Hospital Researchers Research Articles

Study examines psychosis risk with amphetamine prescriptions

Large doses of prescription amphetamine have been associated with a more than five‐fold increased risk of new‐onset psychosis or mania, according to Belmont, Massachusetts‐based McLean Hospital researchers of a new study published online Sept. 12 in the American Journal of Psychiatry.

Tracking climate adaptation in hospitals: An inventory of structural measures

Adaptation plays a critical role in reducing risks from climate change and the need for climate adaptation is increasingly being recognised in national policies. However, evidence of coherent action at sector level is varied and often lacking. This paper critically examines climate adaptation action taken in the health sector. This involved collecting and analysing data for an inventory of hospital-based cases, retrieved from scholarly and grey literature. This process highlighted a paucity of reporting on such interventions, which are not yet well-covered in wider efforts for sustainability or climate action reporting. We found 125 examples of implemented structural measures intended to adapt hospital facilities to respond more favourably to anticipated changes in climate. The inventory provides insight into what adaptation actions are being reported across regions around the world and the motivations behind them, which provides a basis for considering how business cases are being made for these investments.Doing so means we are able to make three contributions to the field of climate adaptation. First, our analysis of the initial data highlights nascent trends, for example, experience of a previous weather event or adherence to current building codes are the two dominant motivating factors for pursuing adaptation. Second, identifying the challenges involved in gathering and compiling adaptation data has implications for the field of climate adaptation itself, and the data needed to drive decision making and better understanding of what is happening. Notably, the evidence collected from various regions contain biases attributed to data retrievability, where North American examples are most readily available. Finally, it is anticipated that the inventory—which provides a baseline for categorising interventions in the sector—has value for generating understanding of what comprises adaptation practice, beneficial to both hospital practitioners and researchers alike.

A STAKEHOLDER-PARTNERED APPROACH TO INEQUITIES AFFECTING HOME HEALTH CARE WORKERS, OLDER ADULTS, AND CAREGIVERS

Abstract Home health aides (HHAs) provide on-site support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers. However, HHAs face structural challenges in work-related transportation. Massachusetts General Hospital (MGH) researchers partnered with community and corporate stakeholders to inform a study evaluating whether on-demand transportation for HHAs via Uber rides will: 1) Improve metrics among HHAs (total visits, total unique patients, hours/week and days/week worked, missed visit/no-show rates, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairments receiving homecare. Community partner CCHERS (Center for Community Health Education Research Services) helps residents of public/publicly-assisted housing in high-need areas of Greater Boston gain training and entry-level employment in healthcare as HHAs. Through its collaborations with other groups (e.g., Mothers for Justice & Equality, HomeCare Aide Council, Mass HomeCare Alliance), CCHERS identified that lack of affordable, accessible, reliable transportation was among the most-cited barriers affecting HHAs and equitable homecare delivery. Corporate partner Uber Health, through work in preliminary social-impact case studies, identified the platform’s central ride-coordination approach as preferred by Black and Hispanic women in the 18-45y age group (~80% of the local HHA workforce). MGH researchers’ study goals and metrics were informed by input of partners. With its community-engaged approach, innovative partnerships, and focus on achieving equity objectives to benefit patients and homecare workers alike, this project has potential for strong local impacts and future implications for state and/or national policies to provide high-quality, equitable homecare by directly addressing employment transportation-related barriers.

The Mapping Mechanism From the Source Domain “Electronic Devices” Onto the Target Domain “Human Being”: An Online Vietnamese Article Context

The article is a study on the appearance of the metaphor “humans are electronic devices” in online Vietnamese articles to clarify the relationship in Vietnamese people's mind map between "electronic devices" and "humans". Based on the correlation between experiences and knowledge from source domain mapping onto the target domain, this study aimed to decode the conceptual diagram, explain the mapping mechanism and the logically-organized mapping scheme of the conceptual metaphor, identify a unique cognitive style in the conceptual structure which is universally characterized by the Fourth Industrial Revolution. The research findings may be beneficial to journalism students who wish to employ conceptual metaphors in writing about physical and mental health. Additionally, hospital website builders, medical staff, doctors, researchers, biomedical therapists, and others in the medical field can use the findings as a reference to improve their skills in using conceptual metaphors in articles about health care and protection, health risk alerts, and understanding the operation mechanism of the human body as a machine. Furthermore, the research results may offer advertisers suggestions on how to use conceptual metaphors for describing health care products in a way that strongly affects consumer awareness about product values and changes their shopping behavior.

