Improve Healthcare Systems Research Articles

Examining dimensions of career intentions: insights from medical and nursing students at a private not-for profit university in Vietnam.

Understanding students' career intentions through evidence-based approaches is crucial for developing effective career guidance and intervention strategies. Although there has been considerable attention in this field, research remains limited, particularly in low- and middle-income countries (LMICs) in Asia. These regions have unique socioeconomic conditions and cultural norms that potentially shape decision-making processes. This study provides insights into the career intentions of medical and nursing students and identifies the key determinants influencing their choices at a newly established private institution (VinUniversity) in Vietnam. This study employs a mixed-methods design. The quantitative phase involved a survey of all undergraduate medical and nursing students. The qualitative phase consisted of in-depth 11 individual interviews with a purposive sample until data saturation. A total of 198 students (77%) participated in the quantitative phase. The majority of students (75.8%) expressed interest in clinical practice, with preferences notably high for surgical specialties (30.9%), internal medicine (10.1%), and pediatrics (10.1%). 22.7% of students expressed a desire to work overseas, and a significant number (70.7%) indicated the lack of a career guidance program. Qualitative data revealed that personal interest, family influence, financial stability, and societal appreciation were primary influencers in career choice. The study underscores the complex interplay between personal interests, family influence, financial considerations, and societal expectations in shaping career choices. The persistent low interest in family medicine and primary care continued to be a concern. This study provides further insights into the career intentions and influencing factors among medical and nursing students at VinUniversity. The implications for practice include implementing tailored career guidance programs, offering diverse elective tracks that incorporate global health experiences, and establishing structured mentorship programs. It is also recommended to measure the impact of these interventions through longitudinal follow-up studies to enhance career satisfaction, better prepare future healthcare professionals, and contribute to the improvement of healthcare systems.

Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse).

In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services. For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement. We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted. The health-care system in Malawi provides substantial health gains with scarce resources. Strengthening interventions could potentially increase these gains, so should be a priority for investigation and investment. An individual-based simulation model of health-care service delivery is valuable for health-care system planning and strengthening. The Wellcome Trust, UK Research and Innovation, the UK Medical Research Council, and Community Jameel.

Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel - National Healthcare Safety Network, United States, 2023-24 Respiratory Virus Season.

The Advisory Committee on Immunization Practices (ACIP) recommends that health care personnel receive an annual influenza vaccine. In September 2023, ACIP recommended that everyone aged ≥6 months receive a 2023-2024 COVID-19 vaccine. Health care facilities, including acute care hospitals and nursing homes, report vaccination of health care personnel against influenza and COVID-19 to CDC's National Healthcare Safety Network (NHSN). During October 2023-March 2024, NHSN defined up-to-date COVID-19 vaccination as receipt of a 2023-2024 COVID-19 vaccine. This analysis describes influenza and 2023-2024 COVID-19 vaccination coverage among health care personnel working in acute care hospitals and nursing homes during the 2023-24 respiratory virus season (October 1, 2023-March 31, 2024). Influenza vaccination coverage was 80.7% among health care personnel at acute care hospitals and 45.4% among health care personnel at nursing homes. Coverage of 2023-2024 COVID-19 vaccination was 15.3% among health care personnel at acute care hospitals and 10.5% among health care personnel at nursing homes. Respiratory viral diseases including influenza and COVID-19 pose risks to health care personnel in U.S. health care settings, and vaccination of health care personnel is an effective strategy for maintaining a healthy workforce and improving health care system resiliency.

