Medical Assistance Research Articles

COVID-19-infected cases in Thailand during the Omicron wave using the capture-recapture method

Thailand is among many countries, severely affected by the COVID-19 pandemic. In December 2021, the Thai Ministry of Public Health announced the discovery of the first imported case of the Omicron variant, and the local transmission of the Omicron variant was confirmed. The Omicron variant spread rapidly but was less dangerous than the Delta. Some patients experienced mild or no symptoms and self-treated without requiring medical assistance. Lower fatality rates during the Omicron outbreak were reported compared with previous variants. Information concerning hidden COVID-19-infected patients is beneficial and will lead to a better understanding of the disease outbreak mechanism. This study proposed the lower bound estimator under the capture-recapture (CR) method to estimate the true value of COVID-19 infections in Thailand during the Omicron wave. The Chao lower bound estimator for the Poisson mixture model was created to take into account the fact that populations can be different based on how cases and deaths have been spread out over time. The approximate variance of the estimator was constructed for a confidence interval of 95%, focusing on the ratio of total estimated infected cases to observed cases in March 2022. The average ratio was 2.99 (95% CI: 2.96 to 3.01), suggesting that for every 100 observed patients, at least 199 infected patients were underreported.

Formation of Soviet Medical Care to Indigenous Minorities of Turukhansk Territory in the 1920s

Due to the specifics of its geographical and climatic location, historically formed disease structure, ethnic approach to the development of traditional medical culture, the North territories’ population possesses a range of characteristics significantly different from the national average. This determines a number of problems and contradictions in medicine. The research of medical care to indigenous minorities of Turukhansk Territory in the 1920s is chosen because of its poor study, as well as the peculiarities of social and economic life of the region and national policy of the Soviet government. The article investigates the early Soviet policy in the sphere of health protection of the indigenous minorities of Turukhansk Territory. It considers two interrelated issues: it characterizes ethnic and regional aspects of traditional medicine; it reveals peculiar traits of the developing Soviet medical care to the indigenous minorities. We conclude that during the period under study despite the lack of financing and medical personnel the forms of interaction with the indigenous minorities of Turukhansk Territory were searched for. Those concerned managed to change the peoples’ attitude to doctors and medical assistants, to involve them into the anti-infective vaccination and to start health education programme. However the problem of publicly accessible medical care was solved only in parts, since major changes in living conditions did not happen, an extensive network of health facilities available to the general public was not created. The article is designed for specialists in the sphere of national healthcare history and cultural life of peoples of the North.

Abstract P315: Using Home Blood Pressure Monitors in the Office Setting as an Alternative to Automated Office Blood Pressure: A Quality Improvement Project

Background: Accurate blood pressure (BP) measurement is key to the diagnosis and effective treatment of hypertension (HTN). The U.S. HTN guideline recommends having patients rest for 5 minutes before measuring BP and obtaining at least two measurements 1-2 minutes apart. This is difficult to achieve in a busy primary care practice, and while automated office BP (AOBP) has been advanced as a solution, the required device may be cost-prohibitive. As home BP monitors are much less expensive, a protocol employing them in the office setting could prove to be an attractive alternative to AOBP. Objective: To promote the recording of multiple BP readings in primary care visits by using home BP monitors for measurement. Methods: Our primary care practice hosts 110 internal medicine residents and completes more than 35,000 patient visits annually. Prior to the intervention, medical assistants (MAs) obtained vital signs (VS) at every visit using a VS cart. In the first version of the new protocol, MAs measured all VS except BP using the VS cart, then measured BP once using an Omron 5 series BP monitor and recorded that reading in the chart. MAs left the cuff on the patient’s arm and instructed him/her to rest quietly for 5 minutes before taking a second BP reading him/herself while waiting for the provider after the MA exited the room. The patient took a third reading 1-2 minutes after the second. The provider recorded the second and third readings in the chart. Results: We implemented the new protocol in November 2023. In February 2024, we met with MAs to solicit feedback. They found the protocol easy to follow overall but had two concerns: (1) It was cumbersome to use two different devices to obtain a full set of VS; and (2) since many patients had normal BP, it did not seem worthwhile to obtain multiple BP measurements for all patients. After this meeting, we began measuring heart rate and oxygen saturation with a portable pulse oximeter instead of the VS cart, which is now only used in special circumstances. We also modified the protocol so that patients with systolic BP < 120 mm Hg and diastolic BP < 80 mm Hg are not required to obtain any repeat BP measurements. Conclusions: A new BP measurement protocol using home BP monitors to obtain multiple readings at each visit was feasible in our large academic primary care practice. We plan to investigate its effect on frequency of repeat BP measurement and likelihood of intensifying therapy for uncontrolled HTN.

