Hospitals In Remote Areas Research Articles

Identifying the hospital logistics key performance indicators for public hospitals in remote areas of Thailand

PurposeThis study aims to investigate and classify the hospital logistics key performance indicators (KPIs) using the context of public hospitals in remote areas.Design/methodology/approachThe public hospitals in northern Thailand were selected for the case study. The questionnaire was developed and used to collect data from hospital logistics experts. Then, the analytic hierarchy process (AHP) method was used to evaluate the hospital logistics KPIs in each dimension.FindingsThis research found that the procurement management dimension is ranked highest. Information and technology management is the last rank in the hospital logistics KPIs used for public hospitals in remote areas.Research limitations/implicationsThe public hospitals located in northern Thailand were selected for the case study. Fuzzy multi-criteria decision-making methods can be used to reduce the vagueness of the values.Practical implicationsThe results from this study can be a guideline for hospitals to improve the efficiency of their logistics operations.Social implicationsThe decision-makers in the hospital can use these results to improve the hospital’s logistics performance in the future, which could help increase the service level and the safety of the patients.Originality/valueThe hospital logistics KPIs were revised, and the crucial KPIs were prioritized for improving the hospital logistics using the AHP method.

A lightweight super-resolution network with skip-connections.

In some hospitals in remote areas, due to the lack of MRI scanners with high magnetic field intensity, only low-resolution MRI images can be obtained, hindering doctors from making correct diagnoses. In our study, higher-resolution images were obtained through low-resolution MRI images. Moreover, as our algorithm is a lightweight algorithm with a small number of parameters, it can be carried out in remote areas under the condition of the lack of computing resources. Moreover, our algorithm is of great clinical significance in providing references for doctors' diagnoses and treatment in remote areas. We compared different super-resolution algorithms to obtain high-resolution MRI images, including SRGAN, SPSR, and LESRCNN. A global skip connection was applied to the original network of LESRCNN to use global semantic information to get better performance. Experiments reported that our network improved SSMI by 0.8% and also achieved an obvious increase in PSNR, PI, and LPIPS compared to LESRCNN in our dataset. Similar to LESRCNN, our network has a very short running time, a small number of parameters, low time complexity, and low space complexity while ensuring high performance compared to SRGAN and SPSR. Five MRI doctors were invited for a subjective evaluation of our algorithm. All agreed on significant improvements and that our algorithm could be used clinically in remote areas and has great value. The experimental results demonstrated the performance of our algorithm in super-resolution MRI image reconstruction. It allows us to obtain high-resolution images in the absence of high-field intensity MRI scanners, which have great clinical significance. The short running time, a small number of parameters, low time complexity, and low space complexity ensure that our network can be used in grassroots hospitals in remote areas that lack computing resources. We can reconstruct high-resolution MRI images in a short time, thus saving time for patients. Our algorithm can be biased towards practical applications; however, doctors have affirmed the clinical value of our algorithm.

CR-Conformer: a fusion network for clinical skin lesion classification.

Deep convolutional neural network (DCNN) models have been widely used to diagnose skin lesions, and some of them have achieved diagnostic results comparable to or even better than dermatologists. Most publicly available skin lesion datasets used to train DCNN were dermoscopic images. Expensive dermoscopic equipment is rarely available in rural clinics or small hospitals in remote areas. Therefore, it is of great significance to rely on clinical images for computer-aided diagnosis of skin lesions. This paper proposes an improved dual-branch fusion network called CR-Conformer. It integrates a DCNN branch that can effectively extract local features and a Transformer branch that can extract global features to capture more valuable features in clinical skin lesion images. In addition, we improved the DCNN branch to extract enhanced features in four directions through the convolutional rotation operation, further improving the classification performance of clinical skin lesion images. To verify the effectiveness of our proposed method, we conducted comprehensive tests on a private dataset named XJUSL, which contains ten types of clinical skin lesions. The test results indicate that our proposed method reduced the number of parameters by 11.17M and improved the accuracy of clinical skin lesion image classification by 1.08%. It has the potential to realize automatic diagnosis of skin lesions in mobile devices.

Interim Storage of Biospecimen at Satellite Collection Centers: Dewar and Cryotube Choice Are Important for Temporary Storage in Liquid Nitrogen.

One major goal of biobanks is to provide the best possible biospecimen quality for research use. This can be achieved, notably in accredited structures, by using standardized procedures for collection, processing, and storage of biosamples and associated data. Since tissue samples of a clinical biobank are commonly collected at surgical theaters in satellite locations or hospitals in remote areas, adequate temporary storage of the biosample is mandatory to maintain optimal sample quality. In cases where immediate snap freezing of the collected material is possible, interim storage of the samples in portable dewars filled with liquid nitrogen (LN2) is a widely used method. Therefore, the ideal dewar size and maximum storage time need to be considered to maintain an optimal biospecimen quality. In addition, the nature of the cryotube material is an important aspect for keeping the biosample safe while storing it in LN2. The objective of this study was to test different dewar vessels with respect to LN2 volume and consumption and to analyze the impact of LN2 contact on cryotube material through scanning electron microscopy.

