Health Service System Research Articles

Pre-Medications for Non-Emergency Tracheal Intubation in the United States Neonatal Intensive Care Units.

Premedication in neonates undergoing elective intubation effectively minimizes the negative physiological events of bradycardia, systemic hypertension, intracranial hypertension, and hypoxia. Premedication decreases procedure-related pain and discomfort. This study aimed to evaluate the current practice of pre-intubation medications for non-emergent intubations in preterm and term neonates in the United States. A cross-sectional survey (Appendix) was sent via e-mail to all level 3 and 4 Neonatal Intensive Care Units (NICUs) of the Organization of Neonatal Perinatal Medicine Training Program Directors (ONTPD), NICU directors with pediatric residency only, and Baylor Scott and White Health, Mednax, and Envision health services systems. Of 170 responses, 41% (69/168) routinely premedicate, 38% (64/168) premedicate under specific circumstances, and 21% (35/168) do not administer any routine pre-intubation medications. Only 46% (77/168) of units had a written policy. The most frequently used drugs were fentanyl (68%, 116/170), atropine (39%, 66/170), midazolam (38%, 64/170), and morphine (26%, 45/170). 21% (36/170) used a two-drug combination, and 38% (64/170) used a three-drug combination. The most commonly used two-drug combination was atropine and fentanyl, and the most common three-drug combination was atropine, fentanyl, and a paralytic agent. Despite the well-documented benefits of premedication for NICU intubations, as aligned with AAP recommendations, the US lags behind other nations, with stagnant rates since 2006. This disparity persists despite a rise in written policies, which exhibit significant content variations. The authors advocate for the adoption of standardized, AAP-aligned policies across all NICUs in the US. Continued research is vital to monitor the progress of this crucial practice and address any underlying barriers to implementation.

Hasil Kadar HbA1C Penderita Diabetes Melitus Tipe 2 Pada Kelompok Prolanis Di Puskesmas Juhar Tahun 2023

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia that occurs due to abnormalities in insulin secretion, insulin action or both. The International Diabetes Federation (IDF) estimates that the number of diabetes sufferers in Indonesia could reach 28.57 million in 2045. This number is 47% greater than the number of 19.47 million in 2021. This research was conducted on patients who had been diagnosed with type 2 DM who were members of the Prolanis group. Prolanis is a health service system that aims to improve the quality of life of participants with chronic diseases, one of which is Diabetes Mellitus type 2. HbA1c is a substance formed from the reaction between glucose and hemoglobin. HbA1c is one of the parameters for assessing glycemic control (patient compliance). The research entitled Analysis of HbA1c Levels in Type 2 Diabetes Mellitus Sufferers in the Prolanis Group at the Juhar Community Health Center aims to analyze and measure HbA1c levels in Type 2 Diabetes Sufferers. The research method used was Descriptive Cross-sectional. The examination material used is median cubital vein blood with EDTA anticoagulant. From the results of the examination, 25 samples were obtained, of which 12 patients had HbA1c levels >8% with criteria for poor DM control, 6 patients had HbA1c levels of 6.5-8% with criteria for moderate DM control, and there were 7 patients with HbA1c levels <6.5%. with the criteria for good DM control. From the results of this study, it was found that controlling DM at the Juhar Community Health Center there were 14 patients who had HbA1c values above 6.5 and after follow-up for the next 6 months, some had HbA1c levels that decreased and others that increased. To obtain good DM control, it is best for people with diabetes to have an HbA1c check every 3 months as part of diabetes management and this management is very important to carry out in health services, including primary level health services.

PENGARUH TARIF RAWAT INAP DAN STANDAR PELAYANAN MINIMAL TERHADAP KEPUASAN PASIEN BPJS DI RUMAH SAKIT SILOAM PURWAKARTA

Effect of Inpatient Rates and Minimum Service Standards on BPJS Patient Satisfaction at Siloam Hospital Purwakarta.Based on optimal Service delivery, a health Service institution provides an impetus for the government to make a regulation regarding equitable standards in the health Service system. This study aims to determine how the influence of minimum Service rates and standards in Siloam Purwakarta hospitals in accordance with existing regulations.The analytical framework used is the inpatient tariff framework and minimum Service standards for patient satisfaction evaluating comfort, patient relationships, staff technical competencies and costs. The analytical method used is descriptive analysis with a quantitative approach.The results of the analysis show (1) Effect of Inpatient Rates on Patient Satisfaction partially has a significant influence on patient satisfaction (2) Effect of Minimum Service Standards on Patient Satisfaction partially has a significant effect on patient satisfaction (3) Effect of Inpatient Rates and Standards Minimal Service to patient satisfaction simultaneously has a significant effect on patient satisfaction and has an influence of 90.6% and the remaining 9.4%> is influenced by other factors not examined. The suggestions given by the authors include: (1) It should be noted again about BPJS hospitalization rates and re-socialization about class promotion programs, namely by analyzing the making of hospitalization rates and making special fields for Information on Service rates. (2) Need to continuously provide an explanation or understanding to patients of the minimum Standard of hospitalization. (3) Due to the simultaneous influence between inpatient rates and minimum Service standards on patient satisfaction, the quality of the two variables must be reviewed.