Joint effect of tobacco and meat on cardiovascular disease and treatment adherence in Indian Women

Abstract Background Cardiovascular disease (CVD) is a leading cause of death for both men and women in India. But it is often overlooked in women. Tobacco and meat consumption are common risk factors for CVD. While individual studies have explored the link between tobacco or meat consumption and CVD, their joint effect remained understudied. Methods The study analyzed data from the National Family Health Survey 2019-21, of 711431 women aged 15 to 49 in India. Univariate and multivariate logistic regression were used to assess the risk of individual and joint effects of tobacco and meat consumptions on self-reported CVD prevalence. Age, BMI, education, wealth index, residency, region, religion, and alcohol were used as covariates. Additionally, interactions model was assessed. Lastly, treatment adherence for CVD was studied, considering treatment behavior, insurance, and healthcare access barriers. Results Cardiovascular disease prevalence was 0.72%. The risk of CVD was higher among the smokers [aOR: 2.26(1.83-2.73)] than smokeless tobacco [aOR: 1.34(1.21-1.49)] consumers. In contrast daily meat consumers showed higher risk [aOR: 1.23(1.03-1.47)] than meat non-consumers. Women who were consumers of both tobacco and meat had risk of [aOR: 1.15 (1.02 - 1.30)] CVD compared to who did not consume both tobacco and meat. Interaction was not detected between tobacco and meat consumption. CVD treatment adherence was higher among the women who possess an insurance [OR: 1.11(1.04-1.19)]. The risk of treatment non-adherence was higher among women who were aged below 40 with no education and from the poorest section of the society. Barriers for accessing health care facilities were solo attendance, provider availability, and drug access. Conclusions Tobacco and meat both need to be addressed to control CVD among women. Empowering women and bringing them under government insurance with an improve health care system are crucial. Key messages • The joint effect of tobacco and meat consumption increased the risk of cardiovascular diseases among women. However, there was no interaction effects observed between tobacco and meat consumption. • Healthcare facilities needs to be improved and awareness among young adults are extremely crucial for better CVD treatment management among women in India.

The Nursing Theory of Complex Adaptive Systems: A New Paradigm for Nursing.

This article explores the theoretical and practical implications of the meaning of thinking, living, and acting within the framework of nursing in Complex Adaptive Systems. The Nursing Theory of Complex Adaptive Systems is grounded in the principles of Complex Adaptive Systems (CASs). It seeks to offer a new paradigm for nursing practice that addresses healthcare's dynamic and evolving nature. The Nursing Theory of Complex Adaptive Systems represents a new nursing paradigm capable of addressing the challenges of a constantly evolving healthcare environment. This theory promotes personalized care plans adaptable to patients' changing needs by emphasizing a holistic and interactive approach to care. It also underscores the importance of interprofessional collaboration and effective communication in improving the quality of care. The Nursing Theory of Complex Adaptive Systems has significant implications for nursing practice, education, and research. It provides a robust framework for developing adaptive and resilient nursing practices that can respond to the complexities of modern healthcare. By integrating the principles of CASs into nursing, the Nursing Theory of Complex Adaptive Systems fosters a more flexible, interdependent, and holistic approach to patient care, ultimately enhancing patient outcomes and improving healthcare systems. This theory has practical applications in various healthcare settings, offering a framework for personalized and adaptable care plans that respond to the dynamic needs of patients while improving overall system efficiency. Future research should focus on the empirical validation of the Nursing Theory of Complex Adaptive Systems and its practical implementation in various healthcare settings.

Integrated Service Pos Program Outcomes for Elderly in Kebonsari Village

Background: The elderly population has unique health needs requiring specialized services. Specific Background: This study investigates the implementation of the Posyandu Lansia Wijaya Kusuma program, focusing on operational procedures and challenges in a rural context. Knowledge Gap: There is a lack of understanding regarding specific obstacles faced in implementing such health programs in similar communities. Aims: This research aims to evaluate program operations and identify hindering factors. Results: Data from interviews and participatory observations indicate a structured Standard Operating Procedure (SOP) for the Posyandu Lansia, facilitating essential health services. While the program follows a clear framework, operational barriers impact service delivery. Novelty: This study highlights the importance of adhering to SOPs to enhance healthcare outcomes for the elderly, offering insights distinct from previous research emphasizing SOP improvements. Implications: Findings emphasize the need to optimize health services for the elderly, informing policy decisions to improve healthcare systems in rural areas and advocating for ongoing evaluation of health programs to address evolving elderly needs. Highlights : Structured SOP: The program follows a clear Standard Operating Procedure for service delivery. Operational Barriers: Identified challenges impact the effectiveness of health services for the elderly. Policy Implications: Findings inform improvements in rural healthcare systems and program evaluation. Keywords: elderly care, health services, Posyandu Lansia, implementation, rural health

Editorial for the Special Issue on “The Role of Accreditation in Improving Healthcare Systems Performance”

The Article Abstract is not available.

