Hospital Care Providers Research Articles

Regionalized networks and guarantee of specialized health care: the experience of Ceará, Brazil.

This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.

Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia

BackgroundPoor hand hygiene compliance is one in all the leading contributory factors to healthcare-associated infections. This is an important source of complications across the continuum of care and poses a serious threat to people admitted to hospitals. However, the magnitude and associated factors of hand hygiene compliance in public primary hospitals were not well investigated in Ethiopia. Therefore, this study was conducted to assess hand hygiene compliance and associated factors among health care providers in Central Gondar Zone public primary hospitals, Northwest Ethiopia.MethodsAn Institutional based cross-sectional study was conducted from March to April 2019 among health care providers. The data were collected using self-administered questionnaires and observational checklists. Using Epi Info 3.1, data was entered and analyzed using SPSS version 23. The data were analyzed using descriptive statistics and logistic regression models. A p-value less than 0.05 with 95% confidence interval was used to declare statistical significance.ResultsOf 335 study participants, 50 (14.9%), had good hand hygiene compliance. Training on hand hygiene (AOR = 8.07, 95%CI: 2.91, 22.39), availability of adequate soap and water for hand hygiene (AOR = 5.10, 95%CI: 1.93, 13.52), availability of alcohol-based hand rub (AOR = 3.23, 95%CI: 1.32, 7.92), knowledge about hand hygiene (AOR = 6.74, 95%CI: 2.96, 15.34) and attitude towards hand hygiene (AOR = 2.15, 95%CI: 1.04, 4.46) were factors associated with hand hygiene compliance.ConclusionThe overall level of hand hygiene compliance among health care providers was poor. Training, availability of adequate soap and water, availability of alcohol-based hand rub, knowledge on hand hygiene, and attitude of health care providers were significantly associated with hand hygiene compliance.

Processo di decentramento del SSN ed evoluzione dell'equità interregionale nell'assistenza sanitaria nel periodo 2001-2012

The policies pursued both at the international and national levels have brought to the fore the concept of governance decentralization of health-care systems. In Italy, in particular, with the approval of legislative decree n. 56/2000 on fiscal federalism and the amendments to Title V of the Constitution (Const. Law n. 3/2001), the Regions have obtained wider political, administrative, organizational and management competencies also in health care. At the international level, several studies have examined the issue of equity in a decentralized health-care system. In the Italian context, this also involves the provision of essential levels of health (LEAs) across Regions. Equity is a constitutional principle, pursued by the central level and monitored through the set of indicators of the LEA Grid (Griglia LEA). Starting from the LEA Grid indicators, through a multidimensional analysis by principal components, the study analyzes the evolution of inter-regional equity in the provision of health (prevention, care, care) between 2001 and 2012, when the process of health-care decentralization became more established. In line with the international literature, this analysis shows a significant inter-regional heterogeneity. In particular, it highlights: 1) an interregional differentiation with respect to the principal components defined vaccination coverage, hospital performance and outpatient for the disabled; 2) a persistent differentiation in hospital care between central-northern and southern regions; 3) a negative trend for the autonomous regions and provinces both in the provision of hospital care and vaccination coverage. The results of the study, innovative for equity dimensions explored and data available, justify the central government’s intervention as guarantor of territorial equity with respect to the provision of health care.

Practice and factors associated with active management of third stage of labor among obstetric care providers in Amhara region referral hospitals, North Ethiopia, 2018: A cross sectional study.

Active management of third stage of labor is the most indispensable intervention to avert post-partum hemorrhage which is one of the typical causes of maternal morbidity and mortality. Therefore, the aim of the study was to assess practice and factors associated with active management of third stage of labor among obstetric care providers in referral hospitals. Institution based cross-sectional study design was conducted from April 1-30, 2018. Simple random sampling technique was used to select a total of 356 obstetric care providers. Data were collected using pretested, structured and self-administered questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 23 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P value <0.05 with 95% confidence level were used to declare statistical significance. This study revealed that practice of active management of third stage of labor was 61.2%. Age group of 20-30 years [AOR = 1.95 (95%CI;1.13-3.38)], Being male obstetric care provider [AOR = 1.74 (95%CI;1.03-2.94)], having work experience ≥2 years [AOR = 1.95(95%CI;1.13-3.38)], availability of oxytocin [AOR = 5.46 (95%CI; 2.41-12.3)], having exposure to manage third stage of labor [AOR = 2.91(95%CI; 1.55-5.48)], and having good knowledge [AOR = 2.67 (95%CI; 1.46-4.90)], were the factors associated with practice. This study showed that practice of active management of third stage of labor was high. Age group between 20-30 years, being a male obstetric care provider, having ≥2years work experience, availability of oxytocin, exposure to third stage management and having good knowledge were factors associated with practice. Therefore, all referral hospitals and concerned bodies need efforts to focus on providing training to increase health care provider's knowledge so as to sustain good practice through appropriate interventions.