Perhitungan Tenaga Keperawatan

Having sufficient nursing staff, services can be provided with high quality standards, optimizing patient care outcomes. The aim of this research is to provide a deeper understanding of the calculation of nursing personnel and the importance of this role in improving the quality and accessibility of health services. This research uses correlation analytics with a cross sectional approach. The population and sample in this study were 33 patient care units in a private hospital in Bogor. The instrument used in this research is the energy calculation formula The Ilyas Method. Statistical analysis uses the Independent Sample T Test. The research results showed that there was a correlation between the number of calculations needed for nursing staff and the current availability in a health service system. Nursing shortages can have serious consequences for patient satisfaction, increase the risk of medical errors, and slow response to emergencies. Holistic and coordinated strategies, such as active recruitment, talent retention, education and training, use of technology, and work schedule flexibility, need to be implemented to overcome the challenge of nursing shortages.

RETRACTED ARTICLE: Application of IoT real-time monitoring based on optical sensors in residents’ sports and health service system

RETRACTED ARTICLE: Application of IoT real-time monitoring based on optical sensors in residents’ sports and health service system

Where are the links? Using a causal loop diagram to assess interactions in healthcare coordination for youth experiencing homelessness in Toronto, Canada

BackgroundYouth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH.MethodsThis study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz’s constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum.ResultsThe CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems.ConclusionsThe CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff–youth relationships be prioritized, as each of these acts interdependently and influences YEH’s access, quality and coordination of healthcare.

ANALISIS PELAYANAN BIDANG FARMASI MENGGUNAKAN INDIKATOR LAYANAN BERBASIS WHO: TINJAUAN SISTEMATIS

Pharmaceutical services in hospitals are an inseparable part of the hospital's health service system that is oriented towards patient service, the provision of quality and affordable pharmaceutical preparations, medical devices, and consumables for all levels of society including clinical pharmacy services. The purpose of this study is to systematically review the implementation of pharmaceutical services based on WHO indicators. The articles used were selected from the Google Scholar journal database published from January 2013 to December 2023. Keywords for the study included "service" or "pharmaceutical" or "pharmacy" or "indicator" or "hospital" or "WHO". A total of 476 articles were generated from the initial search, the author identified 8 articles on pharmaceutical services based on WHO indicators. Based on a systematic review, most hospitals have implemented pharmaceutical services based on WHO indicators. Based on a systematic review, the implementation of pharmaceutical services in accordance with WHO standards is the selection stage: conformity with the hospital formulary; procurement: frequency of procurement of each drug item annually and on an EOQ basis; distribution: the degree of availability of the drug; Usage: percentage of generic prescriptions, percentage of drugs delivered, percentage of drugs labeled complete and average time spent serving prescriptions.

Making development assistance work forAfrica: from aid-dependent disease control to the new public health order.

The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role and effectiveness of DAH in triggering and sustaining health systems investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making and accountability. Africa is diverse and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH benefitted Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal health coverage (UHC) are slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new transparent framework to monitor DAH that captures its contribution to building institutions and systems.

Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information?

This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.

Association Between Health Service Systems and Pressure Injury Problems of Individuals With Chronic Spinal Cord Injury in Malaysia, Indonesia, and Thailand: A Cross-sectional Study.

The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries. This is a cross-sectional study. Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem"). Health service systems were categorized as an inpatient-oriented spinal cord injury-specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems. Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury-specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374-0.866] and 0.591 [95% confidence interval = 0.405-0.864], respectively). Spinal cord injury-specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury-specialized services in middle-income countries to reduce the prevalence of pressure injury problems. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Identify the best strategy for managing pressure injury problems in people with spinal cord injury. (2) Describe common methods for determining health service utilization and evaluating secondary health conditions in people with spinal cord injury. (3) Discuss the advantage of having a SCI-specialized rehabilitation system in middleincome countries as a protective factor from having pressure injury problems. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq.

