International Healthcare Research Articles

The impact of impaired insulin regulation on severity of SARS-CoV-2 infection: a 2-year retrospective single-center analysis

Background: The COVID-19 pandemic has caused an international healthcare crisis and produced a large healthcare burden. Diabetes mellitus (DM) is a common disease that can be controlled via pharmacologic agents; however, many patients have poor glycemic control, leading to disease-related complications. DM has been reported in the literature to be associated with increasing morbidity and mortality in COVID-19 patients. The authors aim to assess the associations between glucose homoeostasis and COVID-19 disease severity and mortality. Methods: A retrospective chart review of patients ages 18–100 years of age admitted with COVID-19 between January 2020 and December 2021 was performed. The primary outcome was COVID-19 mortality with respect to haemoglobin A1C levels of less than 5.7%, 5.7–6.4%, and 6.5% and greater. Disease severity was determined by degree of supplemental oxygen requirements (ambient air, low-flow nasal cannula, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation). COVID-19 mortality and severity were also compared to blood glucose levels on admission as grouped by less than 200 mg/dl and greater than or equal to 200 mg/dl. Results: A total of 1156 patients were included in the final analysis. There was a statistically significant association between diabetic status and mortality (P=0.0002). Statistical significance was also noted between admission blood glucose ≥200 mg/dl and mortality (P=0.0058) and respiratory disease severity (P=0.0381). A multivariate logistic regression for predicting mortality showed increasing haemoglobin A1C was associated with increased mortality (odds ratio 1.72 with 95% CI of 1.122–2.635). Conclusions: In our 2-year retrospective analysis, there was an association between a diagnosis of DM and COVID-19-related mortality. Hyperglycaemia on admission was found to be statistically significant with mortality in patients diagnosed with COVID-19. Glucose homoeostasis and insulin dysregulation likely play a contributing factor to COVID-19 disease severity and mortality.

Abstract 241: Outcomes of Statins Post‐Endovascular Thrombectomy in Ischemic Stroke

Introduction Acute large vessel occlusions (LVOs) represent one‐third of acute ischemic strokes (AIS). LVOs are associated with high mortality and severe functional deficits. Several factors have been reported to play a role in improving outcomes after Endovascular Thrombectomy (EVT). Previous animal studies indicated that statins may have a protective effect on vessel wall injury caused by mechanical thrombectomy. We conducted a retrospective study to analyze whether pretreatment with statins influence the clinical and safety outcomes of EVT in AIS. Methods We conducted a retrospective observational study using the TriNetX database, a global health research network that provides access to electronic medical records retrieved from multiple international healthcare organizations but predominantly from the United States. We collected data about patients' diagnoses (using ICD‐10‐CM codes), medical procedures, medications, and demographics. Investigators were blinded to patients’ personal information or identification of participating healthcare organizations. Our study included adult patients with AIS who received EVT treatment (either extirpation or dilation procedure) between January 4, 2018, and December 31, 2022. The study patients were categorized into two groups based on whether or not they were on statins (Rosuvastatin, Simvastatin, Pravastatin, Atorvastatin, Lovastatin or Pitavastatin) during 3 months prior to hospitalization for AIS. Thirty‐day timepoint assessment was chosen to analyze the primary outcome (all‐cause mortality) and secondary outcomes [intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), decompressive hemicraniectomy procedure (DHC), and aspiration pneumonia]. The chi‐square χ2 test was used to analyze baseline characteristics for categorical variables and the independent‐sample t‐test was used for continuous variables. Matching propensity scores (with a tolerance level of 0.01 and the difference between propensity scores ≤ 0.1) were used to control differences in the comparison cohorts. Results We identified 11,972 patients who received EVT for LVO ischemic stroke. A total of 5,839 patients were on statins during 3 months prior to EVT and 6,133 were not on statins. After 1:1 propensity matching, 1,602 patients were included in each group. Kaplan‐Meier survival analysis showed the 30‐day mortality rates were significantly less for patients who were on statins compared to those who were not and with higher survival probability [87.2% vs. 77.5%, hazard ratio 0.54; confidence interval (CI): 0.45,0.64]. In comparison to EVT patients who were not on statins, those who were on statins had significantly lower rates of ICH [9.9 vs 14.1%; odds ratio (OR) 0.67; 95% CI (0.53,0.84)], lower rates of SAH [4.1 vs. 6.3%; OR 0.64; 95% CI (0.46,0.89)] and lower rates of aspiration pneumonia [5.6 vs 8.3%; OR 0.66; 95% CI (0.50,0.88)]. There was no significant difference in rates of DHC in the statins group in comparison to patients who were not on statins [1.8 vs 2.4%; OR 0.74; 95% CI (0.45,1.22)]. Conclusion Pretreatment with statins was associated with significantly better survival, less bleeding risks, and lower complication rates in LVO ischemic strokes post‐EVT. Future studies may help examine the differential effects of statin type and dose intensity on LVO strokes treated with EVT.

