Health Care In Public Hospitals Research Articles

Real World Data on Treatment of Acute Myeloid Leukemia (AML) in a Private Healthcare Institution in Brazil, a Low-Middle Income Country - Importance of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)

Introduction: Treatment of patients with AML has evolved in the past decade, with development of novel drugs and increased knowledge about the genetic basis of disease. However, results of therapy in AML in LMICs have lagged those seen in more developed countries. A recently published paper highlighted the worse outcome of pts with AML treated in two public healthcare hospitals in Brazil compared with pts treated at an academic center at Oxford, UK, with lower overall survival (OS), lower rates of HSCT and a longer time to HSCT. 1 We hypothesized, however, that better outcomes could be seen in private healthcare institutions in Brazil with a higher rate of HSCT in first remission. Methods: We reviewed medical records of 122 patients with a diagnosis AML treated at Hospital Israelita Albert Einstein in São Paulo, Brazil, from 2010 until 2023. OS was defined as time from diagnosis until death from any cause and estimated by the Kaplan-Meier method. Risk was evaluated by the ELN 2022 risk classification. Results: A total of 122 consecutive patients were included. Median age was 63 years (range 24-91 years), and 45% were female. Per the ELN 2022 risk classification, 17% of patients were low risk, 33% were intermediate risk and 50% were considered high risk cases. Intensive chemotherapy was used in 62.5% of cases, while low-intensity regimens were employed in 37.5% of cases, including venetoclax in 21.4% of patients. After a median follow-up of 36 months, median OS of the whole cohort is 25.2 months (95% CI 19.2-83.8 months), and 3-years OS is 44% (95% CI 34-55%). As expected, patients in the high 2022 ELN risk category had lower 3-years OS probability (15.6% vs. 47.3%/91.6% for intermediate- and low-risk, respectively). Eighty-two patients (67.2% of the cohort) underwent HSCT, and 59% were in MRD-negative complete remission (CR) prior to HSCT. We next analyzed outcomes in patients younger than 60 years of age who received intensive chemotherapy, the subset of patients analyzed by Silveira et al. 1 Results are summarized in Table 1 and figure 1. The outcomes of our patients compare favorable to what has been reported here in Brazil and, like the data from the UK center, has a high rate of HSCT with a low time to transplant. Conclusion: Our results demonstrate that it is feasible to obtain favorable outcomes in patients with AML in a LMIC with a high rate of HSCT in first CR. It is also important to mention that our results also reflect the reality of a private healthcare institution in Brazil. However, even after considering this, our results carry an important message. There is limited availability of clinical trials and novel medications for AML in LMICs compared to the developed world, and options in the salvage setting are usually limited to intensive chemotherapeutic regimes. Allogeneic HSCT is a technique that is readily available in most countries and has the potential to cure AML, particularly when employed in first CR. We believe that physicians and institutions treating patients with AML in a LMIC should primarily focus on strategies that improve access to HSCT in first CR for these patients.

Impact of Molecular Testing Using Next-Generation Sequencing in the Clinical Management of Patients with Non-Small Cell Lung Cancer in a Public Healthcare Hospital

Next-generation sequencing (NGS) is a molecular approach able to provide a comprehensive molecular profile of non-small cell lung cancer (NSCLC). The broad spectrum of biomarker-guided therapies has positioned molecular diagnostic laboratories as a central component of patient clinical management. Here, we show the results of an UNE-EN ISO 15189:2022 NGS-accredited assay in a cohort of 350 patients. TP53 (51.0%), KRAS (26.6%) and EGFR (12.9%) were the most frequently mutated genes. Furthermore, we detected co-occurring and mutually exclusive alterations, as well as distinct molecular profiles according to sex and smoking habits. Actionable genetic alterations were significantly more frequent in female patients (80.5%, p < 0.001) and in never-smoker patients (87.7%, p < 0.001). When NGS was established as the main molecular testing strategy, 36.4% of patients received at least one line of targeted treatment. Among 200 patients with stage IV NSCLC, first-line treatment with targeted therapies was associated with a longer progression-free survival (PFS) (13.4 months (95% CI, 10.2-16.6) (p = 0.001)). Similarly, the overall survival (OS) of patients receiving at least one targeted drug was significantly longer (26.2 months (95% CI, 11.8-40.5) (p < 0.001)). Our results show that the implementation of NGS in the public healthcare system has provided a broader application of precision medicine.

