Implementation Of Health Services Research Articles

Implementation of Evidence in Preventing Postoperative Sore Throat of Patients Undergoing General Anesthesia Intubation Using the i-PARIHS Framework.

Objective The aim of the study was to assess the effectiveness of the implementation of the best evidence in preventing postoperative sore throat in patients undergoing general anesthesia intubation. Methods The related topics of the postoperative sore throat of patients undergoing general anesthesia intubation were systematically searched in the database and evaluated using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Combined with clinical needs and evidence-based professional judgment, 20 pieces of evidence and 6 examination standards on the management process and evidence implementation plan for the prevention of postoperative sore throat in patients with general anesthesia intubation are summarized, implementing the best evidence into clinical practice in anesthesiology, general surgery, orthopedics, thoracic surgery, and gynecology. Results Nurses' knowledge scores and evidence compliance significantly improved after the implementation of the best evidence (P < 0.05); the incidence of the postoperative sore throat in patients undergoing general anesthesia intubation decreased from 41.7% to 28.1%. Conclusion The i-PARIHS framework effectively prevents postoperative sore throat in patients, providing an effective case for translating evidence into practice based on the i-PARIHS framework.

Analysis That Influences The Quality of Nursing Services in Installations of Colonel Abunjani Hospital, Bangko in 2019

The implementation of hospital health services in Indonesia currently faces increasingly complex challenges. The improvement of hospital quality must be improved in accordance with the development of the needs and demands of the community, accompanied by an increase in efficiency and productivity in the field of management, in accordance with the hospital's minimum service standards, professional standards, and standard operating procedures. The study aims to determine the relationship of knowledge, skills, behavior, education, experience, and motivation of nurses with the quality of nursing services at the kolonel abunjani bangko Hospital in 2019. This observational analytic study uses a Cross Sectional design. Chi square statistical test and multiple logistic regression regression were used to analyze data. The population and sample size in this study were 92 nurses where data collection was taken from the results of the questionnaire. The results of the bivariate analysis showed that there was a relationship of knowledge, skills, behavior, potential, education, experience, and motivation with the quality of nursing services at the kolonel abunjani bangko Hospital in 2019. The results of multivariate analysis showed that experience was the most dominant variable affecting quality service. Conclusions obtained are the relationship of knowledge, skills, behavior, potential, education, experience, and motivation of nurses with the quality of nursing services in kolonel abunjani bangko Hospital in 2019. It is recommended to the hospital, to continue to improve knowledge, skills, behavior, education, experience, and continuous motivation. By increasing competence and continuous performance, the nurse's weaknesses and strengths can be known. Thus, good nurse competency can give satisfaction to patients and provide job promotion so as to improve the work performance of nurses so that they can increase the quality of health services.

Pre-implementation evaluation for an HPV vaccine provider communication intervention among primary care clinics

ObjectivesInterventions to improve health care provider communication about HPV vaccination can increase vaccine acceptance. Our objectives were to (1) identify clinics in locations with high HPV-associated cancer and low HPV-vaccination rates that would potentially benefit from dissemination of a proposed HPV Provider Communication intervention and (2) use qualitative interviews and a dissemination and implementation framework to assess readiness for change and fit of the HPV Provider Communication intervention to the context of these clinics. MethodsLocal HPV-associated cancer and HPV vaccination rates were assigned to Practice-Based Research Network clinics using data from the Colorado Central Cancer Registry, the Colorado Immunization Information System, and the American Community Survey. Staff from 38 clinics located in areas with high numbers of adolescents not up-to-date for HPV vaccine and high rates of HPV-associated cancers were recruited for qualitative interviews. Interview questions used the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework and addressed the proposed intervention, current vaccination practices and prior quality improvement (QI) experience. ResultsTwenty-seven interviews were completed with clinicians, clinic managers, and other staff across 17 clinics (9 pediatric, 5 family medicine, 3 public/school-based health). Most clinics had some prior QI experience and there were few thematic differences between sites with more or less foundation for QI/immunization work. Participants were motivated to improve the health of their patients and valued both guidelines and local experience as important evidence to consider adopting an intervention. Interviewees were more interested in implementing the proposed intervention if it aligned with existing priorities and fit within clinic workflows. Facilitation needs included adequate time and external facilitation support for data tracking and analysis. ConclusionsQualitative interviews to understand clinic context and fit of an HPV Provider Communication intervention can inform implementation in settings with the highest potential for clinical impact.