Current Conditions of Support Provision for Nurses at Hub Hospitals in Remote Areas

Current Conditions of Support Provision for Nurses at Hub Hospitals in Remote Areas

Rapid molecular diagnostics of large deletional β0-thalassemia (3.5 kb and 45 kb) using colorimetric LAMP in various thalassemia genotypes

Backgroundβ-thalassemia is an inherited disorder that is reported worldwide. Two common β0-thalassemia mutations (3.5 kb and 45 kb deletions) are prevalent in Southeast Asia and Thailand. Identification of these defects is essential to population screening and prenatal diagnosis. We aimed to develop colorimetric LAMP based on a phenol red indicator and validate it on various thalassemia genotypes. MethodColorimetric LAMP assays for detecting β0-thalassemia 3.5- and 45-kb deletions were developed and validated on 254 routine clinical samples. The results of the assays could be interpreted by the naked eye and compared with the gold standard gap-PCR. ResultsA total of 254 samples related to seven phenotypes and 27 different genotype groups showed 100% concordance between the colorimetric LAMP assays and gap-PCR for detecting β0-thalassemia (3.5- and 45-kb deletions). The sensitivity, specificity, NPV, and PPV were calculated as 100% for both β0-thalassemia 3.5- and 45-kb deletion detection. The comparison of the usefulness of colorimetric LAMP assays and conventional methods was demonstrated in this study. ConclusionsThe developed colorimetric LAMP assays are rapid, simple, and highly cost effective and can be interpreted by the naked eye. These assays should be applied for screening deletional β0-thalassemia in routine settings or small community hospitals in remote areas where thalassemia is highly heterogeneous.

The Effect of Health Information Technology on Time and Cost Saving in Remote areas of Iran

The present study aims at investigating the effect of health information technology on time and cost saving in the perspective of users of teaching hospitals in in remote areas of Iran. This is an applied study with a descriptive-analytical and cross-sectional method conducted on users of hospitals in remote areas of Iran using stratified random sampling. Data collection instrument was a selfmade questionnaire, the face validity and reliability of which were confirmed by Cronbach’s alpha 0.94. Data were collected in person and analyzed by SPSS software V. 21 and descriptive and analytical statistics. Based on the Chi-square test results, there was a significant relationship between the effects of health information technology on time saving as well as cost saving. The results of Kruskal-Wallis test showed no significant relationship between education level, age and work experience and time and cost saving as well. User satisfaction is one of the most important aspects of the success of information systems, therefore, it is recommended that senior managers pay attention to the individual aspects of the employees working in the organization, provide them with necessary training before implementing the information systems, and involve them in the decisions in using such technologies.

Investigation and analysis of social support of clinical nurses in second-level hospitals in remote areas of Tibet

Objective To investigate the social support of clinical nurses in second-level hospitals in remote areas of Tibet, and to explore the influencing factors, so as to provide the basis for nursing managers to develop targeted interventions. Methods A total of 212 nurses were selected by convenient holistic sampling method and investigated by self-designed questionnaire and social support rating scale. Results The total score of social support of clinical nurses was (30.72±6.78) points. The main influencing factors of social support were educational background (F=4.602), ages(F=2.694), working years(F=2.387), budgeted posts(t=2.391), income(F=3.112) and marital status (F=2.636). Difference was statistically significant(P<0.05). Conclusions The social support of clinical nurses in second-level hospitals in remote areas of Tibet is low. It is important to establish a relatively perfect social support system according to the difference of nurses working conditions and geographical to improve their work enthusiasm and satisfaction rate. Key words: Nurses; Social support; Tibetan areas; Investigation analysis

Telemedicine for Trauma and Emergency: the eICU

The purpose of this study was to describe the current use of telemedicine in the intensive care units (ICUs), particularly as it relates to trauma and emergency. Telemedicine in the ICU has been validated through several large before-after studies with positive effects on mortality, morbidity, and length of stay. New research agendas looking at how best to utilize it and to prove efficacy are required. The USA and most of the Western world face several major healthcare challenges including an aging population, lack of critical care physicians, and importantly a lack of financial resources. Telemedicine in the ICU makes possible to use intensivists from major medical centers to provide critical care services in small hospitals in remote areas that otherwise will not be able to care for their sick and injured patients.

Telecardiology application in jordan: its impact on diagnosis and disease management, patients' quality of life, and time- and cost-savings.

Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients' quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients' travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life.

Organizational and Environmental Correlates to Preventive Quality of Care in US Rural Health Clinics

To identify organizational and environmental correlates to rural health clinics' preventive quality of care in the United States. A retrospective observational cohort study design was applied under Donabedian's Structure-Process-Outcome framework. Three structure measures of care (proportion of nonphysicians, absence of physicians, and provider affiliation) and three measures of process (total clinical visits, prevention use for congestive heart failure and diabetes) were used as explanatory variables. Five environmental correlates were included. The Centers for Medicare and Medicaid Services National Medicare Chronic Care Condition Data Warehouse for 2007 was used to obtain clinical data. Preventive quality of care outcomes were measured through Agency for Healthcare Research and Quality prevention quality indicators. The indicators were risk adjusted for age, sex, race, severity, and comorbidity of patients. Structural equation modeling with maximum likelihood estimation was used. Provider affiliation (P = .03), absence of physicians (P = .007), and higher proportion of nonphysicians (P = .007) were negatively related to preventive quality of care. Lower cause-specific mortality rate at the county level as compared to the United States average (P = .05) and rural location (P = .001) were positively related to quality of care. The results of the study showed the need to attract and retain physicians in rural health clinics. The positive relationship between rural location and quality of care reflects more on the limited access to hospitals in remote areas.