Impacts of language barriers on healthcare access and quality among Afaan Oromoo-speaking patients in Addis Ababa, Ethiopia

BackgroundEthiopia is a multilingual and multinational federation with Addis Ababa serving as both the capital city of Oromia regional state and the seat of the Ethiopian federal government. Nevertheless, only Amharic is considered as the working language of the city and federal offices, including hospitals. As a result, Afaan Oromoo-speaking patients may be facing language barriers in the healthcare settings in Addis Ababa. Language barriers have the capacity to affect patients’ experience of care and treatment outcomes. This study, hence, examined the impacts of language barriers on the healthcare access and quality for the Afaan Oromoo-speaking patients in public hospitals in Addis Ababa.MethodsIn-depth interviews with patients (N = 27) and key informant interviews with healthcare providers (N = 9) were conducted in six public hospitals found in Addis Ababa. All the interviews were audio-taped and transcribed verbatim. A thematic analysis technique was employed to address the study objectives.ResultsThe study participants indicated the widely existing problem of language discordance between patients and healthcare providers. The impacts of language barriers on the patients include preventable medical errors, low treatment adherence, low health-seeking behavior, additional treatment cost, increased length of hospital stays, weak therapeutic relation, social desirability bias, less confidence, and dissatisfaction with the healthcare. For the healthcare providers, language barriers are affecting their ability to take patient history, perform diagnoses and provide treatment, and have also increased their work burden. The use of ad hoc interpreters sourced from bilingual/multilingual patients, patient attendants, volunteer healthcare providers, and other casual people has been reported to deal with the problem of language barriers.ConclusionA significant number of Afaan Oromoo-speaking patients are facing language barriers in accessing quality healthcare in public hospitals in Addis Ababa, and this constitutes structural violence. As a way out, making Afaan Oromoo an additional working language of the public hospitals in Addis Ababa, the assignment of professional interpreters, and a hiring system that promotes the recruitment of qualified multi-lingual healthcare providers are suggested.

Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health

BackgroundCardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC.MethodsThis study was a secondary analysis using data from the World Health Organization’s Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients’ choice of USC.ResultsMost of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living.ConclusionsWhilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.

Identity Constructions of Healthcare Middle-Managers: Exploring the Two Faces of Janus

Based on an interpretive research design, this study responds to the need to understand the complexity of middle-managers organizational life in public healthcare. Middle managers are crucial to supporting the effective and efficient delivery of healthcare services. However, we know little about how they experience and respond to their managerial function, operating at the junction of top-down and bottom-up predicaments and the double professional and managerial role. Based upon interviews with heads of medical units, nurses and administrative staff in public healthcare hospitals, and the observation of managerial actions and interactions, we explored how heads of medical units define their work identities. Four middle manager configurations were found: puppet, foreman, integrator and process promoter. The influence of each configuration on interpersonal relationships and decision making is examined. The research results invite the reader to take a closer look at the two faces of middle managers in healthcare organizations, and how they identify their role and deal with organizational complexity.

Under-nutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, southern Ethiopia: A cross-sectional study

BackgroundBalanced and adequate nutritious food during pregnancy helps to improve maternal weight and for the healthy growth of the fetus. There has been little progress in reducing pregnant undernutrition in Ethiopia; it has been too slow. ObjectiveThe objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, Southern Ethiopia. MethodA cross-sectional study design was used in public hospitals of Gedeo Zone, Southern Ethiopia from February 01 to March 01, 2019. Pretested structure questionnaire was used to collect data on the socio-economic and demographic characteristics of the study participants. Epi-data was used to code and enter the data and SPSS-25 was used to analyse and interpret the data. To assess the relationship between the dependent and the independent variables, bi-variable and multivariable logistic regression analysis was done. ResultsIn this study, the prevalence of undernutrition among pregnant women was 21% (95% CI: 20.8–21.2). After controlling other co-variables, the multivariable logistic regression model revealed that average monthly income, women's educational status, nutrition education and counseling, and parity were found to have a significant association with pregnant women's nutritional status. The odds of under-nutrition among pregnant women whose monthly income is <800 ETB were 2.8 times higher than those whose monthly incomes were >1500 (AOR: 2.89; 95%CI: 1.49–5.6). ConclusionIn this study the magnitude of undernutrition among pregnant women was found to be higher than the previously reported findings. Average household monthly income, family size, mother's educational status, nutrition education and counseling, current health condition of the mother, and parity were factors significantly associated with undernutrition of pregnant mothers. Therefore, Interventions should be initiated in earlier stages of pregnancy to prevent the high level of undernutrition during the second and third trimester in this study area.