Hazard Identification and Risk Analysis in Rebar Rolling Plant

Employees are constantly in action for the production of goods and services in workplaces. These workplace activities affect the physical and mental health of the employees and cause occupational accidents. Elimination of these negativities is possible with the implementation of occupational health and safety services. Safety organisation is also very important in steel rolling mills so that employees are not exposed to danger. As in any other industry, steel rolling mill workers work with dangerous machinery that causes injury, disability and death. Safe working is an integral part of risk management. Risk management is the process of taking and implementing action to reduce the possibility of an assessed risk occurring. Therefore, known or tolerable risks are managed. In safe workplaces, productivity is high, work accidents and occupational diseases are low. Safe workplaces are only possible with risk management. In this study, the rolling mill area of a workplace producing rebar with the Fine-Kinney Method was analysed and the necessary precautions were listed. These measures are generally listed as; implementation of control protocols for the routine operation of the process, providing necessary occupational health and safety training for the personnel, providing the necessary information, repeating the training at regular intervals, following up the protective clothing and equipment to be used in the process, maintenance/repair of the units and the tools used. As a result of these measures, the degree of risk will be reduced to acceptable levels.

Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study.

BackgroundUnhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care.MethodsANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework.DiscussionThis study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.

Implementation of health services policy related to treating the problems of mental disorders in the city of Padang Panjang, Indonesia

This researcher uses the perspective of implementing the problems approach introduced by Edwards III in 1984. The data analysis method in this study is qualitative with a descriptive analytic approach. This study uses primary data and secondary data where data collection is carried out through field studies and literature studies. As for taking samples using a purposive technique. Based on the results of the study, it is known that the communication carried out by the Padang Panjang City Health Office is effective. When viewed from the human resources in terms of quality and quantity is still not sufficient. On the aspect of disposition, it can be said that all of them are positive without any resistance. In doing services in the health sector related to handling mental disorders, the Padang Panjang City Health Office does not yet have a standard operating procedure. In this study, researchers provide suggestions that Padang Panjang City Health Office to improve human resources and budget resources. In addition, the researchers also suggested that the Padang Panjang City Health Office immediately make standard operating procedures in giving health services related to the handling of mental disorders.

A knowledge implementation model in health system management based on the PARIHS model

BackgroundThe gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran.MethodsThe present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software.Results The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model.Conclusion The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Involvement of high school teachers in Health Promoting School program in selected township, Yangon Region, Myanmar: A cross-sectional mixed methods study.

BackgroundSchools provide a big opportunity for promoting the student’s health, life skill, and behavior. Teachers play a fundamental role in the promotion and successful implementation of school health services. This study aimed to assess the level of involvement in the Health Promoting School program and its associated factors and to explore the benefits and barriers to involvement among high school teachers in Myanmar.MethodsA mixed methods explanatory sequential study was conducted among 194 high school teachers in Thanlyin Township, Yangon Region, Myanmar, from June to August 2020. Quantitative data were collected with the pretested structural questionnaire and analyzed by Chi-square tests and Fisher’s exact tests. A qualitative strand was added by conducting in-depth interviews (n = 15, five teachers from each level of involvement: poor, medium, and good), analyzed by thematic content analysis.ResultsOf the 194 teachers, 23.7% had a good level of involvement in the Health Promoting School program. The factor associated with involvement in Health Promoting School program were age (p value < 0.001), duration of services (p value = 0.001), and a number of accomplished training-related school health (p value = 0.008). Qualitative data revealed that improvement of the health knowledge and awareness on health problems, the progress of healthy behaviors, development of physical and mental health, prevention of the disease spread, achievement of healthy and productive learning environment, and development of academic achievement were major benefits of teachers’ involvement. Moreover, the main barriers to involvement were insufficient materials and human resources, time constraints, incompetence of the teachers, poor cooperation of school health partnerships, and insufficient awareness of parents.ConclusionsThe proportion of good involvement in the Health Promoting School program among high school teachers was low in this study area. Providing sufficient human resources and material, conducting the on-the-job and refresher training, enhancing parent-teacher cooperation, and strengthening the community partnerships were crucial to improve the level of involvement and reduced the barriers for the achievement of the Health Promoting School program.