CN21 - Development of core indicators of non-specialist palliative care in hospitals: An international modified Delphi study

BackgroundHealthcare providers working in acute care hospitals have significant exposure to cancer patients with palliative care needs, and for the majority of patients these reflect non-specialist rather than specialist palliative care needs. Embedding non-specialist palliative care in acute hospital-based care is challenging. The aim of this paper is to present a core set of indicators for the provision of non-specialist palliative care in hospitals which was determined using a Delphi consensus process. MethodsPreliminary indicators derived from a concept analysis and systematic review were subjected to a three round modified Delphi study, whereby a multidisciplinary expert panel of key stakeholders appraised (rated) each preliminary indicator on its ‘importance’ to non-specialist palliative care provision in hospitals. Stakeholders were also offered an opportunity to add ‘new’ indicators as they considered relevant. Consensus was defined whereby 70%, or more, of the participants across stakeholder groups agreed that an indicator was ‘core’ to non-specialist palliative care provision in the hospital setting. ResultsA total of 92 experts (74% response rate) representing the views of patients, clinicians and researchers, from twelve countries participated in the final round. This study resulted in 32 core indicators of hospital based non-specialist palliative care, categorised into 5 structural indicators (relating to infrastructure and governance), 21 organisational indicators (relating to clinical care processes) and 6 staff indicators (relating to training and support for healthcare providers). ConclusionsThis study presents the first guidance for clinical practice, policy and research related to non-specialist palliative care provision in hospitals, based on evidence and International consensus from all key stakeholder groups. These indicators provide a means to assess, review, and communicate the core elements of non-specialist palliative care in hospitals, thereby setting a benchmark for changes in policy and practice. Legal entity responsible for the studyThe authors. FundingHealth Research Board. DisclosureAll authors have declared no conflicts of interest.

MANAGEMENT OF NON-COMMUNICABLE DISEASE PREVENTION AT DISTRICT LEVEL IN MALAYSIA

Background: The Non –Communicable Disease (NCD) unit in Malaysia has had much focus in recent years as its country undergoes a major epidemiologic transition with the rise in the four largest contributors of NCD deaths namely cardiovascular disease, cancer, diabetes and chronic respiratory disease. In line with reducing the burden of NCD both for the patient and healthcare, the district health office plays a vital role in managing disease prevention through adequate planning, focusing on the implementation of primary, secondary and tertiary prevention and monitoring the health of the population. Materials and Methods: A literature review was conducted through online database search such as Google Scholar and PubMed to identify articles that were related to the current management of non-communicable disease prevention. Initial keywords used were district health management, non-communicable disease, prevention and Malaysia. The reference list was also reviewed for related articles including some that were handpicked. Result: Healthcare system in Malaysia is performed as a top down exercise whereby most of the national planning is conducted at federal level by the Ministry of Health. However, at the ground level, the district health office needs to conduct situational analysis to identify the needs and challenges of the local community within their jurisdiction. The management of NCD prevention is focusing on the implementation of actions through primary, secondary and tertiary prevention levels that fall within the role of health professionals and health care providers in primary care, hospitals and community services environment. Conclusion: Community empowerment and health education are important components in primary prevention of NCD. Early diagnosis and prompt treatment for NCD provided at the district level will stop the progression of the disease, leading to a better prognosis. Tertiary prevention in the form of rehabilitation at district level reduces and limits the disability and impairment related to NCD. Keywords: Non-communicable disease, prevention, district level, NCD program, community empowerment

Implementation of new guidelines in the prehospital services: a nationwide survey of Norway

BackgroundA debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process.MethodAn electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline.ResultsIn all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents.ConclusionAlthough the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline.