AI-Enabled Medical Assessment and Assistance for Vocal Disorders: A Comparative Study

Vocal disorders present significant challenges for patients and clinicians, impacting communication and quality of life. The development of artificial intelligence (AI) technologies offers promising possibilities for improving the assessment and management of vocal disorders. This study aims to evaluate the effectiveness and applicability of different AI approaches in this field through a comparative study of AI-enabled medical assessment and assistance for vocal disorders. Various AI techniques, including machine learning algorithms, deep learning models, and natural language processing methods, are explored in the context of diagnosing vocal disorders, planning treatments, and managing patients. The insights gained from this comparative study contribute to understanding the role of AI in transforming healthcare delivery for vocal disorders, highlighting opportunities, challenges, and future directions for utilizing AI to enhance medical assessment and assistance in this specialized field.

405.6: Organ procurement after medical assistance in dying in Canada.

405.6: Organ procurement after medical assistance in dying in Canada.

261.8: Organ donation following medical assistance in dying: A Canadian environmental scan.

261.8: Organ donation following medical assistance in dying: A Canadian environmental scan.

Exemplary Practices in Kidney Care: Sharing the Experience of " Disease Care Certification"

<p>2019年8月，本院腎臟團隊首次參與醫策會「腎臟病照護品質認證」，在委員查核下通過認證。近三年來，本院透過外部審核和交流，不斷增強自身實力，凝聚成員共識，進行腎臟照護標準化。以「病人為中心」執行醫療服務，促進跨領域合作，拓展研究領域。本團隊亦致力於品質改進和減少異常發生，建立新透析中心積極應對COVID-19及其他嶄新挑戰。在數位轉型過程中，本院更引進電子病歷智慧輔助系統，利用One System整合平台提升照護效率。同時，針對末期腎病(Pre-ESRD)5期病人，提前啟動醫病共享決策(SDM)，成立「愛腎家族」群組，強調醫療團隊成員和病人之間的合作。在高品質連續性照護基礎上，為急性腎損傷、慢性腎臟病、和需要透析的病人建立全面性的照護機制。</p> <p> </p><p>In August 2019, our hospital’s renal team participated for the first time in the Disease-Specific Care Kidney Disease certification program and achieved certification from the Joint Commission of Taiwan. Over the preceding three years, this team has consistently strengthened itself through external audits and exchanges, fostering consensus among its members and achieving standardization in renal care. Focusing on patient-centered care, the team’s main goals are to enhance core medical services, promote cross-disciplinary integration, and expand research areas. Our team is also dedicated to improving quality of care and mitigate anomalies. Furthermore, a new dialysis center was established to proactively respond to COVID-19 and other emerging challenges. During the digital transformation process, our hospital introduced an intelligent electronic medical record assistance system and utilized the One System integration platform to enhance care efficiency. For patients with stage 5 pre-end-stage renal disease, we proposed early shared decision-making standards, established a “Love Kidney Family” group, and emphasized the importance of collaboration between healthcare providers and patients. These initiatives were aimed at developing a foundation for offering comprehensive, high-quality care for patients with acute kidney injury, chronic kidney disease, and those requiring dialysis.</p> <p> </p>