Under-Nutrition and Associated Factors Among Pregnant Women in Public Health Care Hospitals of Gedeo Zone, SNNPR, Ethiopia: A Cross-Sectional Study

Background: Balanced and Adequate nutritious food during pregnancy helps to improve maternal weight and for the healthy growth of the fetus. There has been little progress in reducing pregnant under nutrition in Ethiopia; it has been too slow. Objective: The objective of this study was to assess the prevalence of under-nutrition and determinants amongst pregnant mothers in public health care hospitals of Gedeo Zone, SNNPR, Ethiopia, from Feb, 1 to March, 1- 2019. Method: A cross-sectional study design was used in public hospitals of Gedeo Zone. Pretested structure questionnaire was used to collect data on socio-economic and demographic characteristics of the study participant, while a height measuring board and a digital bath balance were used to collect anthropometric measurements such as MUAC, height, and weight. Epi-data was used to code and enter the data into a computer, and SPSS-25 was used to analyse and interpret the data. To evaluate the relationship between the dependent variable and the independent variables, univariable and multivariable logistic regression analysis was done. Results: In this study, the proportion of pregnant women who were undernourished was 21% (95%CI: 20.8–21.2).After controlling other co-variables, average monthly income, women's educational status, nutrition education and counselling, and parity were found to have a significant relationship with pregnant mothers' nutritional status in multivariable logistic regression analysis. Conclusion: The magnitude of under nutrition in pregnant women in this study was found to be very high; average household monthly income, family size, mother’s educational status, nutrition education and counselling, current health condition of the mother and parity were factors significantly associated with malnourished pregnant mothers. Funding Information: The study was funded by Dilla University, Ethiopia. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was reviewed and approved by the Institutional Review Board (IRB) of Dilla University College of Medicine and Health Science. The study purpose, procedures, possible risks, and benefits were explained to participants in local languages. Informed written consent was obtained and signed.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.

Impact Assessment of RAMed Medical Health Insurance on Access to Healthcare Using Instrumental TechniqueImpact Assessment of RAMed Medical Health Insurance on Access to Healthcare Using Instrumental Approach

The generalization of the RAMed social project on 2012 is one of the key achievements that reflects the commitment of the Moroccan State to strengthen social cohesion and the fight against vulnerability. This article proposes to study the issue of the accessibility of RAMed’s to Basic Health care in Morocco and in particular, to examine, empirically, the causal effect of the coverage by health care. RAMed health insurance on access to health care in public hospitals. In this respect and throughout this research paper, we will try to highlight the barriers limiting the accessibility of these to appropriate health care structures, particularly those of a geographical, socio-economic, socio-demographic and cultural nature. The quantitative analysis conducted in this manuscript highlights a differential care recourse between people covered by basic medical coverage and those not covered by any type of medical insurance. In detail, and taking into account social and economic variables, the use of care varies greatly depending on the coverage scheme. Indeed, members of RAMed (all types) and their descendants are those who consult medicine more than the uncovered. Thus, from the results obtained in this investigation, it is possible to identify two main lessons from which it is conceivable to sketch avenues for government action. Hence, thanks to the extension of RAMed sanitary coverage, the population has been able to access medical care, especially for the poorer classes. The promotion of health culture through awareness campaigns remain a great challenge for public action.

Compliance Rate of Surgical Antimicrobial Prophylaxis and its Association with Knowledge of Guidelines Among Surgical Residents in a Tertiary Care Public Hospital of a Developing Country.