Impact of non-pharmaceutical interventions on COVID-19 incidence and deaths: cross-national natural experiment in 32 European countries

PurposeNon-pharmaceutical interventions (NPIs) have been the cornerstone of COVID-19 pandemic control, but evidence on their effectiveness varies according to the methods and approaches taken to empirical analysis.We analysed the impact of NPIs on incident SARS-CoV-2 across 32 European countries (March-December 2020) using two NPI trackers: the Corona Virus Pandemic Policy Monitor – COV-PPM, and the Oxford Covid-19 Government Response Tracker – OxCGRT.MethodsNPIs were summarized through principal component analysis into three sets, stratified by two waves (C1-C3, weeks 5–25, and C4-C6, weeks 35–52). Longitudinal, multi-level mixed-effects negative binomial regression models were fitted to estimate incidence rate ratios for cases and deaths considering different time-lags and reverse causation (i.e. changing incidence causing NPIs), stratified by waves and geographical regions (Western, Eastern, Northern, Southern, Others).ResultsDuring the first wave, restrictions on movement/mobility, public transport, public events, and public spaces (C1) and healthcare system improvements, border closures and restrictions to public institutions (C2) were associated with a reduction in SARS-CoV-2 incidence after 28 and 35-days. Mask policies (C3) were associated with a reduction in SARS-CoV-2 incidence (except after 35-days). During wave 1, C1 and C2 were associated with a decrease in deaths after 49-days and C3 after 21, 28 and 35-days. During wave 2, restrictions on movement/mobility, public transport and healthcare system improvements (C5) were also associated with a decrease in SARS-CoV-2 cases and deaths across all countries.ConclusionIn the absence of pre-existing immunity, vaccines or treatment options, our results suggest that the observed implementation of different categories of NPIs, showed varied associations with SARS-CoV-2 incidence and deaths across regions, and varied associations across waves. These relationships were consistent across components of NPIs derived from two policy trackers (CoV-PPM and OxCGRT).

Parent and healthcare professional experiences of critical congenital heart disease in New Zealand to advance health equity

BackgroundHigher odds of survival have been reported in European infants compared to Indigenous Māori and Pasifika infants with critical congenital heart disease in New Zealand. We therefore aimed to understand how to mitigate this disparity by investigating the parent and healthcare professional experiences’ of critical congenital heart disease healthcare in New Zealand.MethodsA prospective qualitative study utilising semi-structured interviews was conducted on a cohort of purposefully sampled parents and health professionals with experience of critical congenital heart disease healthcare in New Zealand. Parents were recruited after a fetal critical congenital heart disease diagnosis and offered two interviews at least three months apart, whilst multidisciplinary fetal and cardiosurgical health professionals were interviewed once. Interviews were recorded and transcribed verbatim before coding, categorization and qualitative analysis.ResultsDuring 2022 and 2023, 45 people participated in 57 interviews (25 parents: 19 mothers, 6 fathers; Indigenous Māori, n = 5; Pasifika, n = 6; Asian, n = 4; European, n = 10; and 20 healthcare professionals: European n = 17). The three lessons learned from participants were: (1) Minoritized groups experience disparate healthcare quality; (2) healthcare systems are under-resourced to provide equitable support for the differential needs of grieving parents; and (3) healthcare systems could engage minoritized families more optimally in shared decision-making.ConclusionsAccording to the experiences of parents and healthcare professionals, persisting inequities in CCHD healthcare quality occur by ethnic group, with the New Zealand healthcare system privileging European families. The concepts from this study could be translated by healthcare leaders, policymakers, and professionals into evidence-based healthcare system improvements to enhance experiences for non-European families more broadly.

Using the near real-time effective reproduction number rt as an early-warning tool for seasonal bronchiolitis and influenza-like illness epidemics.

