Minimum Standard Of Care Research Articles

Raising the voice of specialist stoma care nurses: a call for a national strategy in stoma care

Specialist stoma care nurses (SSCNs) are highly educated professionals who play a critical role in the care of people living with a stoma. However, they experience some unique challenges. Currently in the UK, stoma care has no national standards, targets or best practice pathway, resulting in significant variation and an undervalued service. As members of an evidence-based profession, SSCNs need to demonstrate their value. Specialist nurses in cancer care and inflammatory bowel disease are supported by nationally, with pathways, targets and standards of care, as well as career and education frameworks. This system could be used for SSCNs. A national approach is needed to develop an evidence-based best-practice pathway, commissioned and implemented across the UK for all stoma patients and with SSCNs at its heart. SSCNs need to demonstrate their value through data and evidence. Working with Getting it Right First Time, a taskforce aims to review the evidence and establish minimum standards of care for all stoma patients. SSCNs should be co-ordinators and drivers of change at the highest level of national innovation, policy and decision-making. The work of SSCNs should be is recognised and valued because what they do matters.

The Role of the Physician, Bioethics, and Human Rights in Public Policies for Patient Care

The role of the physician in patient care transcends mere clinical practice, encompassing the defense of human dignity. This editorial explores how the principles of bioethics and human rights should guide medical practices to ensure ethical and humane care. Based on the article "Setting a Minimum Standard of Care in Clinical Trials: Human Rights and Bioethics as Complementary Frameworks" by Fatma E. Marouf and Bryn S. Esplin, we discuss the importance of a minimum standard of care and how it reinforces patient dignity.

Impact of COVID-19 on antenatal care provision at public hospitals in the Sidama region, Ethiopia: A mixed methods study.

Coronavirus disease 2019 (COVID-19) continues to pose a global public health threat. The pandemic overstretched already weak health systems in low- and low-middle-income countries, including Ethiopia. There is a paucity of studies on the impact of COVID-19 on antenatal care access, uptake, and provision in Ethiopia. This study examines the impact of COVID-19 on antenatal care provision in the Sidama region, Ethiopia. A concurrent mixed-methods study was conducted between 14 February and 10 May 2022 at 15 public hospitals in the Sidama region. An interrupted times series design was applied for a quantitative study, which included data from all pregnant women who attended antenatal care before COVID-19 (12 months, March 2019 to February 2020) and during COVID-19 (six months, March to August 2020) at 15 public hospitals in the region. The total numbers in the antenatal care 1 cohort (at least one antenatal care contact) and antenatal care 4 cohort (at least four antenatal care contacts) were 15,150 and 5,850, respectively, forming a combined final dataset of 21,000 women. Routinely collected monthly data were derived from the hospitals' health management information system and imported into Stata version 17 for analysis. The mean monthly incidence rate ratio of antenatal care uptake was calculated using a Poisson regression model with a 95% confidence interval. Simultaneously, an exploratory study design was conducted for qualitative using in-depth interviews to explore maternity care providers' perceptions of the impact of COVID-19 on antenatal care access, uptake, and provision. Qualitative data were thematically analysed. The quantitative and qualitative findings were then integrated using the joint display technique. Our findings indicate a significant monthly decrease of 0.7% in antenatal care 1 and 1.8% in antenatal care 4 during the first six months of the pandemic. A lack of medical supplies, fear of contracting COVID-19, inadequate personal protective equipment, discrimination against those attending the hospital, and the absence of antenatal care guidelines for care provision, COVID-19 vaccine hesitancy and long waiting times for ANC led to disrupted access, uptake, and provision of antenatal care during COVID-19. Our findings demonstrate that the COVID-19 pandemic affected antenatal care access, uptake, and provision in the study area from March to August 2020. To mitigate disrupted antenatal care access, uptake and provision, antenatal care clinics should be equipped with medical supplies. It is crucial to maintain rapport between the community and maternity care providers and provide training for maternity care providers regarding the adapted/adopted guidelines during COVID-19 at the hospital grassroots level for use in the current and future pandemics. Pregnant women should have timely access to maternity care providers in order to maintain at least a minimum standard of care in current and future pandemics.

Patchwork Protection: The Politics of Prisoners’ Rights Accountability in the United States

In recent years US prisons have failed to meet legally required minimum standards of care and protection of incarcerated people. Explanations for the failure to protect prisoners in the United States focus on the effects of the Prison Litigation Reform Act (PLRA) and lack of adequate external oversight. However, very little scholarship empirically examines how different systems of accountability for prisoners’ rights work (or do not work) together. In this article, we introduce an accountability framework that helps us examine the prisoners’ rights “accountability environment” in the United States. We then compare two post-PLRA case studies of failure to protect incarcerated women from sexual assault in two different states. We find that the prisoners’ rights accountability environment is a patchwork of legal, bureaucratic, professional, and political systems. The patchwork accountability environment consists of a web of hierarchical and interdependent relationships that constrain or enable accountability. We argue that ultimately the effectiveness of prisoners’ rights accountability environments depends on whether protecting prisoners’ rights aligns with the priorities of dominant political officials. Our argument has implications for efforts to improve prison conditions and incarcerated people’s well-being.