IntroductionSurgical antimicrobial prophylaxis (SAP) means the administration of antibiotics in surgical practice, and it reduces the likelihood of surgical site infections (SSIs). Inappropriate SAP practice regarding the prescription, timing, and duration of antibiotic use prolongs the hospital stay of patients, increases patient morbidity (by exposing them to the adverse effects of antibiotics), promotes bacterial resistance, and puts an economic burden on health care.While developed countries regularly monitor and revise their SAP protocols, there are only a few such researches in developing countries, which is a major setback to proper surgical care.Objectives of the studyThis study aims to compare the practice of SAP in a tertiary health care hospital of a developing country Pakistan, with internationally recommended protocols and evaluate the impact of knowledge of international guidelines on SAP practice. The results of the study will highlight important shortcomings in prophylactic practice in the hospital and help develop recommendations to improve SAP practice and ensure better surgical care for patients.Materials and methodsAn observational, cross-sectional study was conducted in the general surgery unit of Holy Family Hospital (HFH), Rawalpindi, Pakistan, from March 2017 to November 2017 during which antimicrobial prophylaxis of 150 general surgery procedures was documented on the basis of six international SAP criteria, which were “indication for use of prophylaxis, timing of preoperative dose, choice of drug, route of administration, duration of postoperative prophylaxis, and the assessment of beta-lactam allergy.” The compliance rate (number of procedures following all the six criteria) was calculated for each operating surgical resident.A questionnaire was formulated that assessed the knowledge of 33 surgical residents working at that time regarding the above- mentioned six variables of SAP by six close-ended questions. Their responses were then compared to their compliance rate by chi-square analysis and binary logistic regression in SPSS version 23 (IBM Corp, Armonk, NY, US). A p-value of less than or equal to 0.05 was considered significant.The required ethical approval was obtained from the departmental heads as well as institutional research forum.ResultsSeventy-four of 150 observed procedures followed all the six international criteria of SAP, giving a compliance rate of 49.33%. Seventeen out of 33 (51%) surgical residents were aware of the guidelines. A chi-square analysis revealed a highly significant association between the awareness of guidelines and the number of compliant procedures performed by a resident (p<0.000). Forty-five out of 74 compliant procedures were performed by residents who were aware of the guidelines (61% of compliant procedures). The odds ratio for awareness and correct prophylaxis was 4.064 (p<0.000).ConclusionsThe study indicates an overall low compliance rate of 49.33% regarding surgical antimicrobial prophylaxis (SAP) practice in a public health care hospital of a developing country. The most common cause of non-compliance was prolonged postoperative prophylaxis. This study also shows that the knowledge of international guidelines significantly improves the prophylaxis practice by about four times. Hence, proper SAP compliance rate can be increased by actively educating and monitoring surgical residents.

Gestão Hospitalar em Portugal: Resultados Comparados entre Hospitais com Gestão Pública e em Parceria Público-Privadas

Em um mundo globalizado e em crescente competitividade, os hospitais têm que encontrar formas de melhorar continuamente em todos os setores: público, privado e social. Em Portugal, a prestação de cuidados de saúde nos hospitais públicos é globalmente realizada sob o regime jurídico de Entidade Pública Empresarial (hospital EPE) e em regime de Parceria Público-Privada (hospital PPP). O papel e a importância da inovação, em todos os processos, são reconhecidos internacionalmente como um dos principais motores do desenvolvimento e da sustentabilidade em várias áreas de atividade. O presente artigo trata de um estudo de caso que descreve os processos de inovação aplicados à gestão dos hospitais do setor público português e estabelece-se uma comparação entre os principais indicadores de acesso e qualidade entre os hospitais de gestão pública empresarial e os hospitais públicos com gestão em parceria com um parceiro privado, entre os anos 2013 e 2016. Como resultado da análise, verifica-se que a inovação já influenciou positivamente as organizações tanto no modelo EPE como no PPP, tornando-as mais competitivas. No entanto, ambos os modelos apresentam pontos fortes e fracos e por esse motivo ainda é necessário repensar os modelos para melhorar os seus resultados de acesso e qualidade.