Yearly bronchiolitis and influenza-like illness epidemics in France often involve high morbidity and mortality, which severely impacts healthcare. Epidemics are declared by the French National Institute of Public Health based on syndromic surveillance of primary care and emergency departments (ED), using statistics-based alarms. Although the effective reproduction number (Rt) is used to monitor the dynamics of epidemics, it has never been used as an early warning tool for bronchiolitis or influenza-like illness epidemics in France.We assessed whether Rt is useful for detecting seasonal epidemics by comparing it to the tool currently used (MASS) by epidemiologists to declare epidemic phases. We used anonymized ED syndromic data from the Île-de-France region in France from 2010 to 2022. We estimated Rt and compared the indication of accelerated transmission (Rt >1) to the MASS epidemic alarm time points. We computed the difference between those two time points, time to epidemic peak, and the daily cases documented at first indication and peak. Rt provided alarms for influenza-like illness and bronchiolitis epidemics that were, respectively, 6 days (IQR[4;8]) and 64 days (IQR[52;80]) - in median - earlier than the alarms provided by MASS. Rt detected earlier signals of bronchiolitis and influenza-like illness epidemics. Using this early-warning indicator in combination with others to declare an annual epidemic could provide opportunities to improve healthcare system readiness.

Information-Theoretic Security in Wireless Sensor Networks: Mathematical Models for Secure and Energy-Efficient Communication

Wireless Sensor Networks (WSNs) are used for a wide range of things these days, from watching the environment to improving healthcare systems. But because these networks are used everywhere, they are also open to security risks like spying, data corruption, and node capture. It is very important to address these issues in order to protect the accuracy, privacy, and access of data being sent. Information-theoretic security looks like a good way to deal with these problems because it uses mathematical models to make sure that transmission in WSNs is safe and uses little energy. This essay goes into detail about information-theoretic security in WSNs. It gives a full rundown of the mathematical basics and real-world implications for getting strong security in places with limited resources. The idea of "secrecy capacity" is at the heart of this method. It measures the highest rate at which authorized nodes can communicate privately while preventing spying foes. Utilizing the chance that exists in wireless channels, encrypted keys can be generated without using shared secrets, making them resistant to attempts that try to steal them. Because sensor nodes only have a short power life, energy economy is very important in WSNs. Information-theoretic security methods, like physical layer security and joint communication, are designed to use as little energy as possible while still providing strong security. Nodes can work together to improve signal strength and fight channel fading using cooperative methods. This makes the network last longer without compromising security. This article also talks about the trade-offs between security, energy savings, and communication performance in WSNs. This helps us figure out how to make the best transfer schemes.

Advances in pH Sensing: From Traditional Approaches to Next-Generation Sensors in Biological Contexts.

pH has been considered one of the paramount factors in bodily functions because most cellular tasks exclusively rely on precise pH values. In this context, the current techniques for pH sensing provide us with the futuristic insight to further design therapeutic and diagnostic tools. Thus, pH-sensing (electrochemically and optically) is rapidly evolving toward exciting new applications and expanding researchers' interests in many chemical contexts, especially in biomedical applications. The adaptation of cutting-edge technology is subsequently producing the modest form of these biosensors as wearable devices, which are providing us the opportunity to target the real-time collection of vital parameters, including pH for improved healthcare systems. The motif of this review is to provide insight into trending tech-based systems employed in real-time or in-vivo pH-responsive monitoring. Herein, we briefly go through the pH regulation in the human body to help the beginners and scientific community with quick background knowledge, recent advances in the field, and pH detection in real-time biological applications. In the end, we summarize our review by providing an outlook; challenges that need to be addressed, and prospective integration of various pH in vivo platforms with modern electronics that can open new avenues of cutting-edge techniques for disease diagnostics and prevention.