The Myth Of Superfluous Pre-Operative NPO After Midnight.

Madam, Pre-operative nil per or nothing by mouth from midnight practice has been in work since 1960s.1 Its indiscriminate use is believed to prevent perioperative aspiration causing pneumonia 2, respiratory failure, morbidity and mortality. In almost every hospital in Pakistan and globally, the fasting orders from midnight are excessively used in case of morning elective surgical and medical procedures using general or regional anaesthesia.3 These not take into account the duration and type of surgery, type of sedation, choice of airway, risk stratification for increased chances of aspiration such as obesity, age, esophageal disorders. 4 However, the revolutionised current guidelines for pre-operative fasting by ASA 5-6 suggest the much shorter “2-4-6” hour rule, with NPO for two hours for clear liquids, four hours for breast milk and six hours for solids. Hence, the awareness about this myth needs to change in Pakistani healthcare centres. Recent studies have led to a more sophisticated understanding of gastric emptying and pH of gastric contents. For instance, a cochrane review showed no statistical difference in gastric volumes or stomach pH in patients on a prolonged standard fast vs shortened (<180 minute) liquid fast.7 Furthermore, the 2-4-6 rule minimises the risk of dehydration, electrolyte imbalance, patient discomfort (thirst, hunger, nausea, vomiting, anxiety) 8, hypoglycemia, intraoperative haemodynamic instability, post- operative dehyhydration and extended hospital stay. In this way patient cooperation and satisfaction can be increased. Therefore, it is high time to change the highly controversial NPO policy to reach the international healthcare standard.

KNOWLEDGE AND ATTITUDES OF NURSING STUDENTS ABOUT AGEING AND FRAIL-ELDERLY CARING AT COLLEGE OF NURSING IN UNIVERSITY OF BAGHDAD

Introduction: The issue of an ageing population is a significant one now confronting international healthcare systems. The aging population is associated with a higher probability of experiencing health issues, the aims of this study are to assess the knowledge and attitudes of nursing students about ageing and frail-elderly caring at college of nursing in university of Baghdad. Methods: a cross-sectional descriptive investigation carried out among a cohort of nursing students, study sample included 154 nursing students and was distributed according to department. A researcher used a direct interview sheet to gather the data from January 2023 to March 2023, questionnaire consisted of three major parts, data analysis by utilization of the Statistical Package for the Social Sciences version 26, Qualitative data was presented using frequency, percentage distribution and Chi-square test. Results: Results study show knowledge nursing students about ageing and elderly caring all of their answer were know, attitude nursing students about ageing and elderly caring most of their answer were agree, positive significant relationship between nursing students’ knowledge and attitude about ageing and frail-elderly caring. Conclusion: The nursing student’s assessment of knowledge about ageing and frail-elderly caring and is good in all items, good level of attitude about ageing and frail-elderly caring in all items,, age, department and participated in lectures on aging and frail-elderly care, and show high positive significant relationship between nursing students’ attitude about ageing and frail-elderly caring and age, marital status, economic status, and participated in lectures on aging and frail-elderly care.