Re-envisioning community genetics: community empowerment in preventive genomics.

As genomic technologies rapidly develop, polygenic scores (PGS) are entering into a growing conversation on how to improve precision in public health and prevent chronic disease. While the integration of PGS into public health and clinical services raises potential benefits, it also introduces potential harms. In particular, there is a high level of uncertainty about how to incorporate PGS into clinical settings in a manner that is equitable, just, and aligned with the long-term goals of many healthcare systems to support person-centered and value-based care. This paper argues that any conversation about whether and how to design and implement PGS clinical services requires dynamic engagement with local communities, patients, and families. These parties often face the consequences, both positive and negative, of such uncertainties and should therefore drive clinical translation. As a collaborative effort between hospital stakeholders, community partners, and researchers, this paper describes a community-empowered co-design process for addressing uncertainty and making programmatic decisions about the implementation of PGS into clinical services. We provide a framework for others interested in designing clinical programs that are responsive to, and inclusive and respectful of, local communities.

AIMDP: An Artificial Intelligence Modern Data Platform. Use case for Spanish national health service data silo

The huge amount of data being handled today in any environment, such as energy, economics or healthcare, makes data management systems key to extracting information, analysing and creating more efficient daily processes in these environments. However, the inability of current systems to take advantage of the data generated can waste good opportunities for analysing and extracting information from the data. Modern data platforms (MDP) appear suitable for supporting management systems and are able to perform future prospective analyses. This paper presents a data platform called Artificial Intelligence Modern Data Platform (AIMDP), based on Big Data, artificial intelligence for management, and efficient data handling. The different components of AIMDP intervene in the data acquisition phase and implement algorithms capable of analysing massive data collected from heterogeneous sources. In addition, the entire platform is geared towards data management and exploitation with a layer of security and data governance that allows the integrity and privacy of the databases to be maintained. The proposed platform is designed to be used by users who are not experts in data science. To this end, it implements a user-oriented workflow that has effectively been introduced in a use case of two Spanish hospitals to extract knowledge from their historical data, which had been siloed and had never been explored by any hospital researchers or doctors.

Strategies for Reducing Induced Demand in Hospitals Affiliated with Iran University of Medical Sciences: A Qualitative Study

Background: Induced demand is a major challenge for health systems worldwide. It increases costs, especially for patients. The purpose of this study is to identify strategies for reducing induced demand for health care in hospitals affiliated with the Iran University of Medical Sciences (IUMS).
 Methods: This was a qualitative study conducted in 2018. The authors conducted in-depth, semi-structured interviews with 20 participants, including IUMS faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze data. Data analysis was performed in MAXQDA10.
 Results: Overall, the authors extracted 24 subthemes from the interviews and classified them into the health system, insurer, healthcare provider, and healthcare recipient. They are key factors regarding the induced demand for healthcare in the public hospitals under study.
 Conclusion: Reducing induced demand for healthcare requires concerted actions by health policymakers and managers at the level of the health system, insurers, healthcare providers, and healthcare recipients. Therefore, policymakers and managers of the health system should take appropriate measures such as the development of guidelines and protocols by different departments, especially the emergency department, classification (primary, secondary, and tertiary care), and referral system. They expand the monitoring role of insurance companies (transforming the payment system into the global diagnosis-related group) to reduce the induced demand for health.