Associations of understaffing and cardiovascular health of hospital care providers: A multi-source study

BackgroundUnderstaffing in hospitals is a serious problem in healthcare work since it jeopardizes efficiency, reliability and quality of care as well as the work life of the healthcare professionals. However, estimates on the associations of understaffing and cardiovascular health in healthcare professionals are lacking. Further shortcomings refer to the problem, that determinant and outcome measures are often assessed via self-reports what increases the risk of spurious estimates due to common source bias. ObjectiveWe sought to reliably identify associations between understaffing and cardiovascular health in hospital nurses. MethodsMulti-source and cross-sectional study. N = 273 nurses of a large academic hospital were surveyed. All filled out a standardized questionnaire to report psychosocial work conditions and underwent a standardized medical examination. Cardiovascular health outcomes were blood pressure and blood cholesterol (total cholesterol level, LDL-cholesterol) as well as the SCORE classification. Logistic regression analyses were applied to calculate risk estimates for the understaffing and cardiovascular health relationship, adjusted for individual and life-style factors (e.g., sex, age, BMI, alcohol consumption, smoking) and work related characteristics (i.e., shift work, leadership position, work load, autonomy, social support at work). ResultsMultivariate associations revealed significant relationships of perceived understaffing with increased blood pressure [OR = 1.60, 95% CI: 1.05, 2.43] and increased total cholesterol [OR = 1.42, 95 CI: 1.04, 1.95]. LDL cholesterol level was associated with understaffing. We furthermore observed associations of high autonomy and high cholesterol levels. ConclusionsNurses in hospital units with lower staffing ratios had an increased risk for adverse cardiovascular health, irrespective of workload and social support. We discuss implications for future research on potential mechanisms of understaffing and nurses’ health outcomes. The associated risks of poor nurse-patient-ratios for provider health need to be addressed through work and organizational design efforts.

Current realities versus theoretical optima: quantifying efficiency and sociospatial equity of travel time to hospitals in low-income and middle-income countries

BackgroundHaving hospitals located in urban areas where people, resources and wealth concentrate is efficient, but leaves long travel times for the rural and often poorer population and goes against the...

Compression shorts reduce prenatal pelvic and low back pain: a prospective quasi-experimental controlled study.

BackgroundCommon prenatal ailments negatively impact performance of activities of daily living and it has been proposed that the use of dynamic elastomeric fabric orthoses, more commonly referred to as compression garments, during pregnancy might aid in the reduction of pain from these ailments, allowing for improved functional capacity. However, the effectiveness of such garments in this context has not been established. This study aims to determine whether compression shorts are effective and thermally safe in the prevention and management of prenatal pelvic and low back pain (LBP).MethodA prospective quasi-experimental controlled study using parallel groups without random allocation was conducted, involving 55 childbearing women (gestational weeks 16–31) recruited from hospital and community-based maternity care providers. The compression shorts group (SG) wore SRC Pregnancy Shorts in addition to receiving usual care. The comparison group (CG) received usual care alone. Primary outcome measures—Numeric Pain Rating Scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ) and secondary measures Pelvic Floor Impact Questionnaire - 7 (PFIQ-7) and SF-36 Short Form Health Survey—were assessed fortnightly over 6-weeks for both groups. The compression SG self-assessed daily their body temperatures to monitor thermal impact. Data analysis involved descriptive analyses of the primary and secondary outcome measures scores by group and time-point, and multivariable linear regressions to assess between-group differences in change scores at 6-weeks from baseline while controlling for baseline factors.ResultsAfter controlling for baseline scores, gestational weeks and parity, statistically significant differences in NPRS and RMDQ change scores between groups were in favour of the compression SG. At 6-weeks, mean (SD) NPRS change scores in the compression SG and CG were significantly different, at −0.38 (2.21) and 2.82 (2.68), respectively, p = 0.003. Mean (SD) RMDQ change scores in the compression SG and CG were also significantly different, at 0.46 (3.05) and 3.64 (3.32), respectively, p = 0.009. A total of 883 (99.7%) of the reported daily self-assessed body temperatures ranged between 35.4 and 38.0 °C when wearing the compression shorts. At 6-weeks, mean (SD) PFIQ-7 and SF-36 change scores in the compression SG and CG were not significantly different.ConclusionCompression shorts are effective and thermally safe for prenatal management of pelvic and LBP.RegistrationTrial registration was not required (Australian Government Department of Health Therapeutic Goods Administration (TGA), 2018).