Achieving Equitable Lung Cancer Screening Implementation in a Texas Safety Net Health System

IntroductionA lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation. MethodsFrom 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥ 20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided tele-care shared decision-making (SDM), coordinated screening, and offered smoking cessation. To assess equity, LDCT completion across demographics was compared, in 2023. Results6,486 patients were mailed outreach materials; 479 patients responded, of whom 108 (22.5%) were eligible and 71 (65.7%) participated in SDM. 629 eligible patients were referred internally; 579 (92.0%) completed SDM. Of the 650 patients who completed SDM, 636 (97.8%) agreed to screening.Mean age was 61.7; 38.1% were female. The population was diverse: 35.8% identified as Latino, 17.8% as African-American, 26.8% had Medicare or Medicaid, 48.0% used the county medical assistance program, 14.2% were uninsured, and 76.7% currently smoked.Overall, 528 (83.0%) patients completed LDCT. There were no statistically significant differences in completion by age, gender, race/ethnicity, or insurance status. Spanish-speaking patients were more likely to complete the CT than English speakers (OR 2.22, 95% CI 1.22, 4.41) and those who formerly smoked were more likely to complete the CT than patients who currently smoked (OR 1.93, 95% CI 1.12, 3.51). ConclusionsThe navigator-centered program achieved equitable implementation of lung cancer screening in a diverse FQHC system.

Cardiac autonomic neuropathy modified the association between obesity and hypoglycemia in type 2 diabetes.

Previous studies have shown that increasing body mass index (BMI) was associated with decreased hypoglycemia in type 2 diabetes, but it remains uncertain whether this finding could be applied to patients with and without cardiac autonomic neuropathy (CAN). The study included 7789 participants with type 2 diabetes from action to control cardiovascular risk in diabetes (ACCORD) trail. CAN was defined as SDNN < 8.2 ms and RMSSD < 8.0 ms. Obesity was defined as BMI ≥ 30 kg/m2. Outcomes were identified as severe hypoglycemia requiring any assistance (HAA) or requiring medical assistance (HMA). We assessed the association between obesity and severe hypoglycemia in type 2 diabetes with or without CAN using COX regression models adjusted for baseline characteristics. Over a median follow-up of 4.7 years, a total of 893 participants developed HAA and 584 participants developed HMA. Compared with non-obesity, obesity was associated with lower risk of severe hypoglycemia (HAA: hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.38-0.68, P < 0.001; HMA: HR 0.57, 95% CI 0.40-0.82, P = 0.002) in CAN present group, but not in CAN absent group (HAA: HR 0.98, 95% CI 0.83-1.16, P = 0.830; HMA: HR 0.97, 95% CI 0.79-1.19, P = 0.754). Similarly, increasing BMI was associated with reduced severe hypoglycemic events in participants with CAN, but not in participants without CAN. CAN modifies the association between obesity and hypoglycemia in type 2 diabetes. Type 2 diabetic individuals with CAN who are under weight control should pay attention to hypoglycemic events. http://www. gov . Unique identifier: NCT00000620.

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice

BackgroundDiabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams. ObjectiveThe objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved. Practice descriptionThis study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist and manages diabetes through a collaborative practice agreement. Practice innovationA regional Medicaid plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted. Evaluation methodsThe rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics. ResultsA total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam. ConclusionThis pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

Kajian Perilaku Kepatuhan Medikasi Pasien Tuberculosis Paru di Kabupaten Ngawi: Sebuah Model Matematis