Health status and health care utilization profiles of adolescents with disabilities

BackgroundAdolescents with physical disabilities of childhood often require a transition from pediatric to adult systems as part of life-long, comprehensive health care once they reach 18 years of age. The process of transition can be complex, challenging, and influenced by health-related factors and availability of health care resources. ObjectiveTo provide a baseline profile of health-related quality of life, health management, social participation, and health care utilization for adolescents 16 years of age with spina bifida (SB), acquired brain injury (ABI), or cerebral palsy (CP) in Toronto, Canada. MethodsA cross-sectional survey design was used. A sample was drawn from a large, urban pediatric rehabilitation hospital as part of a prospective, longitudinal, observational mixed-methods study. Seven English language, paper-copy standardized measures were completed; measures were organized across the three domains of interest. Health care utilization data were obtained from population-based, health services administrative datasets held by ICES. These data included outpatient physician visits, emergency department visits, and hospitalizations over a 12-month period, beginning at their 16th birthday. ResultsThe sample comprised 99 participants: survey measures were completed by 59 participants (12 SB, 19 ABI, and 28 CP) and health care utilization obtained for 92 participants (19 SB, 25 ABI, and 48 CP). Baseline scores across measures and rates of health care utilization are provided. All three groups reported relatively good health-related quality of life. Youth with CP had lower scores on health utility, health management, and social participation, compared with the SB and ABI groups. Youth with SB had slightly higher health care utilization in the 12-month period after their 16th birthday, compared with the ABI and CP groups. ConclusionsThis cross-sectional survey collected comprehensive health status and health care utilization data on 16-year-old youth with SB, ABI, and CP in Toronto, Canada. With few exceptions, the CP group consistently scored lower across measurement domains. These baseline data may be useful for hospital administrators, policy makers, and researchers examining changes in health-related quality of life, health management, social participation, and health care utilization among youth with SB, ABI, and CP, particularly in the context of transition planning and evaluation.

Expert appraisal and prioritization of barriers to mHealth use for older adults living with Alzheimer's disease and related Dementias: A Delphi study

IntroductionOlder adults living with Alzheimer's disease and related dementias (ADRD) can benefit from mHealth innovations in (daily) care. However, successful implementation and adoption of such innovations can be hindered by a lack of inclusive design. Inclusive design can be challenging, due to the variety of ADRD- and aging-related symptoms that can pose barriers to using mHealth. Previously, a literature-based model with 53 barriers to mHealth use for this population has been developed (“MHealth for OLder adults living with DEMentia – USability“ or MOLDEM-US). In this study, we aim to prioritize these through a Delphi study with ADRD experts (case managers, informal caregivers, hospital healthcare professionals, district nurses, and researchers). Methods: In the first round, participant characteristics and potentially new insights into barriers to mHealth use for older adults living with ADRD were gathered. The consensus questionnaire was submitted in the second round, containing barriers to mHealth use for this population (from MOLDEM-US) with questions inquiring its impact and frequency. In the third round, participants rejudged those barriers for which no consensus (<51 %) or minor consensus (51 % − 60 %) was reached. Results: Thirty-seven participants completed the three rounds of the study. Consensus was reached for eleven barriers after the second round, all having major impact and frequency: integration of functions during daily activities, perceived complexity, efficiency in seeing benefits, trust in own ability, restlessness and agitation, computer literacy, self confidence in using wearables, learnability, working memory, and visual acuity. Conclusion: After round three, consensus was achieved for all 53 barriers. Twenty-six barriers are considered to majorly affect mHealth use, most of which relate to cognition and frame of mind. This study contributes to the development of mHealth design guidelines that take into account the progressive and diverse ADRD- and aging-related symptoms negatively affecting mHealth implementation and adoption.

For-profit hospitals could play a distinctive role as anchor institutions.