Inequalities in oral health service utilisation in Ireland: results from the Healthy Ireland Survey

Abstract Background Good oral health is important for overall health and wellbeing; poor oral health disproportionately affects disadvantaged groups and is associated with various non-communicable diseases, many of which have shared risk factors, including diabetes and cardiovascular disease. Regular dental attendance with risk assessment optimises oral health. Due to an ageing dentate population, demands on oral health services are predicted to increase in Ireland. This cross-sectional assessment of oral health service utilisation aimed to inform equitable national resource allocation. Methods Secondary analysis of the Healthy Ireland Survey 2022, a telephone-delivered survey of a representative sample of the Irish public aged ≥15 years, was conducted. Prevalence of dental attendance in the preceding year was measured with 95% Confidence Intervals (CIs). Logistic regression determined factors associated with dental attendance using Adjusted Odds Ratios (aORs). Results Response rate was 40.4% (N = 7,455). Most participants (81.3%) self-reported good or very good overall oral health; 49.3% had attended dental services in the previous year. Compared to comparative counterparts those of higher educational level (aOR 1.28 95% CI 1.09-1.50), those with private health insurance (aOR 1.66 95% CI 1.48-1.86) and those with no missing teeth (aOR 2.91 95% CI 2.19-3.85) were significantly more likely to have attended dental services in the previous year. Conversely, compared to those aged 25-34 years, those aged 65+ had significantly lower odds of dental attendance in the previous year. Conclusions Disparities in oral healthcare utilisation identified in this study suggest potential unmet population oral health needs. Combined with population ageing and a growing scarcity of dentists available to provide care to disadvantaged groups such coverage gaps are key considerations for Irish oral healthcare planning, namely implementation of Ireland's National Oral Health Policy ‘Smile agus Sláinte’ 2019. Key messages • In this nationally representative cross-sectional survey of Irish adults notable disparities in oral health service utilisation were evident, especially among older adults. • Aligning with the universal health coverage agenda, suggested unmet population oral health needs are key considerations for national and international oral healthcare planning and resource allocation.

The Future of HSR Program Evaluation: A European Perspective

Abstract There is a long tradition of program evaluation in public health, due to the influence of medical approaches and the development of evidence-based medicine. Health services research have thus provided substantial evidence and built itself partially on the evaluation of organizational innovations over time in various international healthcare settings. What is new here? What is the future of HSR from an evaluation perspective? Since the turn of the century, two main shifts in the resources and methods available to public health researchers could provide a significant leap for HSR research in Europe, and in France especially. First, more data are being produced and made available to researchers. Most healthcare systems in Europe have implemented DRGs and for doing so, information systems have been developed incidentally. This led to the routine production of data initially used for payment schemes, that are now increasingly being used for research. Although this is similar to what happened in the US, the main difference with European healthcare systems lies in the generalized approach of the welfare system to the whole population. Second, evaluation methods recently evolved towards the framework of what is known as “realist evaluation” based on the causal analysis of programs or public policies while incorporating contextual effects and a theoretical perspective to explain rather than merely measure the effect - or lack thereof. To conclude, we shall argue that the future of HSR program evaluation may bring together researchers, health professionals and policymakers to discuss, explore, experiment and implement innovative actions in healthcare to address the challenges to come.

Sustainability efforts in healthcare simulation and clinical learning: An international survey

BackgroundLittle is known about international environmental sustainability practices in healthcare simulation education. Understanding these practices can elucidate current differences in practice, promote sharing of current practices, and establish baseline efforts for improving sustainability practices globally. Therefore, an electronic survey was undertaken targeting international healthcare simulation centers to acquire a more comprehensive understanding of healthcare simulation education sustainability practices in differing international settings. ResultsOnly 40 % of respondents had a written sustainability plan, but 68.75 % indicated their center purchased environmentally preferable supplies, 100 % endorsed supply reuse, 60.4 % endorsed supply recycling, and 37.5 % endorsed sustainable supply disposal. Most participants cited “environmental consciousness” motivated these efforts. Comparison analyses found significant differences between the U.S. and Canada for recycling (p = 0.0065) and disposal (p = 0.0074), and between Canada and international countries for recycling (p = 0.01395). ConclusionCanadian simulation centers implement more waste reduction practices than any other country surveyed. Further research should investigate factors contributing to variability and perceptions of sustainability efforts, as well as differences in international waste reduction capabilities. Countries with the most successful waste reduction efforts should advertise and expand them. In addition, healthcare simulation centers must be aware of current options for plastic reuse and embed those practices into healthcare simulation centers. Embedded practices should be taught to all simulation educators and students, with the ultimate goal of students translating these ideas into practice. The summation of improving these sustainability efforts in healthcare simulation education can have a positive global impact.

Implementing digital mental health interventions at scale: one-year evaluation of a national digital CBT service in Ireland

BackgroundIn recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service).MethodsA retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models.ResultsThere were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (β = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (β = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen’s d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%.ConclusionsEfforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.