Corruption Impede Access to Public Health Services in Benin

Health care is one of the indispensable factors contributing to the improvement of productivity and the welfare of human capital. Indeed, most developed countries focus on improving the health status of populations. Despite significant improvements in the health status of human capital, there are disparities in equal access to health care. This finding is fundamentally linked to the structuring, organization and functioning of public hospitals in developing countries. The purpose of this article is to analyze the effect of corruption behavior on access to health care in public hospitals in Benin. The methodological approach adopted in this work explains the probability, for a user in contact with the health services of public hospitals, of developing corrupt behaviors [1, 2]. The estimation of selection model, based on survey data from users of public hospitals in Benin, shows that corruption behavior facilitates access to health care for applicant. But taking collectively, they slow down the normal functioning of health care services, create a congestion effect and increase the vulnerability of users of public health hospitals. In addition, the estimation results reveal a negative and significant effect between drug diversion and corrupt behavior on the one hand and the fact of not having social security coverage decreases the probability of developing corruption behaviors other. The study recommends, on the one hand, the establishment of surveillance mechanisms for public hospital actors and, on the other hand, an increase in penalties for corrupt behavior.

Recognition and role of public health care in public hospitals staffs : Analysis of consensus conference by regions

Recognition and role of public health care in public hospitals staffs : Analysis of consensus conference by regions

Work engagement in public hospitals: a social exchange approach

We develop and test a model that envisages work engagement in public services as determined by interactions with supervisor and co-workers. Specifically, we apply the framework of Social Exchange Theory to explore the impact of Leader–Member exchange (LMX) and Team–Member exchange (TMX) on Work Engagement in the provision of health care in public hospitals. Our investigation suggests that both LMX and TMX represent significant factors associated with work engagement among the hospital medical staff.

The comparison of hospitals' performance indicators before and after the Iran's hospital care transformations plan.

INTRODUCTION:Hospital care transformation plan (HCTP) was implemented, in 2014, with the aim of ensuring all Iranians have fair access to hospital care, mainly in the public sector. It was assumed that HCTP would lead to increased quality and effectiveness of health care in public hospitals. To explore whether HCTP has achieved its aim, this study has investigated the impact of this plan on performance indicators (PIs) of the public hospitals.MATERIALS AND METHODS:This cross-sectional descriptive study was conducted in 2016. The study population included all hospitals in the Isfahan City. Data (10 selected PIs) were collected through formal reports which were available at the Isfahan University of Medical Sciences and analyzed using Statistical Package for Social Sciences (version 17). The statistical significant level analysis was 0.05.RESULTS:After HCTP, it was shown an increase of (1) Bed occupancy, bed turnover, occupied bed-days, inpatients visits, and number of surgeries in all types of hospitals, (2) Outpatients’ visits in all hospitals except private ones, (3) Emergency visits in public and social security hospitals, and (4) Natural deliveries in public and semi-public hospitals. Furthermore, the average length of stay and hospital mortality rate has decreased in all types of hospitals after HCTP implementation.DISCUSSION AND CONCLUSION:Although, improving PIs of hospitals were not directly stated and known objectives of HCTP implementation, it seems HCTP could improve the performance of all hospitals, including involved and noninvolved ones.

FACTOR ANALYSIS OF HEALTHCARE SERVICE QUALITY IN MEDAN�S GOVERNMENT HOSPITAL

Ponte Academic JournalOct 2016, Volume 72, Issue 10 FACTOR ANALYSIS OF HEALTHCARE SERVICE QUALITY IN MEDAN�S GOVERNMENT HOSPITALAuthor(s): Prihatin Lumbanraja ,Arlina Nurbaity Lubis, Rodiah Rahmawaty Lubis, Beby Kendida HasibuanJ. Ponte - Oct 2016 - Volume 72 - Issue 10 doi: 10.21506/j.ponte.2016.10.11 Abstract:Service sector increases rapidly especially in Indonesia. This can be seen from the distribution of the percentage of Product Domestic Bruto (PDB) based on job vacancy showing that the service sector contribution approaches 50%. One of the service/care industries with rapid growth is healthcare service. It can be seen from the government plan year 2015-2016 to do healthcare reinforcement. Generally, healthcare is identically related to hospital. A hospital is a professional healthcare institution in which its service is provided by doctors, nurses, and other healthcare providers. Among the numerous competitions of hospital industries until now, there are still many people who choose to go overseas to get medication; this is related to the point of view that the quality of the domestic medical service is worse than what is provided in Singapore or Malaysia. This is indicated by the more sophisticated medical equipment and clearer operational procedure standard, so that the diagnosis can be faster and more accurate. It is estimated that each year there are �600.000 Indonesian people go to Malaysia and Singapore to get check-ups and �100.000 of them are from North Sumatera (Malaysia Tourism Board Medan, 2005). This research aims at identifying and analyzing the factors that influence the quality of healthcare in public hospitals in the town. This research employs the method of descriptive quantitative approach. The steps of the activities that will be conducted are 1. Identifying various indicators and dimensions of the quality of healthcare in the hospital using survey method and literature review. 2. Evaluating the indicators and dimensions using factor analysis. This factor analysis shows 12 factors forming that can explain 77.98% of the data variance. The twelve factors are factor 1 patient educational services, factor 2 staff professionalism, factor 3 food aspect, factor 4 assurance, factor 5 responsiveness and convenience services, factor 6 empathy, factor 7 cleanliness, factor 8 well educated staff, factor 9 patient trust, factor 10 reliability, factor 11 Parking area, factor 12 Patient privacy. However, the 11th and 12th factors cannot be stated as factors because they only cover less than three indicators, so that the service quality forming consists of ten factors only. Download full text:Check if you have access through your login credentials or your institution Username Password