Implementing a Financial Decision-Making Scale in APS Financial Exploitation Investigations: Use of the PARIHS Conceptual Framework.

Background and ObjectivesAdult protective services (APS) agencies investigate cases of financial exploitation, and a critical aspect of such investigations is often the assessment of decision-making abilities. This study examined APS workers’ implementation of a 10-item financial decision-making screening tool, the Financial Decision Tracker (FDT), across a 34-month period: pre-COVID-19, throughout COVID-19 restrictions, and for 1 year following the restrictions.Research Design and MethodsUsing the Promoting Action in Research Implementation in the Health Services implementation science conceptual framework, we examined aspects of context, facilitation, and evidence to determine how well APS workers were trained, certified, and skilled in using the FDT. Using individual and group interviews, we assessed factors often related to successful implementation (context and facilitation) and measured the number of scales used, the types of decisions under investigation, and how the tool’s scoring system aligned with the APS workers’ final ratings (evidence).ResultsOverall, implementation was sustained throughout the 34-month period. However, during COVID-19 restrictions, usage dropped to a rate 58% below that prior to and following the restrictions. A total of 839 scales were administered. Individuals with no decision-making deficits were slightly older (78.7 vs 77.1 years; t(837) = 2.54, p = .01) and had completed high school at a significantly higher rate (69% vs 59%, χ 2(1) = 5.20, p = .023) than those who had decision-making deficits.Discussion and ImplicationsOverall, the implementation trial can be considered a success. The FDT was used so often and effectively that it is now an APS best practices tool, meaning that in audits, the correct use of the FDT will be assessed.

IMPLEMENTASI PELAYANAN KESEHATAN WARGA BINAAN DI RUTAN KELAS II B TAKENGON

Law No. 12 of 1995 article 14 (1) concerning correction which in Letter (d) states that prisioners receive healt services and proper food. Inadequate health services are one of the impacts that can be felt by the inmates of the class II B Takengon Prison, which affect prisoners’ health. In this study, the author discussed the way on how prosiners’ health has been implemented in class II B Takengon prison. This study used an empirical legal research method which tried to explain fact in the field through interviews or direct observation. This study aimed to find out how the implementations of health services for inmates in Class II B Takengon Prison. The result showed that the implementation of health services for the inmates in the Class II B Takengon Prison is not optimal due to the lack of healthcare workers such as dentists and slow process of fund disbursement which affects the limitation of medicine availability as well as inadequate health facilities. It can be concluded that the implementation of health services for inmates in the Class II B Takengon is not optimal and the facilities is inadequate. The researcher suggests that Takengon prison should improve health services and add more health facilities.

Trends and country-level variation in age at first sex in sub-Saharan Africa among birth cohorts entering adulthood between 1985 and 2020