Since December 2019, the World Health Organization (WHO) has encouraged National Tuberculosis Programs to deprioritize the use of injectable-containing regimens and roll-out all-oral bedaquiline-containing regimens for rifampicin-resistant tuberculosis (RR-TB) treatment. Consequently, Iraq gradually replaced the injectable-containing regimen with an all-oral regimen, including bedaquiline. To assess treatment enrolment and outcomes of both regimens during a transitioning phase in Iraq, where health system services are recovering from decades of war, we conducted a nationwide retrospective cohort study using routinely collected programmatic data for patients enrolled between 2019-2021. We describe treatment enrolment and use logistic regression to identify predictors of unfavorable treatment outcomes (failure, death, or lost to follow-up), including regimen type. Nationwide, a total of 301 RR-TB patients started treatment, of whom 167 concluded treatment. The proportion of patients enrolled on the all-oral regimen increased from 53.2% (50/94) in 2020, to 75.5% (80/106) in 2021. Successful treatment was achieved in 82.1% (32/39) and 63.3% (81/128), for all-oral and injectable-containing regimens respectively. Moreover, the proportion of lost to follow-up was lower among those treated with the all-oral versus the long injectable-containing regimen; respectively 2.6% (1/39) versus 17.9% (23/128: p = 0.02). Unfavorable treatment outcome was associated with male gender (aOR 2.12, 95%CI:1.02-4.43) and age <15 years (vs 30-49 years, aOR 5.80, 95%CI:1.30-25.86). Regimen type (aOR 2.37, 95%CI: 0.91-6.13) was not significantly associated with having an unfavorable treatment outcome. In Iraq, the use of bedaquiline-containing all-oral regimen resulted in a high treatment success and reduced lost to follow-up.

Edukasi Fisioterapi Stretching Pada Senam Prolanis Lansia di Puskesmas Sibela Kelurahan Mojosongo Surakarta

Elderly people are individuals over 60 years old. The elderly is related to the aging process accompanied by physical, mental and social changes, which have an impact on health such as hypertension and diabetes mellitus. Stretching before exercise is to prevent injury, maintain the elasticity of muscles and tendons, thereby increasing the range of movement. Prolanis is a health service system and a proactive approach that is implemented in an integrated, involving manner. participants, health facilities and the Social Security Administering Agency (BPJS). The aim of this activity is to increase the effectiveness of prolanis exercise in the elderly and prevent injuries from occurring when carrying out prolanis exercise activities. The activity stages were given stretching education before starting prolanis exercises in the Sibela Community Health Center environment. The results obtained from prolanis exercise activities show that prolanis exercise is carried out 4 (four) times a month, education is given once in the second week to prolanis exercise participants through direct practical activities in the field before the exercise is carried out so that participants can understand the importance of stretching or stretching the muscles of the upper and lower limbs to prevent injury.

Pengaruh Mutu Pelayanan Terhadap Minat Kembali Di RSUD Piru Kabupaten Seram Bagian Barat

Hospitals are an internal part of the health service system. In Indonesia, all public and private hospitals have the duty to carry out curative and rehabilitative efforts without neglecting preventive and promotive efforts as well as making referral efforts. Patients have the right to obtain quality health services in accordance with professional standards and standard operational procedures so that hospitals are always required to improve the quality of service. The aim of this research is to determine the influence of the quality of health services on interest in returning to Piru Hospital, West Seram Regency. This research method is quantitative using a cross sectional approach. The sample in this study consisted of 30 respondents according to Sugiyono 2019:127. This research instrument uses a questionnaire. Data processing uses SPSS, using the chi-square test with a significance level of (0.05). The results of the research on the influence of health service quality on return interest showed that the p value was &lt;0.000 with (α&lt;0.05), meaning there was a significant relationship between the influence of health service quality on return interest at Piru District Hospital. . The results of research on the influence of health service quality on interest showed that the p value was &gt; 0.05 with (α &gt; 0.05), meaning there was no significant relationship.

Moderating Effect of Mobile Technology on the Relationship Between Health Systems Governance and Service Delivery in National Referral Hospitals in Kenya

In recent years, there is an increased attention to build formidable health systems governance to promote the highest attainable standard of health service delivery which has become a fundamental part of our human rights and of our understanding of a life in dignity. The health systems governance through the establishment of health policy has taken on increasing importance in the provision of health care services in the health institutions. The public hospitals in Kenya have weak health systems governance attributed to the existing health policy affecting quality healthcare. The current study sought to examine the moderating effect of mobile technology on the relationship between health systems governance and service delivery in National Referral Hospitals in Kenya. The study was anchored to the Contingency Leadership Theory. The study identified six categories of the target respondents, namely, 5 directors, 43 board members and 88 head of departments. The study used regression analysis to analyze the association between the variables at 0.05 level of significance. Results revealed that mobile technology positively and significantly moderated the relationship between health systems governance and service delivery in national referral hospitals in Kenya. The results support the current theories related to the study. Consequently, this study provides national referral hospitals with insights of how to improve health care service delivery through the adoption of appropriate mobile technology and health systems governance in the national referral hospitals. This could go a long way in ensuring there is improved service delivery in the national referral hospitals in Kenya. The implications of the study are that the moderating effect of mobile technology on the relationship between health systems governance and healthcare service delivery in Kenyan hospitals can lead to positive outcomes such as improved communication, data management, and patient-centered care. However, it also presents challenges that need to be carefully addressed through appropriate governance mechanisms. The successful integration of mobile technology requires a comprehensive and adaptive approach to healthcare governance in the national referral hospitals in the country.