Background: Tuberculosis (TB) is currently still a health issue in Indonesia. Indonesia is the country that contributes the second largest number of tuberculosis cases after India. Ngawi is one of the cities in East Java Province with a large number of tuberculosis cases. In 2022, tuberculosis cases in Ngawi Regency will double from the previous year with the death rate also increasing from the previous year. This shows that tuberculosis control in Ngawi Regency has not been effective. Efforts are needed to increase medication compliance in tuberculosis sufferers so that therapeutic success can be achieved so that the death rate and tuberculosis transmission rate can be reduced.Methods: This research is an analytical observational study with a cross sectional research design which aims to create a mathematical model of medication adherence in pulmonary TB sufferers in Ngawi Regency. This research involved 102 pulmonary TB sufferers at Dr. Soeroto Hospital, Widodo Hospital and Ngawi Regency Health Center. Pulmonary TB sufferers were selected using a purposive sampling technique. Data were analyzed using multiple logistic regression tests.Result: Based on interviews conducted with 102 respondents, the results obtained were that the variables age, length of treatment, motivation to recover, self-perception, knowledge, access to health facilities, medication assistance, family support, drug side effects and health facility administration were candidates for bivariate testing.Conclusion : The variables of self-perception, knowledge, family support and health facility administration are the dominant factors influencing medication compliance in pulmonary TB sufferers in Ngawi Regency in 2023.

Modulation of Brain-derived Neurotrophic Factor Expression by Physical Exercise in Reserpine-induced Pain-depression Dyad in Mice.

Pain accompanied by depressive symptoms is a common reason for seeking medical assistance, and many chronic pain patients experience comorbid depression. The brain-derived neurotrophic factor (BDNF) is a well-known neurotrophin expressed throughout the nervous system, playing a crucial role in neuronal growth and neuroplasticity. This study aimed to examine the effects of exercise on BDNF expression in the nervous system and reserpine (RSP)-induced pain-depression dyad. RSP (1 mg/kg) was subcutaneously administered once daily for three days in mice. The exercise was performed using a rota-rod tester for seven consecutive days following RSP administration. Pain responses were evaluated using von Frey filaments, and depression-like behaviors were assessed through forced swimming and open field tests. Immunofluorescence staining was performed to examine the changes in BDNF expression in the dorsal root ganglion (DRG), spinal cord, and hippocampus. Administration of RSP reduced mechanical paw withdrawal threshold, increased immobility time in the forced swimming test, and decreased movement in the open field test. The immunoreactivity of BDNF was increased in the DRG and spinal dorsal regions, and decreased in the hippocampus after RSP administration. Physical exercise significantly reduced the RSP-induced mechanical hypersensitivity and depression-like behaviors. In addition, exercise suppressed not only the increased expression of BDNF in the DRG and spinal dorsal regions but also the decreased expression of BDNF in the hippocampus induced by RSP administration. These findings suggest that repetitive exercise could serve as an effective and non-invasive treatment option for individuals experiencing both pain and depression by modulating BDNF expression.

Factors Associated with Nurse Preparedness in Handling Disaster Victims in Central Sulawesi

Several factors influence nurses' preparedness in handling disaster victims. This study aims to identify the factors associated with nurses' preparedness to manage Central Sulawesi disaster victims. Conducted between April and July 2023, this cross-sectional quantitative study involved 124 nurses from Undata Hospital, Anutapura Hospital, Madani Hospital, Bhayangkara Hospital, and Dr. Sindhu Trisno Hospital, selected through total sampling. Preparedness was measured using the Disaster Preparedness Evaluation Tool (DPET). At the same time, knowledge, attitudes, and experiences in disaster management were assessed with the Knowledge, Attitude, and Practices of Disaster Management (KAP DM) questionnaire. Data were analyzed using chi-square and linear regression tests. The chi-square results indicated significant relationships between preparedness and knowledge (p=0.004), attitude (p=0.045), length of service (p=0.037), participation in disaster training (p=0.004), and experience in disaster management (p=0.028). At the same time, education level showed no significant relationship (p = 0.075). Linear regression revealed that knowledge had the strongest influence on preparedness. The study concludes that knowledge, attitudes, length of service, disaster training, and disaster management experience are key factors affecting nurses' preparedness. It is recommended that emergency nurses regularly participate in disaster-related training to enhance their ability to provide timely medical assistance, thereby reducing disaster-related mortality.