BackgroundDebuting sexual intercourse marks exposure to pregnancy or fatherhood and sexually transmitted infections (STIs), including HIV. In sub-Saharan Africa (SSA), sexual debut varies according to cultural, religious, and economic factors, and encouraging delay has been a longstanding component of behavioural HIV prevention strategies. Age at first sex (AFS) is routinely collected in national household surveys, but data are affected by reporting biases, limiting utility to monitor trends and guide sexual health interventions.MethodsWe collated individual-level data from nationally-representative household surveys to analyse timing and national trends in AFS in 42 SSA countries. We used a log-skew-logistic distribution to characterize the time to AFS in a Bayesian spatio-temporal model, providing estimates of the sexual debut rate by sex, age, time, and country. We statistically adjusted for reporting biases by comparing AFS reported by the same birth cohorts in multiple survey rounds, allowing different reporting biases by sex and country.ResultsMedian AFS in 2015 ranged from 15.8 among Angolan women to 25.3 among men in Niger. AFS was younger for women than men in 37/40 countries. The gap was largest for Sahel region countries and minimal in southern African countries. The distribution of female AFS was asymmetric with half debuting sex in an age range of 3.9 years [IQR 3.4–5.0 across countries]. Median AFS increased slightly between 1985 and 2020, ranging 0.84 years [IQR 0.11–1.55] and 0.79 [IQR -0.23–1.98] for females and males, respectively. The gender gap changed little over time in most countries. Female teens often reported higher AFS compared to when asked in their late twenties while male teens reported lower AFS; both sexes recalled a higher AFS in older ages compared to their thirties.ConclusionsAFS increased slightly in most SSA countries, but changes were modest relative to large and persistent variation between countries and sexes, indicating relatively entrenched socio-cultural practices around sexual debut. Sexual health, family planning, and HIV/STI prevention services should adapt to local practices rather than focusing interventions to change AFS. These estimates for rates of sexual debut provide data to guide programmatic prioritization and implementation of sexual health services.

Pengetahuan Keluarga Tentang Pencegahan Penyakit Covid-19 di Kelurahan Penaraga Wilayah Kerja Puskesmas Pena Nae

Covid-19 is currently a serious world problem with the number of cases increasing every day. Attacks everyone regardless of age or gender. In the province of West Nusa Tenggara, patients with the corona virus reached 9,698 patients, 8,338 recovered, and 404 patients died (Rikesda Prov.NTB, 2021). In Bima City, there were 1106 COVID-19 cases. Many residents did not know about COVID-19 and did not comply with the COVID-19 prevention protocol in the form of washing hands with soap and running water, wearing masks, maintaining distance and avoiding crowds by staying at home. Preventive action is the key to implementation in health and community services (PERKESMAS). Prevention steps in the community are to wash hands with hand sanitizer, wear masks, and maintain a distance (at least 1 meter) from other people. This study aims to describe the family's knowledge about the prevention of COVID-19 in the Penaraga Village, the working area of the Pena Na'e Health Center. using descriptive analytic method with cross sectional design. The population in this study were all families in Penaraga Village, Pena Nae Health Center working area as many as 214. The sample in this study was families in Penaraga village, totaling 25 samples. sample among the population in accordance with the wishes of the researcher. The type of research instrument that can be used in this study is a questionnaire with 10 question items. Results. The data obtained from family knowledge about COVID-19 prevention in Penaraga Village, Pena Nae Health Center, Bima City, the majority of respondents were knowledgeable enough, namely 13 respondents with a percentage (52%), good knowledge as many as 7 with a percentage (28%), and then respondents who had less knowledge as many as 5 respondents with a percentage (20%)

Leveraging Stakeholder Engagement and Virtual Environments to Develop a Strategy for Implementation of Adolescent Depression Services Integrated Within Primary Care Clinics of Mozambique.

Psychiatric disorders are the number one cause of disability in adolescents worldwide. Yet, in low- and middle-income countries (LMIC), where 90% of adolescents reside, mental health services are extremely limited, and the majority do not have access to treatment. Integration of mental health services within primary care of LMICs has been proposed as an efficient and sustainable way to close the adolescent mental health treatment gap. However, there is limited research on how to effectively implement integrated mental health care in LMIC. In the present study, we employed Implementation Mapping to develop a multilevel strategy for integrating adolescent depression services within primary care clinics of Maputo, Mozambique. Both in-person and virtual approaches for Implementation Mapping activities were used to support an international implementation planning partnership and promote the engagement of multilevel stakeholders. We identified determinants to implementation of mental health services for adolescents in LMIC across all levels of the Consolidated Framework for Implementation Research, of which of 25% were unique to adolescent-specific services. Through a series of stakeholder workshops focused on implementation strategy selection, prioritization, and specification, we then developed an implementation plan comprising 33 unique strategies that target determinants at the intervention, patient, provider, policy, and community levels. The implementation plan developed in this study will be evaluated for delivering adolescent depression services in Mozambican primary care and may serve as a model for other low-resource settings.