The significance of a small, level‐3 ‘semi evacuation’ hospital in a terrorist attack in a nearby town

Terrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.

EMERGING TRENDS IN ICU MANAGEMENT AND STAFFING

It is likely that greater on-site intensivist coverage in critical care units will be observed in the future. Regionalization of critical care services will make this a financial reality because this level of expertise cannot realistically be provided to all hospitals. Perhaps units above a certain size will warrant this level of coverage and smaller community hospitals will transfer patients in need of a very high level of service, which can be provided only by intensivists on site. Community hospitals may rely on specially trained nurse practitioners or physician assistants to provide more on-site coverage during off hours. As technology advances, telemedicine will play a greater role in providing intensivist coverage to ICUs during off hours or to community hospitals in remote areas. Advanced technology and reorganization of critical care services offer opportunities for creative and nontraditional ways to deliver improved care to patients.

Rural telepsychiatry.

Telepsychiatry is the use of telecommunications technology to connect patients and health care providers, permitting effective diagnosis, education, treatment, consultation, transfer of medical data, research, and other health care activities. Telepsychiatry has been used as a partial solution to the problem of limited psychiatric services for clinics and hospitals in remote areas of areas underserved by psychiatrists and other mental health care specialists. In the United States, eastern Oregon's RodeoNet telepsychiatry program and the telemedicine program of the Kansas University Medical Center, which has a psychiatric component, are excellent models. Telepsychiatric applications can be cost-effective, but careful evaluation is needed.

A Decentralized Trauma System Design for a Rural Area

Most trauma-care systems are based on an urban model in which patients are found in sufficient proximity to the trauma to allow preferential triage. The roles of other hospitals in the community are limited. In rural areas, patients may be remote from the trauma and may require initial stabilization at a closer, nontrauma center designated hospital. An inclusive trauma system design is more appropriate in such situations. The Emergency Department Approved for Trauma (EDAT) is a program implemented in a rural area of northeastern California that establishes minimum standards for nontrauma designated hospitals in remote areas. It integrates these hospitals into the trauma system through transfer guidelines and agreements and participation in systemwide quality assurance/improvement programs. The EDAT program promotes both improved initial treatment of rural trauma patients and appropriate transfer of patients to designated trauma centers.

A Decentralized Trauma System Design for a Rural Area

Most trauma-care systems are based on an urban model in which patients are found in sufficient proximity to the trauma center to allow preferential triage. The roles of other hospitals in the community are limited. In rural areas, patients may be remote from the trauma center and may require initial stabilization at a closer, nontrauma "center" designated hospital. An inclusive trauma system design is more appropriate in such situations. The Emergency Department Approved for Trauma (EDAT) is a program implemented in a rural area of northeastern California that establishes minimum standards for nontrauma center designated hospitals in remote areas. It integrates these hospitals into the trauma system through transfer guidelines and agreements and participation in systemwide quality assurance/improvement programs. The EDAT program promotes both improved initial treatment of rural trauma patients and appropriate transfer of patients to designated trauma centers.

Predicting Hypoxia in Children with Acute Lower Respiratory Infection: a Study in the Highlands of Papua New Guinea

Pneumonia accounts for nearly half of all admissions amongst children less than 5 years of age to health centres and hospitals in the highlands of Papua New Guinea. Until recently, the indications for the use of oxygen in the management of childhood pneumonia in Papua New Guinea had been confined to the detection of cyanosis and restlessness. Oxygen is, however, difficult to deliver to many parts of Papua New Guinea, leading to high transport costs and shortages. Health workers in rural areas are continually faced with decisions as to which children should be given oxygen when it is in short supply. This study related clinical signs to the oxygen saturation of the blood using a pulse oximeter, in order to offer rational criteria for the use of oxygen in health centres and hospitals in remote areas. Data were collected on 110 children who were admitted to Tari Hospital with a diagnosis of moderate or severe pneumonia. Following admission, assessments were repeated at 12-hourly intervals until the child was discharged from the intensive nursing ward. All clinical assessments and oximetry readings were taken by a registered nurse. A rule developed via quadratic discrimination analysis was able to correctly classify 80 per cent of children as having adequate/inadequate oxygen saturation, with 'inadequate oxygen saturation' defined as less than 85 per cent. This, however, involved a complicated equation which would not be suitable for general use in a developing country. The use of a 'clinical score' using a summation of the major clinical signs was not found to offer any advantage over the recognition of any one of four 'indicator' signs.(ABSTRACT TRUNCATED AT 250 WORDS)