Climate Variability and Malaria Transmission: Unraveling the Complex Relationship

Climate change, an emerging issue, significantly impacts international health, particularly malaria, a critical issue that affects tropical and subtropical areas. Researchers have identified climate variability as a major determinant of malaria transmission and distribution. This review aims to disentangle the interplay between climate variability and malaria transmission, with a focus on temperature, rainfall, humidity, and extreme weather events and their influence on the Anopheles mosquito and Plasmodium parasites' life cycles. Writing this review article involved consulting several scientific databases and compiling information from them. Thus, incorporating data from epidemiology, ecology, climatology, and public health, this paper aimed at integrating knowledge on how climatic factors influence malaria incidence, distribution, and transmission density. This study emphasizes the importance of cross-disciplinary approaches in addressing these issues and highlights the need for synergy in implementing climate change mitigation, improved health care systems, advanced surveillance, and community mobilization to mitigate and manage malaria in the changing climate. Awareness of the factors determining climate variability and their relationship with malaria transmission patterns is important in formulating adequate strategies to cushion the impact of climate change on malaria incidence and secure world health.

Development of Medical Tourism Connections between Republic of Uzbekistan and Russian Federation

Today, global health and medical tourism issues are put on the front burner by the international community. Governments intend to design strategies for developing multi-country medical tourism programs while the number of cross-border private trips for medical services is increasing. All of this significantly contributes to the improvement of national healthcare systems. Internationalization is one of the major trends in the progress of global health, covering aspects of information, analytics and research. It results in a growing volume of medical services received abroad. These processes are called medical tourism in the context of global migration and the export of medical services in the context of the development of national economies.

Factors leading to lapses in professional behaviour of Gynae residents in Pakistan: a study reflecting through the lenses of patients and family, consultants and residents

IntroductionProfessional behaviour is the first manifestation of professionalism. In teaching hospitals, the residents can be considered vulnerable to lapses in professional behaviour when they fail to meet the set standards of professionalism. Residents of some specialties are more at risk of lapses in professional behaviour due to the demanding nature of work. Research focusing on the behaviour of residents in the field of Gynae and the underlying factors contributing to such behaviour is notably lacking in the literature. Additionally, there is a gap in understanding the perspectives of patients from Pakistan on this matter, as it remains unexplored thus far, which constitutes the central focus of this study.An increase in complaints lodged against Gynae resident’s professional behaviour in Pakistan Citizen Portal (PCP) was observed. Therefore, an exploratory qualitative study was conducted to investigate the factors and rationales contributing to the lapses in resident’s professional behaviour.The study collected the viewpoints of three stakeholder groups: patients and their families, consultants and residents. The study was conducted in three phases. First, the document analysis of written complaints was conducted, followed by face-to-face interviews (11 per group) conducted by trained researchers from an independent 3rd party. Finally, the interview data was transcribed, coded and analysed.In total 15 themes were identified from the interviews with 3 stakeholders, which were then categorized and resulted in 6 overlapping themes. The most prevalent lapse reported by all 3 stakeholders was poor verbal behaviour of residents.ConclusionThe highly ranked factors contributing to triggering the situation were associated with workplace challenges, well-being of residents, limited resources, patients and family characteristics, patients’ expectations, lack of administrative and paramedic support, cultural factors and challenges specific to Gynae specialty.Another intriguing and emerging theme was related to the characteristics of patients and attendants which helped in understanding the causes and implications of conflicting environments. The value of competency also emphasized that can be accomplished by training and mentoring systems. The thorough examination of these factors by key stakeholders aided in accurately analysing the issue, its causes, and possible solutions. The study's findings will assist higher authorities in implementing corrective actions and offering evidence-based guidance to policymakers to improve healthcare system.

Rationalizing the Influence of Co-Design on Distress, Clinical Decision-Making and Disease Self-Management of Cancer Patients-as-Partners: A Quasi-Experimental Study.