A Brief Overview of the Development and Significance of Modern Scientific Medicine in China: Take Chinese Academy of Medical Science and Peking Union Medical College as an Example

Since the early 20th century, China has gradually established a clinical, educational, and research system centered around modern scientific medicine, which has now become the dominant force in China's medical and health system and services, with the construction and development of the Chinese Academy of Medical Sciences and Peking Union Medical College as the most prominent symbol. The scientific medicine in the new era requires close cooperation across multiple disciplines and fields to build a high-quality and efficient medical and health service system. It also involves combining the excellent traditional Chinese culture with Western medicine to explore a unique path of modern scientific medicine with Chinese characteristics.

Prototype of Integrated Health Service System for Diabetes Mellitus Prevention: Indonesian Population

The low knowledge about Diabetes Mellitus health service systems in other countries causes Indonesian migrant workers and students to choose not to be checked when they feel sick. The aims of this study to design a prototype of an integrated health service system for foreign in Taiwan. This study using Action Research method with two cycles, the first cycle was to designing prototype framework and the second cycle was to socialization of the prototype that has been developed. This study was conducted on February 2024 at Taiwan city with 85 participants. The findings of this study indicate that the integrated health service system prototype can provide assistance to Indonesian population to understand the operation of the health system, how to access the health services available in Taiwan, and help them understand their rights as patients and health insurance claims procedures. Effective socialization about the integrated healthcare system provides significant benefits, including helping to overcome barriers faced by Indonesian population in accessing healthcare services in Taiwan. It also assists them in enhancing their skills in managing their personal health and improve their quality of life by managing their health conditions more effectively and taking appropriate preventive measures.

GERONTOLOGICAL AND GERIATRIC SERVICES FOR THE OLDER GENERATION

The article deals with measures aimed at the development of gerontological and geriatric services, the study of social and psychological determinants of the elderly in order to improve the processes of the organization of providing medical, social and psychological services to people with mental health problems. Attention is paid to topical issues of gerontpsychology, issues of adaptation of people with mental health disorders in society, development of abilities that allow them to live independently. The current state of the system of mental health and social protection services is presented from the point of view of the need to create alternative forms of services. The article pays attention to the importance and necessity of introducing and developing new forms and types of psychological and medical-social care, increasing the targeting of services based on individual psychological features and capabilities of elderly people with mental health problems. The data of the studies conducted by the author as well as those conducted with his participation are given. Conclusions are made and recommendations are provided on the measures necessary to improve the social and psychological condition of people with mental health disorders.

Research on the Construction and Strategies of the “Familyschool-social-medical” Collaboration System for Adolescent Mental Health Services

Research on the Construction and Strategies of the “Familyschool-social-medical” Collaboration System for Adolescent Mental Health Services

A Retrospective Record-Based Study to Identify the Indications and Outcomes of Obstetric Referrals to A Tertiary Care Centre in Gujarat, India

Background: Obstetric referral services in the public health system play a crucial role in managing obstetric emergencies. However obstetric referrals to tertiary care centres should be used judiciously and effectively and not convenience-based. Objectives: To study the indications of obstetric referrals from primary and secondary care centres and to assess the referral communications and outcome of referred mothers. Methods: This was a retrospective record-based study done at a tertiary care centre in Gujarat from January to December 2022. All obstetric referrals during the study period were included in the study. Non-obstetric referrals and registered antenatal cases were excluded from the study. Results: Of 1227 mothers referred 62.7% were referred from CHC and 34.7% from SDH. 96.7% of them were referred to in the first stage of labour. There was no pre-referral communication in about 44% of referrals. Referral slip was incomplete in 15% of the mothers. Two-thirds of them had normal delivery (64.5%). Only 3.7% of mothers needed ICU support. 97.91% of the mothers had live births. Conclusion: Unjustified, unindicated, and convenience-based referrals from peripheral health centres and poor referral communication were noted. This study highlights the need for formulation, implementation and monitoring of an obstetric referral policy to avoid clogging tertiary care centres with patients that can be managed at peripheral health centres.

Stroke Care in South Asia - Identifying Gaps for Future Action.

Stroke causes around 730,000 deaths in South Asia, nearly half of stroke-related deaths in developing countries. This highlights the need to address health system responses, considering poverty, service quality, and availability. The article identifies four key challenges in stroke management and rehabilitation in South Asia, emphasizing long-term monitoring, risk factor control, and community surveillance, drawing on experiences from Nepal.