Hospitals have a longstanding presence in United States communities and contribute to economic development and community well-being through widespread employment, purchasingand direct community engagement. Most of the data on anchor institutions to date, however, has focused on nonprofit organisations, especially nonprofit hospitals, colleges and universities. The aim of this study is to better understand if for-profit hospitals engage in explicit anchor activities, and whether these organisations adopt unique strategies in carrying out this study. We used an inductive, qualitative approach to understand how for-profit hospitals perceive their anchoring efforts as distinct as compared to nonprofits. We conducted in-depth interviews with 23 hospital leaders, researchersand members of advocacy organisations, representing 11 different hospital organisations and 10 communities; and used thematic analysis to generate study findings. For-profit hospitals do see at least three primary differences that render them distinctive in their efforts to anchor themselves within their communities-namely, barriers that for-profits encounter that nonprofits may not; their emphasis on strategic and synergistic practices; and their status as hospitals that also support their communities economically as tax-paying entities. With a better understanding of their unique contributions as for-profit organisations, policymakers can identify ways to leverage these hospitals to support their communities through outreach and engagement.

The Importance of Social Entrepreneurship Orientation and Social Salience on Hospital Performance: The Mediating Role of Business Planning

The purpose of this study is to discover the internal resources that have a significant impact on the performance of social enterprises. This study is quantitative research. The population in this study is a hospital in Pekanbaru City, Riau Province, Indonesia. Twenty-nine hospitals were taken as samples for the study using a purposive sampling technique. SEM-PLS was used to evaluate the data obtained. The result showed that hospital performance was significantly influenced by social entrepreneurship orientation and business planning. Although social salience has a considerable impact on the hospital's social performance, it has no direct impact on its financial performance. This finding reflects the hospital's current state as a complicated organization with challenges balancing financial and social performance. Business planning acts as a mediator that significantly affects the relationship between resources and hospital performance. Therefore, the complexity of the hospital hybrid business requires business planning to balance the two performances. These findings can help hospital management determine the hospital’s strategic direction and provide model guidance for hospital investors, policymakers, and researchers.

Contextual factors associated with organizational learning in hospitals: An instrument development study.

Develop a valid, reliable research instrument to measure contextual factors associated with organizational learning in hospitals. A valid, reliable instrument for measuring contextual factors associated with organizational learning is needed so nurse leaders and researchers can improve healthcare by facilitating and studying organizational learning. The Organizational Learning in Hospitals model guided development of the Organizational Learning Instrument-Context. Content validity was refined and evaluated through cognitive interviews and expert reviews. The instrument was distributed to direct care nurses in Magnet® hospitals in the United States. Intraclass correlation coefficients validated the use of multilevel analyses. Construct validity was assessed using multilevel confirmatory factor analysis, and coefficient omega was used to assess internal reliability. Participants were 1063 nurses in 120 inpatient units in 11 Magnet® hospitals. Results were as follows: item-level content validity = 0.86-1.0, scale-level content validity = 0.95, intraclass correlation coefficients = 0.171-0.270, coefficient omega = 0.945-0.982 and standardized factors loadings = 0.672-0.964. Model fit statistics were CFI = 0.963, TLI = 0.961 and RMSEA = 0.059. [Correction added on 31 May 2022, after first online publication: In the first line of the 'Results' section, "163 nurses" has been corrected to "1063 nurses" in this version.] CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Context has adequate levels of reliability, content validity and construct validity. Hospital leaders and researchers may begin using this instrument to improve and study contextual factors associated with organizational learning in hospital units.

The nature of innovation in hospital building design: a mixed grounded theory study