The Effect of the E-Patuh Application on HIV/Aids Patients’ Adherence in Consuming Antiretroviral

Medication adherence is behavior that refers to client obeys in following a medication, and makes lifestyle changes in accordance of recommendations from health care providers. Antiretroviral adherence is paramount for HIV/AIDS patients. The effects were often a problem in antiretroviral treatment and toxicity and often be the reason for replacing or stopping antiretroviral treatment. This study aimed to determine the “E-Patuh” Applications effect on antiretroviral adherence in patients Of HIV/AIDS In West Java. The research design was a quasi-experimental with nonequivalent control group design. The location of this research was in RSUD Kota Bandung and in RSUD Kota Banjar. The respondents was selected without randomization and used purposive sampling technique. Respondents in this study were 30 respondents. Data were obtained using self-report questionnaires. The intervention group was monitored a 30-day android-based E-Patuh application and monitored on an E-Patuh website and then measured adherence value with self-report. Data were analyzed using SPSS 22 with chi-square test. The results showed a significant difference between adherence value before and after application of E-Patuh in the intervention group with (p &lt;0.05) with obtained p value = 0,006. The results of this study prove a positive effect on the using of E-Patuh applications against ARV medication adherence in the intervention group with the support system of the E-Patuh application. The used of E-Patuh is helpful in improving ARV adherence in HIV/AIDS patients. The features contained in E-Patuh were directly reminiscent of the timing of taking medication for PWLH. E-Patuh should be consideration for PLHIV and health care providers in hospitals to improve ARV adherence to reduce mortality rates in people living with HIV.

Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden.

IntroductionPhysical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.MethodsFrail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.ResultsThis study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p>0.001) and HRHS 2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).ConclusionIn frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

Impact of short basic emergency medicine training in introducing emergency medicine as a specialty in Sub-Saharan Africa: experience from Tanzania

BackgroundEmergency medicine (EM) is a new specialty in Tanzania. Little is known about how to introduce EM to health care providers (HCPs) in hospitals without EM. We determined the impact of a 2-day EM training program on the understanding, perception, and choice of EM as a career amongst HCPs at hospitals in Tanzania without EM.MethodsThis was a pre- and post-training interventional study including randomly selected HCPs from four tertiary hospitals in Tanzania without EM. Understanding, perception, and desirability of EM as a career were assessed before and after a 2-day university-accredited basic EM short-course training given by EM physicians. A paper-based Likert scale (out of 5) questionnaire was used, which were analyzed by T tests, Mann-Whitney, and Kruskal-Wallis tests.ResultsDuring the study period, 96 health care providers (100% capture) in the four tertiary hospitals participated in the study. The median age of participants was 34 years (IQR 28–43); 35 (36.0%) were males. Sixty (63%) were nurses, 26 (27%) doctors, and 3 (3%) were administrators. The four hospitals were equally represented. Median pre-training scores for all Likert questions were 3.49 (IQR 3.3–3.9); understanding 3.3 (IQR 3.0–3.7), perception 3.40 (IQR 3.1–3.7), and career decision-making 3.7 (IQR 3.3–4.0). Post-training scores improved with median scores of 4.6 (IQR 4.5–4.7) overall, 4.7 (IQR 4.0–4.7) for understanding, 4.6 (IQR 4.5–4.9) for perception, and 4.7 (IQR 4.3–4.8) for career decision-making (all p < 0.01).ConclusionA 2-day training in basic EM care had a positive impact on understanding, perception, and career decisions regarding EM amongst Tanzania HCPs that work in hospitals without EM. Follow-up to assess long-term impact, and expansion of this program, is recommended to foster EM in countries where this is a new specialty.

