19 pandemic, which had limited the number of participants interviewed. Therefore, the sample size obtained is relatively small to find more significant results. Future studies can be expanded through quantitative approach methods among traditional medicine practitioners and other communities in different regions that use marine resources in their daily life.

Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study

BackgroundDespite the large treatment gap in Indonesia, limited studies have attempted to explore both service users’ and providers’ evaluations of the current mental health system holistically. This study aims to explore the perceived challenges and support needs of Indonesian mental health stakeholders.MethodsThis qualitative study collected data from 17 participants from two mental health stakeholders in Yogyakarta (i.e., health professionals and service users) through a semi-structured interview. Thematic analysis was used to analyze the data.ResultsFindings reveal that service providers and users shared equally strong concerns regarding challenges and needs for improving mental health literacy, accessibility to services, and government support. However, a distinct emphasis was made in several areas—with service providers hinting more towards issues with interprofessional collaboration. In contrast, service users emphasized the negative attitude of health professionals and poor accessibility to service information.ConclusionThe mental health service system is challenged by the lack of accessibility to service information, the limited spread of mental health practitioners, stigma, and lack of mental health literacy among both the public and professionals. A need for improvement in mental health promotion, accessibility, and quality of mental health workers is highlighted to satisfy the needs of both service users and providers.

Role of air pollution in chronic kidney disease: an update on evidence, mechanisms and mitigation strategies.

Air pollution results from a variable and complex mixture of harmful gases and suspended particles and is the most worrisome of all environmental hazards. It is implicated in several non -communicable diseases and is recognized to be a public health problem. Though the initial exposure to air pollution is through the respiratory system, kidneys are thought to be exposed to higher concentrations owing to their filtration function. Chronic kidney disease is the insidious end result of several disease processes which cumulatively form a large healthcare burden, particularly in low- and middle-income countries. There is a growing body of evidence that air pollution may be a contributing factor that leads to CKD by not only its direct effects, but can also compound the effect of other factors/diseases causing kidney injury. PM2.5 exposure particularly has been implicated, although there is some evidence regarding other air pollutants as well. These pollutants are thought to act on kidneys through several interlinked systemic pathways and mechanisms which individually and collectively damage the nephrons. Long-term exposures seem to gradually diminish renal function and lead to end-stage renal disease. A thorough understanding of the mechanism of kidney injury is the key for formulating and implementing effective strategies for reducing this burden. Maintaining the air quality, promoting education, improving health quality and promotion of targeted nephroprotective measures through effective policy and research support are required in addressing this global public health problem.

Data Quality Improvement and Internal Data Audit of the Chinese Neonatal Network Data Collection System.

Background: The Chinese Neonatal Network (CHNN) is a nationwide neonatal network that aims to improve clinical neonatal care quality and short- and long-term health outcomes of infants. This study aims to assess the quality of the Chinese Neonatal Network database by conducting an internal audit of data extraction.Methods: A data audit was performed by independently replicating the data collection and entry process in all 58 tertiary neonatal intensive care units (NICU) participating in the CHNN. Eighty-eight data elements selected for re-abstraction were classified into three categories (critical, important, less important), and agreement rates for original and re-abstracted data were predefined. Three to five records were randomly selected at each site for re-abstraction, including one short- (0–7 days), two medium- (8–28 days), and two long-stay (more than 28 days) cases. Agreement rates for each data item were calculated for individual NICUs and across the network, respectively.Results: A total of 283 cases and 24,904 data fields were re-abstracted. The agreement rates for original and re-abstracted data elements were 96.1% overall, and 97.2, 94.3, and 96.6% for critical, important, and less important data elements, respectively. Individual site variation for discrepancies ranged between 0.0 and 18.4% for all collected data elements.Conclusion: The completeness, precision, and quality of data in the CHNN database are high, providing assurance for multipurpose use, including health service evaluation, quality improvement, clinical trials, and other research.