Towards interoperability in infection control: a standard data model for microbiology

The COVID-19 pandemic has made it clear: sharing and exchanging data among research institutions is crucial in order to efficiently respond to global health threats. This can be facilitated by defining health data models based on interoperability standards. In Germany, a national effort is in progress to create common data models using international healthcare IT standards. In this context, collaborative work on a data set module for microbiology is of particular importance as the WHO has declared antimicrobial resistance one of the top global public health threats that humanity is facing. In this article, we describe how we developed a common model for microbiology data in an interdisciplinary collaborative effort and how we make use of the standard HL7 FHIR and terminologies such as SNOMED CT or LOINC to ensure syntactic and semantic interoperability. The use of international healthcare standards qualifies our data model to be adopted beyond the environment where it was first developed and used at an international level.

Development and validation of the early warning system scores ontology

BackgroundClinical early warning scoring systems, have improved patient outcomes in a range of specializations and global contexts. These systems are used to predict patient deterioration. A multitude of patient-level physiological decompensation data has been made available through the widespread integration of early warning scoring systems within EHRs across national and international health care organizations. These data can be used to promote secondary research. The diversity of early warning scoring systems and various EHR systems is one barrier to secondary analysis of early warning score data. Given that early warning score parameters are varied, this makes it difficult to query across providers and EHR systems. Moreover, mapping and merging the parameters is challenging. We develop and validate the Early Warning System Scores Ontology (EWSSO), representing three commonly used early warning scores: the National Early Warning Score (NEWS), the six-item modified Early Warning Score (MEWS), and the quick Sequential Organ Failure Assessment (qSOFA) to overcome these problems.MethodsWe apply the Software Development Lifecycle Framework—conceived by Winston Boyce in 1970—to model the activities involved in organizing, producing, and evaluating the EWSSO. We also follow OBO Foundry Principles and the principles of best practice for domain ontology design, terms, definitions, and classifications to meet BFO requirements for ontology building.ResultsWe developed twenty-nine new classes, reused four classes and four object properties to create the EWSSO. When we queried the data our ontology-based process could differentiate between necessary and unnecessary features for score calculation 100% of the time. Further, our process applied the proper temperature conversions for the early warning score calculator 100% of the time.ConclusionsUsing synthetic datasets, we demonstrate the EWSSO can be used to generate and query health system data on vital signs and provide input to calculate the NEWS, six-item MEWS, and qSOFA. Future work includes extending the EWSSO by introducing additional early warning scores for adult and pediatric patient populations and creating patient profiles that contain clinical, demographic, and outcomes data regarding the patient.

292 Frailty at the front door team compliance with the 4Ms of the international healthcare improvement age-friendly healthcare system

Abstract Background Age-friendly health systems entail assessing the 4Ms (1) what Matters to you (2) Mood and Mental state (3) Medication review and (4) Mobility and functional assessment. This study aimed to measure Frailty at the Front Door team compliance with the 4Ms. Methods An abbreviated ‘4MsComprehensive Geriatric Assessment (CGA) was designed. Members of an interdisciplinary team, including geriatric medicine doctors, physiotherapists, occupational therapists, speech and language therapist and dietitian completed CGAs for older patients. Data from scanned CGAs (compliance rate approximately 30%) between January–December 2022 was entered onto Excel by trained administrators. Compliance with the 4Msassessment was retrospectively assessed. Data was analysed using descriptive statistics. Results 588 CGAs were scanned. 96 excluded due to incomplete data (n = 93), or age under 65 years (n = 3). 493 CGAs included. Mean (SD) age was 83 (7.8) years. Female:Male ratio was 1.4:1. Mean (SD) CFS was 5 (1.2). 83% (n = 412) answered ‘what matters to you’. No answer recorded in 16% (n = 81). Common themes were; home (20%), family/friends/pets (18%), functional independence (7%), health (6%), and miscellaneous (40%). 100% had a 4AT documented, mean (SD) 4AT of 2 (2.9). The presence/absence of dementia was recorded in 73% (n = 364). 80% (n = 395) recorded presence/absence of depression. 11% (n = 57) had current or previous depression. 87% (n = 450) had a medication screen +/− review performed. 27% (n = 126) of presentations were related directly to either medications or falls. 96% (n = 473) had a mobility/functional assessment recorded.. Conclusion There was 83% or greater compliance across all areas of the 4Ms Cognition, mobility and functional status demonstrated the highest compliance rates. Data capture was incomplete due to the inefficiency of scanning CGAs onto a database. Incorporating age-friendly systems into FFD practice is feasible. Future steps will be to accredit the Emergency Department as an age-friendly healthcare system.