Evaluation of Collaborative Medication Reviews for High-Risk Older Adults

Despite the widespread use of medication reviews, many older adults are still exposed to the risks of polypharmacy. To quantify and describe the drug therapy problems identified and interventions undertaken by pharmacists before and after implementation (on July 1, 2015) of collaborative medication review for high-risk older adult patients (> 80 years of age). A retrospective single-centre pre-post cohort study was conducted between July 1, 2014, and July 31, 2016, to characterize the impact of collaborative medication reviews-consisting of a thorough medication review by a pharmacist and care conferences with the hospitalist and family physician-on prescribing patterns in an Acute Care for Elders unit. A standardized template was used to conduct medication reviews for the post-implementation group, whereas a chart review was conducted for the pre-implementation group. The primary outcomes were the number of drug therapy problems identified by the clinical pharmacists and the associated interventions by the pharmacists, which were categorized as clinical or compliance interventions. Secondary outcomes included the number of medications at discharge, the rate of hospital readmission within 30 days, and the length of hospital stay. A total of 137 patients were identified for inclusion in either the pre-implementation group (n = 70) or the post-implementation group (n = 67). After implementation of collaborative medication reviews, there were statistically significant increases in the mean number of drug therapy problems identified (p < 0.001), the mean number of interventions undertaken (p = 0.004), and the median length of hospital stay (p < 0.001). There was no difference between the 2 groups in the number of medications at discharge, the proportion of patients taking more than 5 medications at discharge, or readmission within 30 days. At the study institution, implementation of a quality improvement program that included pharmacist-led medication reviews and collaborative care conferences involving community and hospital care providers helped to improve documentation by clinical pharmacists of potential medication-related problems and led to more interventions to optimize patients' medication regimens.

Evaluation of critical care providers' knowledge in basic mechanical ventilation management: An opportunity for improvement

Objectives: This investigation aims to evaluate the knowledge of critical care providers in mechanical ventilation (MV) management and to assess the impact of a 2-day educational package on their knowledge. Materials and Methods: Eighty-nine physicians and nurses attended a 2-day educational course about basic MV management. The basic MV course was conducted in February to June 2017 at Majmaah, Hail, and Arar, Saudi Arabia. Participants were part of a pre-MV course assessment and answered 12 items on a multiple choice questionnaire. After the course, participants repeated the same test (post-MV course assessment). Participants were asked to rate their knowledge of MV management on a scale of 1-10 (before and after the basic MV course). Results: Forty critical care providers (14 physicians and 26 nurses) completed the basic MV course. The participants' clinical experience, on average (±standard deviation), was 5.96 ± 4.6 years. Clinical experience favored physicians. The pre-MV course score for all participants was 4.7 ± 2.29 out of 12, while the post-MV course score was 5.65 ± 2.47. There was a significant statistical difference between pre- and post-MV assessment scores (P = 0.03). Differences between physicians and nurses were significant, on both pre-MV course assessment (P = 0.01) and post-MV course assessment (P = 0.006). There was significant correlation between clinical experience and preassessment scores (r = 0.37; P = 0.03). Conclusion: The present investigation shows that MV management knowledge of critical care providers in hospitals located in small cities is limited. Therefore, it is advisable that critical care providers engaged in continuous professional educational activities related to MV management.

Local Health Units in Portugal: The Influence of Chronic Conditions on Inpatient Readmissions

Background: In Portugal, a public policy established the Local Health Units (LHUs), merging primary and hospital care providers. LHUs are expected to provide better continuity and coordination of care, thus decreasing the number of unplanned readmissions among those with chronic conditions. This study aims to evaluate the influence of chronic conditions on the risk of readmission at LHUs. Methods: We used inpatient care administrative databases for the years 2002–2014 (n = 1,679,634). We assessed the effects of chronic conditions on the risk of readmission with a difference-in-differences technique, comparing LHUs with a control group. Multivariate Cox regression was used to evaluate time to readmission. Results: The risk of readmission decreased in four LHUs, but significantly only in two. Individuals with more chronic conditions presented a lesser risk of read­mission at LHUs, in contrast to those in the control group. Conclusions: After adjusting for the number of chronic conditions and comorbidities, we concluded that LHUs may successfully decrease unplanned readmissions. Several challenges still have to be addressed to achieve a larger and long-lasting effect. Further investigation is needed to account for contextual and organizational effects that may explain differences across LHUs.