The current status of continuous subcutaneous insulin infusion and continuous glucose monitoring systems in the Community of Madrid

Abstract Objective To analyze the available information about continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems in the public health care system of the Community of Madrid. Material and methods A survey consisting of 31 items was sent to the 28 endocrinology department of the Madrid public hospitals. Items focused on CSII and CGM and included patients’ registrations, as well as data regarding healthcare, administrative, and logistic aspects. Responses from a total of 20 hospitals where these procedures are used were received from March 2013 to May 2014. Data about pediatric patients were obtained from adult endocrinology departments, except for two hospitals which directly reported the information. Results A total of 1256 CSII pumps were recorded in the Madrid region, of which 1089 were used by adults, and the remaining 167 by pediatric patients. During 2013, 151 new CSII systems were implanted (12% of the total), while 14 pumps were withdrawn. Availability of human resources (medical assistance) and the number of staff practitioners experienced in management of these systems widely varied between hospitals. Eighty-five percent of hospitals used retrospective CGM systems, and 40% routinely placed them before starting an insulin pump. Thirteen hospitals (65%) used long-term, real-time CGM systems in selected cases (a total of 67 patients). Conclusions Use of these technologies in diabetes is unequal between public health care hospitals in Madrid, and is still significantly lower as compared to other countries with similar incomes. However, there appears to be a trend to an increase in their use.

Estado actual de los sistemas de infusión subcutánea continua de insulina y monitorización continua de glucosa en la Comunidad de Madrid

ObjectiveTo analyze the available information about continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems in the public health care system of the Community of Madrid. Material and methodsA survey consisting of 31 items was sent to the 28 endocrinology department of the Madrid public hospitals. Items focused on CSII and CGM and included patients’ registrations, as well as data regarding healthcare, administrative, and logistic aspects. Responses from a total of 20 hospitals where these procedures are used were received from March 2013 to May 2014. Data about pediatric patients were obtained from adult endocrinology departments, except for two hospitals which directly reported the information. ResultsA total of 1256 CSII pumps were recorded in the Madrid region, of which 1089 were used by adults, and the remaining 167 by pediatric patients. During 2013, 151 new CSII systems were implanted (12% of the total), while 14 pumps were withdrawn. Availability of human resources (medical assistance) and the number of staff practitioners experienced in management of these systems widely varied between hospitals. Eighty-five percent of hospitals used retrospective CGM systems, and 40% routinely placed them before starting an insulin pump. Thirteen hospitals (65%) used long-term, real-time CGM systems in selected cases (a total of 67 patients). ConclusionsUse of these technologies in diabetes is unequal between public health care hospitals in Madrid, and is still significantly lower as compared to other countries with similar incomes. However, there appears to be a trend to an increase in their use.