Global interprofessional education: An international healthcare student challenge.

Global interprofessional education: An international healthcare student challenge.

A retrospective analysis of mortality risk and immunosuppressive therapy for Stevens-Johnson Syndrome and toxic epidermal necrolysis syndrome using the TriNetX research network

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) exist on a spectrum of autoimmune conditions which cause epidermal detachment and keratinocyte necrosis. Due to the rare incidence of these conditions, a dramatic heterogeneity in treatment algorithms exists. To better appreciate pharmacologic immunosuppressive therapies' impact on survival, the authors queried a multi-institutional data network. Data for this study was extracted from TriNetX Research Network, a platform that contains ICD-9/ICD-10 coding data from a consortium of international healthcare organizations. Seventy-one institutions were queried to identify adult patients diagnosed with SJS, TEN or SJS-TEN Overlap. Cohorts were created based on the therapy received: systemic steroids (SS), diphenhydramine (DH), cyclosporine (CS), intravenous immunoglobulin (IVIG), tumor necrosis factor alpha inhibitors (TNFαi), or a combination of treatments. Cohorts were then propensity matched with patients who received supportive care. Patients who only received one of the above treatments showed no significant reduction in 90-day mortality. Patients who received CS or IVIG as part of their multitherapy showed a significantly increased risk of death when compared to supportive care (CS: RR = 1.583, 95% CI [1.119, 2.240]; IVIG: RR = 2.132, 95% CI [1.485, 3.059]). Despite their frequent utilization, this study’s analysis suggests that none of these therapies confer significant 90-day mortality survival over supportive care alone. These results highlight the heterogeneity of therapies and emphasize the need for critical prospective appraisal of their outcomes in SJS and TEN.

Patient Monitoring for Personalized Mobile Health (PMH) based on Medical Virtual Instruments

One of the newest technologies, mobile health, has the potential to support the provision of care for older adults and offer them individualised treatment. This study’s goal is to evaluate the benefits and challenges of personalised mobile health (PMH) for elderly residential care. Virtual worlds are quickly integrating into the landscape of instructional technologies. One of the most well-known of these settings is Second Life (SL). Despite the potential of SL for health professions education, there aren’t many official SL applications for this purpose, and the effectiveness of these applications hasn’t been evaluated to the fullest extent possible. Similarly, it appears that nothing is known about the use of virtual worlds for continuing medical education. In order to better grasp the fundamentals of the aid of MVIs for personal health monitoring (PHM), we were able to pinpoint the key disease regions, sensors, channels, calculations and communication protocols. The main obstacles limiting MVIs’ degree of integration into the international health care system were also identified. The analysis demonstrates that MVIs offer an excellent possibility for the creation of affordable, personalised health systems that meet the unique equipment requirements of a certain field of medicine.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

COVID-19 transmission in dental practice: risks and prevention – narrative review

Dentists are on the frontline of infection, especially regarding respiratory viruses like the new coronavirus. The production of aerosols and droplets accompanies many dental procedures. The emergence of severe acute air-droplet disease, respiratory syndrome, or SARS, warrants a revision of the infection control procedures for aerosols.&#x0D; The aim. In this article, we aim to raise awareness of the potential risks of COVID-19 transmission in dental practice and discuss and suggest some preventive measures.&#x0D; Methods. This study reviewed the published research articles and the guidelines of international healthcare institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms.&#x0D; Results. The main way of transmission of the SARS CoV is air-droplet. Thus, healthcare professionals that perform aerosol-generating procedures, i.e. dentists, need to be updated about the origin of the disease. The patient and the dentist often share close contact while ongoing dental treatment; thus, knowledge about the disease and necessary preventive measures is required. In addition to the standard precautions, some special preventive measures that should be implemented during an outbreak of disease have been raised in this review.&#x0D; Conclusions. Following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting

Self-Preparation and Professional Development of Nurses: Psychiatric Mental Health Care Issues