Returning to everyday life after discharge from a short-stay unit at the Emergency Department—a qualitative study of elderly patients’ experiences

ABSTRACT Introduction: Elderly patients often receive care and rehabilitation from different providers across healthcare settings. Collaboration between hospital and primary care providers is therefore essential to ensure that the discharge and transition of rehabilitation is coherent. However, research that focuses on elderly patients’ experiences of the discharge, and their everyday lives after, has attracted little attention. Purpose: This study explores elderly patients’ experiences of being discharged and returning to everyday lives after discharge from a short-stay unit at the Emergency Department. Methods: Eleven qualitative interviews with elderly patients were conducted two weeks after their discharge. The transcribed interviews were analysed using systematic text condensation. Results: The study identified four themes related to the participants experiences. In the participants perspective it was difficult, due to fatigue and pain, to perform daily activities after discharge. Participants who experienced not being prepared and clarified in relation to their discharge continued to have concerns for the future. They also experienced some challenges related to lack of being involved and lack of receiving the information needed. Conclusion: The findings contribute with impotant knowledge about elderly patients' experiences and concerns which should be taken into consideration in the discharge planning process .

CHILD CARE AS A DIRECTION OF THEIR SOCIO-CULTURAL MAINTENANCE IN UKRAINE (THE BEGINNING OF THE 20TH CENTURY)

The article is dedicated to the revelation of the purpose and peculiarities of childcare in Ukraine in 1900-1917. Childcare was aimed at ensuring basic protection of children and their care that is necessary for life. It was caused by low level of education and culture of children and their social insecurity. The peculiarities of realization of childcare were the following: taking measures aimed at strengthening children’s health; organization of social work with orphaned children and children deprived of parental care; satisfaction of children’s material needs. Taking measures aimed at strengthening children’s health included provision of hospital care to children, conducting medical examinations of children, examination of children’s institutions, proper arrangement of children’s institutions with educational materials and providing them with rationally constructed furniture, conducting conversations with parents, teachers and children about the necessity of healthy lifestyle, arranging school first aid kits, establishing children’s summer camps, organization of special classes for refugee children during summer holidays. Organization of social work with orphaned children and children deprived of parental care included establishment and maintenance of welfare institutions, identification of the causes of neglecting children and preventing these cases, children’s patronage (children were taken by urban and peasant families that fed and bring them up), support of activity of courts for juvenile offenders (they were in Odesa, Kharkiv and Kyiv). Satisfaction of children’s material needs included creation of free canteens, providing children’s with hot breakfast at educational institutions, rent of apartments for children, providing children with financial aid of different types.

A pilot study on the provision of tracheostomy healthcare and patient engagement in quality improvement measures: a global perspective.

Work describing patient and family outcomes after tracheostomy has indicated that patients do not feel prepared at the time of discharge. To assess healthcare professional-patient interactions in tracheostomy care and the current provision of care. A global electronic survey was disseminated via e-mail. The majority of respondents were nursing or speech and language staff, from over 10 countries. Only 23 per cent of respondents' institutions routinely offered patients the ability to meet people with a tracheostomy pre-operatively. Only 31 per cent consistently provided or co-ordinated full nursing and equipment requirements on discharge. Only half of the institutions participated in tracheostomy quality improvement initiatives; less than one-third of these involved patients. The provision of tracheostomy care in hospital and at discharge can be improved. The current practice of clinician-led audit is becoming less viable; future initiatives should focus upon patient-centred outcomes to ensure excellence in healthcare delivery.

Guiding interoperable electronic health records through patient-sharing networks

Effective sharing of clinical information between care providers is a critical component of a safe, efficient health system. National data-sharing systems may be costly, politically contentious and do not reflect local patterns of care delivery. This study examines hospital attendances in England from 2013 to 2015 to identify instances of patient sharing between hospitals. Of 19.6 million patients receiving care from 155 hospital care providers, 130 million presentations were identified. On 14.7 million occasions (12%), patients attended a different hospital to the one they attended on their previous interaction. A network of hospitals was constructed based on the frequency of patient sharing between hospitals which was partitioned using the Louvain algorithm into ten distinct data-sharing communities, improving the continuity of data sharing in such instances from 0 to 65–95%. Locally implemented data-sharing communities of hospitals may achieve effective accessibility of clinical information without a large-scale national interoperable information system.