PurposeDespite the undeniable need for innovation in hospital building design, the literature highlights the disconnect between research and practice as the primary knowledge gap hindering such innovation. This study shows this focus to be an oversimplification, for the complex processes that trigger design innovations and impact their ecosystems need to be examined from a systemic perspective. This paper aims to conceptualise the evolution of hospital building design and identify and explain the main factors triggering design and construction innovations over the past 100 years.Design/methodology/approachA novel hybrid research design to mixed grounded theory (MGT) methodology, with Charmaz constructivist paradigm, is developed as a new systematic way of constructing and interpreting the concepts and interconnections among them that triggered design innovation.FindingsThis study represents a taxonomy of concepts and an explanatory innovation framework, containing 617 interconnections between 146 factors classified across 14 categories. The complex innovation ecosystem comprises multi-faceted processes between heterogenous factors with both individual and collective impacts on design innovations.Originality/valueThis research highlights the main components of the innovation ecosystem and its overall behaviour in this field, and the most influential and interrelated contextual factors, as well as representing and mapping generative interactions that support innovation processes. This knowledge can help hospital researchers, designers, policymakers and stakeholders adopt a multidimensional outlook to analyse the strength of all influential factors, introduce potential novel ways of collaborating, conceptualise an organisational approach, re-formulate research questions through transdisciplinary methods and introduce interdisciplinary courses and programs in architecture schools, thereby contributing to timely design innovation.

A STUDY OF THE LEVEL OF AWARENESS,CAPACITY AND CONSENT AMONG EMERGENCY HEALTHCARE WORKERS IN A TERTIARY CARE HOSPITAL IN KOLKATA.

Introduction: Most patients lack the medical competency to grasp the optimal course of treatment for their health, thus doctors and nurses must constantly assess whether patients can consent to tests and treatments. Patients who refuse to go to the hospital or who do not comprehend what medical activity is benecial to their health frequently require all health care personnel to make these kinds of decisions. Thus, every healthcare provider must be aware of the risk that some of their choices may one day be criticised or reconsidered on the grounds that they neglected to offer critical therapy to a person with limited capacity because they picked an unfavorable treatment route. Patients who have self-harmed refuse medical treatment when it is detected, which is an increasingly concerning trend in today's culture. Consequently, it's vital that medical professionals in tertiary care facilities across the country are well-versed in capacity and consent difculties such as the above metropolises like Kolkata, Mumbai, Chennai. To conduct research into emergency healthcare providers' awareness of abi Aim: Materials And Methods: lity and consent. Peerless Hospital researchers interviewed 84 members of the emergency medical services from July to October using a cross-sectional questionnaire (4 months). The B.K. Roy Research Center and Peerless Hospital are both located in Kolkata, West Bengal, India. SPSS 24.0 and GraphPad Prism 5 were used to perform statistical analyses on the data imported into Microsoft Excel. Unpaired proportions were compared using Chi-square or Fischer's exact tests, depending on whether statistical signicance was required. We found that association of Q1 vs. group was Results: statistically signicant (p=0.0015). Association of Q2 vs. group was not statistically signicant (p=0.2002). Association of Q3 vs. group was statistically signicant (p=0.0463). We came to the conclusion that the vas Conclusion: t majority of emergency medical technicians lacked statistically meaningful information.

COVID-19 Pandemic as a Change Agent in the Structure and Practice of Statistical Consulting Centers

When New York City (NYC) became an epicenter of the COVID-19 pandemic in the spring of 2020, statistical consulting centers at academic medical institutions in the area were immediately inundated with requests from hospital leadership and researchers for methodological support to address different aspects of the outbreak. Statisticians suddenly had to pivot from their usual responsibilities to focus entirely on COVID-19 work, and consulting centers had to devise innovative strategies to restructure their workflow and develop new infrastructure to address the acute demand for support. As statisticians from seven NYC-area institutions, we share our experiences and lessons learned during the pandemic, with the hope that this will lead not only to better preparedness for future public health crises when the skills and expertise of statisticians are critically needed, but also to lasting improvements to the structure and practice of statistical consulting centers.

Searching for a new normal-Hospital-employed researchers' experiences during the COVID-19 pandemic.