Medical Marijuana Documentation Practices in Patient Electronic Health Records: A Retrospective Observational Study Using Smart Data Elements and Chart Review.

Medical Marijuana (MMJ) is available in Pennsylvania (PA) and participation in the state-regulated program requires a patient to register and receive certification by an approved physician. There is currently no integration of MMJ certification data in PA into health records that would allow for clinicians to rapidly identify patients that are using MMJ, as there are with other scheduled drugs. This absence of a formal data sharing structure necessitates tools that aid in consistent documentation practices to enable comprehensive patient care. Customized smart data elements (SDEs) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in PA. The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic chart review protocol, with the goal of creating a tool that resulted in consistent human data extraction. We developed a chart review protocol for extracting MMJ-related information. The protocol was developed between August to December of 2022 and focused on a patient group that received one of several MMJ SDEs between 1/25/2019 and 5/26/2022. Characteristics were first identified on a small pilot sample of patients (n=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, two reviewers were assigned 200 patient charts, selected randomly from the larger cohort, with a third reviewer examining a subsample (n=30) to determine reliability. We then summarized the clinician-level and patient-level features from 156 charts with a table-format SDE that best captured MMJ information. We found the chart review protocol was feasible for those with minimal medical background to complete, with high inter-rater reliability (Kappa = .966 (P<.001), 95% CI (.954 - .978)). MMJ certification was largely documented by nurses and medical assistants (88.5%) and typically within primary care settings (68.6%). The SDE has six pre-set field prompts with heterogeneous documentation completion rates, including certifying conditions (93.6%), product (92.9%), authorized dispensary (87.8%), active ingredient (83.3%), certifying provider (61.5%), and dosage (30.8%). We found pre-set fields were overall well-recorded (76.6% across all fields). Primary diagnostic codes recorded at documentation encounters varied, with the most frequent being routine exams and testing (21.8%), musculoskeletal/nervous conditions (13.5%), and signs and symptoms not classified elsewhere (13.5%). This method of chart review yields high quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients. Additional data captured presents an overview of the conditions under which MMJ is currently being documented. Improving adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use, treatment efficacy, and outcomes.

Public mental health services in Southern China and related health outcomes among individuals living with severe mental illness

Background Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users.MethodsA cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis.ResultsThe four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1–0.5), Guangzhou (B = 0.2; 95%CI: 0.1–0.3), and Shenzhen (B = 0.3; 95%CI: 0.1–0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5).ConclusionsThere have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients’ utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

Characteristics of Medical and Psychological Emergency Units (CUMP) intervention in maritime environmnent: Les spécificités de l'intervention CUMP en milieu maritime

The maritime environment is impacted by the frequent occurrence of events with psychotraumatic potential. Within the framework of medical assistance at sea and the coordination of maritime and land-based rescue services, the medical-psychological emergency unit (CUMP) may be called upon to intervene in situations of collective disasters involving seafarers, requiring consideration of the characteristics of this environment, whether in terms of the functioning of a crew, risk factors, or psychotraumatic manifestations in seafarers. In this context, the CUMP intervention must be adjusted to these specificities, both in terms of individual and group care, but also in terms of crisis management on a ship, with the necessary articulation with the ship's command.

Improving uptake of colorectal cancer screening by complex patients at an academic primary care practice: a feasibility study

BackgroundRegular screening reduces mortality from colorectal cancer (CRC). The Canton of Vaud, Switzerland, has a regional screening programme offering faecal immunochemical tests (FITs) or colonoscopy. Participation in the screening programme...