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model

BackgroundFrail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation.MethodsUsing the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes.ResultsThere were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process.ConclusionsThe i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.

Supervision for the Public Health Services for Older Adults Under the Background of Government Purchasing: An Evolutionary Game Analysis Framework.

As an important measure to involve services for older adults, the government procurement practices have become a key link for public health services. However, the information asymmetry between public health service purchasers and public health service undertakers triggers a supervision dilemma. Based on this background, this study uses the evolutionary game theory to analyze the symbiotic evolution between local governments and public health service institutions under different reward and punishment mechanisms, explore game evolution, strategy adjustment, and influencing factors of different game subjects, and analyze the necessity and appropriate intensity of dynamic rewards and punishment mechanisms. The results show that: under the static condition, the penalty can change the strategies of local governments to a certain extent, but it is still difficult to achieve complete self-discipline management of public health service institutions. If local governments implement a dynamic reward or penalty mechanism in the supervision process of public health services for older adults, the equilibrium between them tends to be evolutionary stable. For three dynamic mechanisms, a dynamic reward mechanism is more conducive to adopting a self-discipline behavior of public health service institutions, which is helpful to realize the supervision of public health services for older adults. Also, there is a positive correlation between the proportion of public health service institutions who adopt a “self-discipline behavior” strategy and the maximum punishment intensity, and a negative correlation with the reward intensity. This study provides theoretical and decision-making references for governments to explore the promotion and implementation of public health services in older adults.

Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia

BackgroundThe health insurance system in Indonesia was transformed in 2014 to achieve universal health coverage (UHC). The effective implementation of essential primary health services through UHC has resulted in efficient healthcare utilisation, which is reflected in the health-seeking behaviour of the community. Our study aimed to examine the changes in health-seeking behaviour before and after the implementation of UHC in Indonesia and to identify what factors determine these changes.MethodsWe conducted a retrospective cohort study using the recall method and data collected through questionnaire-based interviews in Bandung, Indonesia. We used a two-step sampling technique—randomised sampling and purposive sampling, and a total of 579 respondents with acute or chronic episodes were recruited. {chi }^{2} tests were used to identify the association between factors. Difference in difference model and a logistic regression model for binary outcomes were used to estimate the effect of the implementation of UHC on the health-seeking behaviour.ResultsUtilisation of public health facilities increased significantly after implementation of UHC, from 34.9% to 65.4% among the respondents with acute episodes and 33.7% to 65.8% among those with chronic episodes. The odds of respondents going to health facilities when they developed an acute episode increased after the implementation of UHC (OR = 1.22, p = 0.05; AOR = 1.42, p < 0.001). For respondents experiencing chronic episodes, the implementation of UHC increased the odds ratio (OR = 1.74, p < 0.001; AOR = 1.64, p < 0.001) that they would use health facilities. Five years after the implementation of UHC, we still found respondents who did not have health insurance (26 and 19 respondents among those with acute episode and chronic episode, respectively).ConclusionsThe effect of the implementation of UHC seemed greater for those experiencing chronic episodes than for those with an acute episode. Although the implementation of UHC has improved utilisation of public health facilities, the presence of people who are not covered by health insurance is a potential problem that could threaten future improvements in healthcare access and utilisation.

Analisis Determinan Kejadian Stres Kerja pada Pegawai Rumah Sakit Nasional Diponegoro Semarang Selama Pandemi Covid-19

Hospital is one form of health facilities, organized by the community to carry out basic health efforts or health referrals and supporting health efforts. Nurses and employees as one of the professions in the hospital have an important role in the implementation of health services. The main task of a hospital employee is to serve and care for patients to speed up the healing process. Because of its dynamic work, a nurse and employee need to have good body condition, healthy, and have enough energy. Unfavorable body conditions result in a nurse easily discouraged when while working he experienced physical fatigue, emotional exhaustion, and mental fatigue.. Work stress is an emotional and physical response that is disturbing or detrimental that occurs when the demands of the task are not in accordance with the ability, resources, or desires of the worker. The purpose of this study was to look at factors related to work stress events such as workload, work shifts, social support, and out-of-work activities at employees of Diponegoro National Hospital Semarang during the Covid-19 Pandemic. This research uses this type of analytical survey research with cross sectional methods. The population in this study was 83 employees. The total sample size is 83 employees. Data analysis using Chi square correlation test with significance level of 0.05. The results showed that the characteristics of respondents in this study were the majority of respondents with female gender (67.5%), young adulthood (24 - 29 years), Poly Outpatient work (12%), and working life 0-4 years (48.2%). There is a relationship between work stress and workload and work stress with work, while variable social support, and activities outside of work have no significant relationship with work stress in employees of Diponegoro National Hospital Semarang during the Covid-19 pandemic.