BackgroundThis study focuses on hospital‐employed researchers, a relatively new staff group. Their job descriptions vary, which may lead to lack of clarity or preparedness regarding their roles and core tasks during a crisis such as COVID‐19.AimThe aim of this study was to explore hospital‐employed healthcare researchers' experiences of work during the COVID‐19 pandemic.DesignA qualitative design based on Graneheim and Lundman's latent content analysis of two focus groups with researchers in clinical practice was chosen to explore researchers' experiences of work during the COVID‐19 pandemic.MethodsFifteen hospital researchers participated in two focus groups, divided into predoctoral and postdoctoral researchers. Focus groups were conducted in May 2020 during the COVID‐19 pandemic, using the voice over IP service, Skype®, due to risk of contagion.Findings‘Searching for a new normal during the COVID‐19 pandemic’ was the main theme during the latent content interpretation, with subthemes of (i) balancing calm and insecurity, (ii) negotiating core tasks and (iii) considering the future.ConclusionThe 15 researchers tried to balance calm and insecurity within work and family, on standby for the hospital's contingency plan, and in their research tasks. This led them to negotiate their core tasks and to reflect on the changes and consequences for their positions as researchers in clinical practice in the future.

The main factors of supplier-induced demand in health care: A qualitative study.

BACKGROUND:Induced demand is a major challenge for financing health promotion, whereby providers exploit patients' information gap to manipulate their demand for health care. The purpose of this study was to identify the factors associated with induced demand for health-care services in hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018.MATERIALS AND METHODS:In this qualitative study, semi-structured interviews were conducted with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze the data.RESULTS:Overall, 24 subthemes or factors were identified and classified into the health system, the insurer, health-care provider, and health-care recipient themes. Poor monitoring and control, the fee-for-service payment system, limited role of insurance companies, insufficient monitoring of insurance companies, the educational nature of our health centers, health-care providers' interests, and patients' information gap were some important factors in induced demand for health-care services.CONCLUSION:Our results showed that there are many factors that contribute to induced demand for health care. Given the four levels of factors identified in this study, health policymakers and managers must develop strategies at each level to reduce induced demand for health care.

Extracting hospital hotel standards and criteria with a specialized hospital design approach

Background and Aim: Hospital design is based on the theoretical foundations of architecture and careful planning based on activities, equipment, standards and specific relationships between spaces. Applying the right standards and relationships between functions has a direct impact on the proper context of treatment. According to what has been said, the purpose of this study is to extract the standards and criteria of the hospital hotel with a specialized hospital design approach. Materials and Methods: The present study is a quantitative-qualitative method and based on this, first the qualitative evaluation of hospital environments in Kermanshah and then in the next stage, the obtained and presented standards have been proved. In order to evaluate the quality and evaluate the compatibility of the use of the standard environment, a semi-structured individual interview with hospital design specialists and researchers in this field and qualitative analysis of texts were used. The data obtained from the interviews were analyzed by coding method and in the next step, using the confirmatory factor analysis and laser software, the presented indicators were proved. Results and Results: In establishing hoteling standards in a specialized hospital, in addition to designing the initial physical spaces appropriate to the type of disease, three main questions were: Reasons for using the hospital hotel standard, the fit of the standards with the patient's needs and what these standards are. From the present study, we can point to the required standards in the field of hospital hotels with the approach of a specialized hospital with four basic indicators such as building and equipment, welfare services, human factors and functional factors. These are among the basic and emphasized standards that have been neglected.

Public Health and Project Management: Do Projects Deliver?

Maternal, newborn, and child health (MNCH) has remained an ever-concerning area for hospital management and researchers throughout the world. Nevertheless, in the literature, less attention is paid to developing countries. The current study identifies the problems faced by maternal newborn and child health projects at each phase. We obtained data on MNCH projects via interviews from district project managers and extracted various themes for each phase of the MNCH project. The results indicated the most significant problems faced by the MNCH project emanate from the inefficient bureaucratic structure, lack of realistic planning, weak working environment, political interference, and inefficient knowledge acquisition. The current study found that project managers experience various problems from the initiation stage of the project to its closure. Additionally, they find themselves to be poorly equipped to manage such problems. We proposed various strategies such as implementing a bottom-up management approach, more decentralization, establishing patient feedback systems, giving more authority to the project managers, and so forth.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.