Cancer is regarded as a major worldwide burden. Patient distress has been linked to disease progression. Studies show that engagement strategies affect clinical decision-making and patient outcomes. The optimal engagement method is a partnership that integrates the patient's expertise into the comprehensive co-design of the healthcare system. This is the first study to investigate cancer patient-as-partner experience and its impact on distress levels, decision-making and self-management. It is a quantitative and quasi-experimental study that adopted a partnership committee at a Lebanese hospital. A stratified random sampling approach was used, and data were collected by self-administered questionnaires. We utilized the standardized distress thermometer and PPEET. We recruited 100 patient partners. Cancer patients-as-partners had optimal engagement experience in QI projects (mean = 4; SD = 0.4). The main partnership benefit was improved hospitalization experience (49%). Almost half of PP reported no challenges faced (49%). Recommendations for improvement were training (19%), team dynamics management (12%) and proper time allocation (7%). The distress level post-partnership was significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of partnership and ‎its ability to influence shared decision-making preference [χ2(2) = 13.81, p = 0.025] and self-management practices [F(3, 11.87) = 7.294, p = 0.005]. Research findings suggest that partners from disadvantaged groups can have optimal partnership experience. A partnership model of care can shape the healthcare system into a people-oriented culture. Further research is needed to explore diverse PP engagement methodologies and their effect on organizational development. Patients and family members were engaged in the co-design of the study methodology, especially the modification of a research instrument. Patient partners with lived experience were involved in the patient partnership committee as core members to improve healthcare system design and evaluation.

Giving patients a voice for healthcare reform in Austria: the qualitative voice-study.

Inclusion of patients in healthcare service and system planning is an increasingly important tool to improve healthcare systems worldwide. In 2012, a focused healthcare reform was initiated in Austria to strengthen the primary care sector which is still underway in 2023. The aim of this study was to assess the perceptions, desires, and needs of patients in terms of primary care as a necessary building block of the Austrian healthcare reform. This study was designed as an exploratory qualitative study using semi-structured interviews between the years 2013 and 2018. Interviews with patients focused on positive and negative experiences with regard to general practice (GP) consultations and perceptions of the primary care system in general, as well as desires for improvement. Qualitative content analysis was used to analyse the material using the software atlas.ti. Altogether, 41 interviews were conducted with seven categories identified. These categories include organization and time management around consultation, access, and availability including opening hours, human and professional aspects of consultation, infrastructure and hygiene of the waiting room, healthcare system factors, as well as non-clinical/administrative staff. Appreciating and responding to patients' perceptions and needs, healthcare reform in Austria should include improvements regarding consultation/waiting time, coordination, and navigation in Primary Care. Successful healthcare reform has to include the patient voice.

#2582 For an efficient CKD healthcare delivery, knock on a door of the orthopaedist!

Abstract Background and Aims CKD patients are usually free from symptoms. Some of them do not wish to visit a physician until the very moment when they suffer from symptoms. Those CKD patients might be found more often in certain medical specialities than others. In order to improve healthcare system efficacy, it is imperative to find the best field we should dig in. Method A hospital-wide survey was performed including all the patient visits according to specialities over 365 days in a general hospital. All the laboratory data including eGFR and haemoglobin were retrieved during the period. In case of multiple laboratory measurements in a single patient, a median value was used for analysis. Prevalence of cases with at least one measurement of eGFR during the period was 5 559/11 582 (48.0%) in medicine, 1 195/2 405 (49.7%) in surgery, 691/3 301 (20.9%) in orthopaedics, and 2 808/12 450 (22.5%) in “other” specialities. Here, “other” specialities are highly heterogeneous, including gynecology, dermatology, ophthalmology, otorhinolaryngology, anesthesiology and urology. Results A total of 29 738 patients were analyzed. The prevalence of eGFR less than 60 mL/min/1.73 m2 was highest in orthopaedics (353/691, 51.1% among patients with eGFR measurement), much more than those in medicine (2,341/5,559, 42.1%), in surgery (364/1 195, 30.5%) or in others (1 052/2 808, 37.4%). The prevalence of eGFR less than 45 mL/min/1.73 m2 was highest again in orthopaedics (133/691, 19.2%), much more than those in medicine (794/5 559, 14.3%), in surgery (80/1,195, 6.7%) or in others (339/2,808, 12.0%). The prevalence of renal anemia, defined as eGFR &amp;lt;60 mL/min/1.73 m2 and haemoglobin &amp;lt;11 g/dL, was highest in orthopaedics (74/691, 10.7%), compared with those in medicine (302/5 559, 5.4%), in surgery (35/1 195, 2.9%) or in others (123/2 808, 4.5%). Conclusion For an efficient CKD healthcare delivery, the exceedingly high prevalence of CKD among patients visiting orthopaedics should not be missed.