ASPEK PENYELENGGARAAN HUKUM PRAKTIK KEDOKTERAN BERDASARKAN UNDANG-UNDANG NO. 9/2004 TENTANG PRAKTIK KEDOKTERAN

The community is not just an object but also as a subject of health services, therefor, the implementation of public health services is the responsibility of government and community. A strategic public policy such as Medical Practice Act No. 29 of 2004, is expected to overcome problems related to health services. Two basic issues of this regulation, firstly, to protect community from an exploitative and unethical of medical practice which may decrease community trust toward medical professions; secondly, to provide a legal certainty and legal protection of medical profession against an excessive community litigation

Training and Assistance for Housewives' Group to Create a CEHATI Family (Smart, Healthy, and Active) in Efforts to Maintain Children's Health

The school age is a critical period, because at this time infectious diseases often occur in children. The incidence of infectious diseases in children is increasing which will have an impact on the growth and physical development of children. The role of mother is very important such as in the implementation of health services for children and families in order to make efforts to prevent infectious diseases in children. The purpose of training and mentoring activities by forming a CEHATI (Smart, Healthy and Active) family can increase the knowledge and skills of mothers in efforts to maintain children's health at home. The method of implementing community service activities is carried out by providing education, training and assistance to 50 housewives groups. Education is carried out by providing health education about disease problems in children, PHBS and Handling the Risk of Injury to children, followed by simulation and training on handling injuries at home and providing assistance. The results of the implementation of this community service activity showed that the mother's knowledge of infectious diseases and PHBS was in good category (100%), after training and mentoring activities were carried out. The results of the paired t-test before and after being given training and mentoring obtained a p value of 0.000. As a result of this activity, it is hoped that the group of housewives can increase their knowledge and be independent in efforts to maintain children's health so that they are formed into a CEHATI (Smart, Healthy and Active) family.

Professionals\u2019 perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary healthcare

BackgroundGout affects nearly 2 % of the population and is associated with repeated painful flares of arthritis. Preventive urate-lowering therapy is widely available, but only one third of patients receive adequate treatment. Lack of knowledge among healthcare professionals and patients within primary healthcare are implicated as partial explanations for this undertreatment. Nurse-led care has proved to be an effective model when treating patients with gout, but there is a need for more knowledge about factors that can be expected to influence the future implementation of such care. The aim of this study was to describe factors influencing existing gout care in primary healthcare and the conditions for a future implementation of nurse-led gout care based on national treatment recommendations.MethodsIn this qualitative study, focus group discussions with 56 nurses and physicians and individual interviews with eight managers were conducted at nine primary healthcare units in central Sweden. A deductive qualitative content analysis based on the main constructs of the framework Integrated Promoting Action on Research Implementation in Health Services was followed by an inductive analysis within the frames of the main constructs: innovation, recipients and context.ResultsGout-related contacts with primary healthcare was described as being patient initiated, diagnostics was in some respects complex and nurse-led care was experienced as a favourable primary healthcare model in general (innovation). Gout was seen as a low-priority condition with acute flares and there was inadequate knowledge of gout, including preventive treatment (recipients). Primary healthcare was perceived as having a holistic but fragmented responsibility for gout care, recommendations against keeping waiting lists complicated follow-up appointments and a need for motivation and support when introducing new practices was emphasised (context).ConclusionIn this study, investigating the perspective of professionals, several factors were found to influence existing gout care. It will be crucial to target these factors in the development of a future implementation strategy.