Today's mental health care needs are diverse. After the COVID-19 pandemic, factors related to individuals, the environment, and their interactions represent complex and cumulative risks. Physical and mental health problems rely on early detection, trust building, care engagement, and disease identification to provide complete psychiatric assessment, management, and continuum of care for affected people. Thus, early detection and intervention in nursing is beneficial for the discovery and treatment of psychological symptoms. However, the nursing profession is divided into multiple specialties, and the current education system lacks integrated interdisciplinary psychiatric mental healthcare training. In this article, the multifaceted aspects of mental health care services and interdisciplinary nursing professional development in mental health are explored, covering the roles and tasks of interdisciplinary nurses, the function and purpose of psychological care in hospitals, reflections on the role of school nursing in adolescent mental health issues, and novel developments in domestic and international psychiatric mental health care. It is hoped that this article can promote reflections on psychological health issues for nurses and help promote cross-disciplinary consensus on nursing strategies to facilitate cooperation among multidisciplinary nurses to promote more comprehensive quality of care, social participation, and professional innovation.

Depression in healthcare workers during COVID-19 pandemic: results from Czech arm of HEROES Study

The pandemic due to COVID-19 brought new risks for depression of health care workers, which may have differently influenced men and women. We aimed to investigate (1) whether health care workers in Czechia experienced an increase in depression during the COVID-19 pandemic, (2) which factors contributed the most to this change, and (3) whether the magnitude of the associations differed by gender. We studied 2564 participants of the Czech arm of the international COVID-19 HEalth caRe wOrkErS (HEROES) Study. Online questionnaire was administered to health care workers in summer 2020 (wave 0) and spring 2021 (wave 1). Depression was defined by reaching 10 or more points on the Patient Health Questionnaire. Logistic regression investigated the association of participant´s characteristics with depression and multivariable decomposition for non-linear models assessed, to what extent the characteristic explained the change in depression occurrence. The prevalence of depression increased twice during the pandemic (11% in wave 0 and 22% in wave 1). Stress accounted for 50% of the difference, experience of death due to COVID-19 for 15% and contact with COVID-19 patients for 14%. Greater resilience and sufficient personal protective equipment were strongly associated with lower occurrence of depression. The protective association of resilience with depression was stronger in men than in women. We conclude that interventions to promote mental health of health care workers in future health crisis should aim at decreasing stress and enhancing resilience. They should be delivered especially to individuals who have contact with the affected patients and may face their death.

How artificial intelligence impacts the competitive position of healthcare organizations

Purpose Digital transformation affected modern society influencing how businesses cooperate and produce value. In this context, Artificial Intelligence plays a critical role. This study aims to explore the role of Artificial Intelligence in organisational positioning within the market, influencing firms' competitiveness. In this vein, this research seeks to respond to the following research question: How does AI impact the competitive advantage of healthcare organizations?.Design/methodology/approach To tackle the research question, an explorative analysis using the case study method to investigate an international healthcare center in Dubai was conducted. Nine semi-structured interviews were conducted with the head and the members of the robotic surgery team in CMC Dubai to thoroughly understand what the components of the robotic approach are and how the arrangement before the introduction of this innovative technique while shedding light on the added value and the advantages of adopting such technique on both patient safety and patient satisfaction. Additionally, archival data and online documentation (e.g. industry reports, newspaper articles and internal documents) were analyzed to obtain data triangulation.Findings The results highlight three primary outcomes influenced by implementing AI in organizational processes: clinical, financial and technological outcomes. The study will offer interesting non-studied insights about the implementation of Artificial Intelligence tools in the healthcare sector and specifically robotic surgeries, and to which extent this will contribute and represent a competitive advantage. Results will hopefully insert a brick in the wall of the impact of AI tools on the quality and the results of surgical operations while emphasizing the benefits of integrating AI in surgical practice.Originality/value This study offers interesting theoretical and practical implications. It opens a new perspective to understand and manage AI tools in service. This research is not without limits providing valuable insights for future research.

Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country

Background: The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers’ experiences in Ethiopia in building relationships with local healthcare providers. Methods: Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi’s phenomenological method. Results: Ten subthemes emerged from five themes: “facing new situations”, “accepting myself as an outsider in Ethiopia”, “impact on the wall of prejudice”, “adapting to a new culture”, and “positive outlook”. Conclusions: This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.