Opinion review of drug resistant tuberculosis in West Africa: tackling the challenges for effective control.

Drug-resistant (DR) tuberculosis (TB) is a major public health concern globally, complicating TB control and management efforts. West Africa has historically faced difficulty in combating DR-TB due to limited diagnostic skills, insufficient access to excellent healthcare, and ineffective healthcare systems. This has aided in the emergence and dissemination of DR Mycobacterium tuberculosis complex (MTBC) strains in the region. In the past, DR-TB patients faced insufficient resources, fragmented efforts, and suboptimal treatment outcomes. However, current efforts to combat DR-TB in the region are promising. These efforts include strengthening diagnostic capacities, improving access to quality healthcare services, and implementing evidence-based treatment regimens for DR-TB. Additionally, many West African National TB control programs are collaborating with international partners to scale up laboratory infrastructure, enhance surveillance systems, and promote infection control measures. Moreso, novel TB drugs and regimens, such as bedaquiline and delamanid, are being introduced to improve treatment outcomes for DR-TB cases. Despite these obstacles, there is optimism for the future of DR-TB control in West Africa. Investments are being made to improve healthcare systems, expand laboratory capacity, and support TB research and innovation. West African institutions are now supporting knowledge sharing, capacity building, and resource mobilization through collaborative initiatives such as the West African Network for TB, AIDS, and Malaria (WANETAM), the West African Health Organization (WAHO), and other regional or global partners. These efforts hold promise for improved diagnostics, optimized treatment regimens, and provide better patient outcomes in the future where drug-resistant TB in WA can be effectively controlled, reducing the burden of the disease, and improving the health outcomes of affected individuals.

A longitudinal qualitative exploration of Victorian healthcare workers’ and organisations’ evolving views and experiences during COVID-19

BackgroundThe COVID-19 pandemic has profoundly impacted individuals, society, and healthcare organisations worldwide. Recent international research suggests that concerns, needs, and experiences of healthcare workers (HCWs) have evolved throughout the pandemic. This longitudinal qualitative study explored the evolving views and experiences of Victorian healthcare workers (HCWs) and organisational key personnel during the coronavirus disease (COVID-19) pandemic.MethodsWe recruited participants from the Coronavirus in Victorian Health and Aged care workers (COVIC-HA) study cohort. We conducted two rounds of semi-structured interviews with HCWs and organisational key personnel from three different healthcare settings (hospital, aged care and primary care) in Victoria, Australia, in May-July 2021 and May-July 2022. Data were analysed thematically using trajectory and recurrent cross-sectional approaches, guided by a temporal change framework.ResultsTwelve HCWs and five key personnel from various professional roles participated in interviews at both timepoints. Expected themes derived from mid-2021 interviews (navigating uncertainty, maintaining service delivery, and addressing staff needs) evolved over time. Concerns shifted from personal health and safety to workforce pressures, contributing to HCW burnout and fatigue and ongoing mental health support needs. New themes emerged from mid-2022 interviews, including managing ongoing COVID-19 impacts and supporting the healthcare workforce into the future. Clear and consistent communication, stable guidelines and forward-looking organisational responses were considered crucial.ConclusionsOur longitudinal qualitative study highlighted the evolving impact of the COVID-19 pandemic on HCWs’ perceptions, health and wellbeing and uncovered long-term sector vulnerabilities. Analysing HCW experiences and key personnel insights over time and across different pandemic phases provided crucial insights for policymakers to protect the healthcare workforce. Findings emphasise the need for proactive strategies that prioritise HCWs’ wellbeing and workforce sustainability. Policy makers must invest in HCW health and wellbeing initiatives alongside healthcare system improvements to ensure resilience and capacity to meet future challenges.Trial registrationThis study was approved through the Victorian Streamlined Ethical Review Process (SERP: Project Number 68,086) and registered with ANZCTR (ACTRN12621000533897) on 6 May 2021.