“We just ignored them.” Adaptation strategies used by emergency department personnel in the face of workplace violence: A qualitative study

BackgroundWorkplace violence (WPV) can have adverse psychological, physical, and emotional effects on emergency department (ED) personnel. Adaptive strategies can help them better adapt to WPV. The study aimed to explore ED personnel’s experiences with adaptive strategies used in the face of WPV. MethodsIn this qualitative study, 22 ED personnel (nurses, doctors, services patient care assistants, and security guards) were selected using purposive sampling from Urmia city hospitals. Deep semi-structured individual face-to-face interviews were used to collect data. After recording and implementing interviews, conventional content analysis was used to extract concepts. ResultsData analysis led to extracting an overarching theme of “mastering the situation and avoiding harm.” Two categories that supported the main theme were: “effort to avoid violence” and “effort to escape suffering.” The seven subcategories supported main categories included “managing patients and companions, ”self-control,“ ”seeking support, “emotional discharge,” “thought diversion, ”tendency to spirituality,“ and ”seeking medical assistance.“ ConclusionGiven the experiences of ED personnel regarding strategies used, health managers and policymakers are recommended to develop and implement comprehensive programs to reduce violence and empower nurses before and after dealing with violence. The following programs will help: developing and implementing guidelines such as zero-tolerance WPV policy, criminalizing violence against personnel and punishing perpetrators; holding classes related to communication skills, self-control skills, and deviant thinking skills for ED personnel; raising public awareness of the prevailing conditions in the emergency through mass media, and counseling and treating violent ED personnel.

Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia

The research determines the level of financial risk in the Russian healthcare system and identifies prospects for improving the current Russian practice of financial risk management in healthcare when providing high-tech medical care for sustainable development (using Russia as an example). The author summarizes the advanced experience of the top 20 largest healthcare organizations in Russia by revenue in 2022. Based on this experience, the author developed an SEM model of the financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. The theoretical significance of the developed model lies in uncovering the previously unknown causal relationships between the implementation of the ICT, sustainable development support, and financial risks in healthcare. The model reveals a new market dimension of financial risks for healthcare organizations in Russia. The main conclusion is that implementing the ICT and support for sustainable development helps to reduce the financial risks in healthcare. The identified potential for reducing financial risks in providing high-tech medical care in Russia until 2026 is practically significant. This prospect can be practically applied as a roadmap for the digital modernization and sustainable development of healthcare until 2026, enhancing the state healthcare policy in Russia. The established systemic relationship between ICT implementation, sustainable development support, and financial risks in healthcare is of managerial importance because it will increase the predictability of the financial risks in the market dimension of healthcare in Russia. The newly developed approach to risk management in healthcare during the provision of high-tech medical care in Russia has expanded the instrumental framework of risk management for healthcare organizations in Russia and revealed further opportunities for improving its efficiency.

Drug Prescribing Evaluation to Foreign Travelers in Bali: A Study of Two Travel Clinics

Bali is one of the world's favorite travel destinations in developing countries. Most travelers who travel to developing countries seek medical assistance before, during and after travelling. Irrational prescribing is one of the causes of the higher medical cost. The objective was to evaluate drug prescriptions to foreign travelers in 2 travel clinics in Bali using the WHO prescribing indicators. This retrospective study used a cross-sectional method. Foreign travelers who took medication and received drug therapy at the travel clinics from January until December 2019 and had complete and legible medical record data were included in this study. Drug prescription were evaluated by following the WHO prescribing indicators, including the number of drugs per prescription sheet, the percentage of prescription drugs with generic names, the percentage of antibiotic prescriptions, the percentage of prescribed injections, and the percentage of drugs that were in accordance with the formulary. Drug use was said to berationalifall indicators were in accordance with WHO prescribing indicators where as it was said to be irrational if it did not meet the indicators set by WHO. We found a total number of prescriptions was 220 and the number of types of drugs in this study was 544. We found many poly pharmacy events, low prescriptions with generic names (14,2%), not all prescriptionsmetnationalformulary (64,8%), high prescriptions of antibiotic (50,0%) and injection (29,1%). Through this study, we concluded that there has been a phenomenon of irrational prescribing in those travel clinics.