Overall Management, Outcomes and Costs on a 4-Year Period of 21,757 Acute Leukemia (AL) Patients in France. Data Report from the National Health Registry

The aim of this study is to evaluate the management outcomes and hospital costs of acute leukemia (AL) patients over a 4-year period in France using the national Program for a Medicalised Information System (PMSI) database, which records all hospitalisations in the country.We identified patients with AL or another underlying hematologic malignancy prone to transform into AL (e.g. myelodysplastic syndromes) at diagnosis and hospitalized between 2006 and 2012 and retained only incident patients. We used a retrospective cohort approach, with a 5-year follow-up time from index date (i.e. 2008 to 2012), with an additional focus on the autologous and allogeneic stem cell transplanted (SCT) patient populations during the year 2012. Hospital costs calculations were based on the national scale of costs.A total of 21,757 patients were included with 5,655 acute lymphoblastic leukemias (ALL) (26%) and 16,102 acute myelogenous leukemias (AML) at an incidence rate of 4,300 newly diagnosed AL/year. 54.7% were males (57.6% for ALL and 53.7 for AML) with a median age of 18 years (range 0-100, peak between 0-10 years) for ALL and 71 years (range 0-104, peak between 71-80 years) for AML. In 96.7% of the cases patients were hospitalized in a public healthcare hospital. The median duration of the first hospitalization was 7 days (quartiles: 1-29), with an overall death rate during this first hospitalization of 10.5% (4.4% for ALL and 12.6% for AML). Fifty-nine percent of the patients received chemotherapy, (77% for ALL, and 52% for AML); 3,079 (14%) of patients received an autologous or allogeneic stem cell transplantation (SCT) [883 in ALL patients, 2,196 in AML patients]. Among SCT patients, 2,732 (89%) had an allogeneic SCT [774 in ALL patients and 1,958 in AML patients]. Over the 2,732 allogeneic SCT group, 1,243 (45%) suffered from an acute GVHD (55% of ALL patients and 42% of AML patients), and 21% from chronic GVHD (25% of ALL patients and 20% of AML patients).Post SCT transplant survival rates for AML and ALL were 83% and 86% at one year and 55% and 58% at 4 years. Without SCT transplant, survival rates were 40% and 77% at one year and 24% and 70% at 4 years for AML and ALL respectively. The overall survival rates were significantly improved with transplant for AML patients but not for ALL patients at 4 years (see figure 1). [Display omitted] Cost analyses showed an overall median hospitalization cost the first year after diagnosis of 44,453 € for AL (72,360 € for ALL, and 40,477 € for AML), the second year after diagnosis the median overall hospitalization cost for AL was reduced to 2,185 € (6,212 € for ALL and 904 € for AML). The median hospitalization costs of the stay for SCT were 42 068€ for ALL and also 42 068€ for ALM patients, while the cost of allogenic vs. autologous patients was nearly three times higher.In conclusion, this study in an extremely large national cohort illustrates the current characteristics of the care of acute leukemia patients in our country and provides significant information on the economic impact of the hospital care as well as the additional cost of stem cell transplant. DisclosuresNicolini:Novartis: Consultancy. Laurendeau:CEMKA: Employment. Bureau:CEMKA: Employment. Ricci:Wellmera: Employment. Gerbeau:Novartis: Employment. Bouee:CEMKA: Employment.

'Your health our concern, our health whose concern?': perceptions of injustice in organizational relationships and processes and frontline health worker motivation in Ghana.

Taking a perspective of frontline health workers as internal clients within health systems, this study explored how perceived injustice in policy and organizational matters influence frontline health worker motivation and the consequent effect on workers’ attitudes and performance in delivering maternal and neonatal health care in public hospitals. It consisted of an ethnographic study in two public hospitals in Southern Ghana. Participant observation, conversation and in-depth interviews were conducted over a 16-month period. Ethical approval and consent were obtained from relevant persons and authorities. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Findings showed that most workers perceived injustice in distributive, procedural and interactional dimensions at various levels in the health system. At the national policy level this included poor conditions of service. At the hospital level, it included perceived inequity in distribution of incentives, lack of protection and respect for workers. These influenced frontline worker motivation negatively and sometimes led to poor response to client needs. However, intrinsically motivated workers overcame these challenges and responded positively to clients’ health care needs. It is important to recognize and conceptualize frontline workers in health systems as internal clients of the facilities and organizations within which they work. Their quality needs must be adequately met if they are to be highly motivated and supported to provide quality and responsive care to their clients. Meeting these quality needs of internal clients and creating a sense of fairness in governance arrangements between frontline workers, facilities and health system managers is crucial. Consequently, intervention measures such as creating more open door policies, involving frontline workers in decision making, recognizing their needs and challenges and working together to address them are critical.