The Impact of Medical Negligence on LGBTQIA+ Community

ABSTRACT The umbrella phrase ‘medical negligence’ has gained popularity for describing wrongdoings committed by medical personnel while practicing their trade and interacting with patients. In none of the Indian laws that have been passed, the phrase is defined or even mentioned once. This article aims to describe the fundamental aspects of "medical negligence". Additionally, this article is meant to enlighten rather than debate the complex problems raised by the topic. Instead of being an exhaustive list of authorities, this article is informative and the methodology used is descriptive. Outlining some of the medical negligence histories, the general effects of medical negligence are described at the beginning of this article, followed by an outline of the fundamental elements of medical negligence, a description of the obligations of doctors, some examples, and the legal minimum standards of care. The article then discusses the type of information that must be given to the patient for consultation and treatment before coming to a conclusion with a mention of the general advice that the Supreme Court issued for doctors to heed as a precaution and the guidelines it issued to protect doctors from harassment if criminally prosecuted. In the end it suggests that bringing awareness in people's mind will not only help the people of the LGBTQIA+ Community feel safe in the society but also help them be their true self and reduce mental health stressors. Key Words: Medical Negligence, Awareness, Homosexuality, Sexual Orientations, Mental Disorder

A consensus statement on minimum operational standards for geriatric emergency care in Belgium: a modified Delphi study

BackgroundAs emergency department (ED) leaders started integrating geriatric emergency guidelines on a facultative basis, important variations have emerged between EDs in care for older patients. The aim of this study was to establish a consensus on minimum operational standards for Geriatric ED care in Belgium.MethodsA two-stage modified Delphi study was conducted. Twenty panellists were recruited from Dutch and French speaking regions in Belgium to join an interdisciplinary expert panel. In the first stage, an online survey was conducted to identify and define all possible elements of geriatric emergency care. In the second stage, an online survey and online expert panel meeting were organized consecutively to determine which elements should be recognized as minimum operational standards.ResultsBetween March 2020 and February 2021, the expert panel developed a broad consensus including ten statements focusing on the target population, specific goals, availability of geriatric practitioners and quality assurance. Additionally, the expert panel also determined which protocols, materials and accommodation criteria should be available in conventional EDs (39 standards) and in observational EDs (57 standards).ConclusionsThis study presents a consensus on minimum operational standards for geriatric emergency care in two ED types: the conventional ED and the observational ED. These findings may serve as a starting point towards broadly supported minimum standards of care stipulated by legislation in Belgium or other countries.

Psychosocial services for pediatric oncology patients in low- and middle-income countries from health care providers' perspectives: A survey-based report from the SIOP Global Health Network Psychosocial Working Group.

While pediatric cancer survival rates have improved in high-income countries, they remain much lower in low- and middle-income countries (L/MICs). While much focus in recent years has been on remediating the survivorship gap, less is known about the psychosocial needs and availability of psychosocial services for this population. A questionnaire was created by the SIOP Global Health Network Psychosocial Working Group to assess psychosocial needs and services in L/MIC. The questionnaire was distributed to pediatric oncology professionals, both in-person at the SIOP Annual Congress in Lyon (2019) conference and then electronically. Individuals not part of SIOP were also invited to participate via social media posts. Sixty-six respondents from 31 countries completed the questionnaire. The majority of participants were physicians, followed by nurses. Participants from low- and lower-middle-income countries (L/LMICs) perceived patients as having higher rates of anxiety and caregivers as having higher rates of depression as compared to those in upper-middle-income countries (UMICs). Across all L/MICs represented, 85% of physicians reported that psychosocial issues sometimes, frequently, or always affect their clinical obligations. Participants reflected on the availability of professionals who treat mental health concerns; the availability of social workers, psychologists, and non-professional volunteers differed significantly between L/LMICs and UMICs. Treatment abandonment and myths/disinformation were highlighted as the most pressing psychosocial priorities. Our study highlights pediatric oncology providers' perceptions of psychosocial concerns. Based on responses, proposals for minimum standards of care are made, as well as the importance of training existing providers and funding additional psychosocially-focused professionals.

Delegation and Directors' Reliance on the Performance of Others – A Companies Act 2008 Analysis in the Light of International Best Practices

South Africa has included in the Companies Act 71 of 2008 (the Act), provisions dealing with directors' delegation and reliance on the performance of others for their (the directors') own performance. In keeping with their role of managing the affairs of the company in terms of section 66(1) of the Act, directors must make decisions in the best interests of the company. Given the company board's strategic role in the company governance, as opposed to the day-to-day management done by the executive management, directors must rely on the performance of others to fulfil their role. These "others" include professional experts and company employees who can either provide guidance/specialist advice or to whom the board may delegate certain powers and authority to perform certain functions geared towards providing the board with a basis for decision-making. This article in the main interrogates the question whether South Africa has now established globally competitive legal standards of directors' delegation and reliance on the performance of others in line with company law reform objectives prior to 2008. One such objective is ensuring compatibility and harmonisation of the new company law with the best practice jurisdictions internationally as a way of promoting the global competitiveness of the South African economy. In this respect this article examines relevant laws in two foreign jurisdictions to provide a comparative aspect to the relevant South African company law aspects. First the article very briefly examines English law, which provides South Africa with its common law heritage of the duty of care, and it is argued that reliance and delegation relate to the irreducible minimum standard of care and the standard to exercise independent judgment. An examination of Australian statutory provisions on reliance and delegation is followed by a critical evaluation of reliance and delegation in section 76(4)(b)-(5) of the Companies Act 2008. It is concluded that South Africa has established globally competitive principles of reliance and delegation. Nonetheless, there are gaps in statutory reliance and delegation provisions under the Act, and lessons can be drawn from the best practices in Australian statutory and case law. Firm suggestions are made on how the gaps can be plugged and how the legal standards can be further tightened to enhance the global competitiveness of South African company law.

The Use of a Treatment Package to Increase Timely Submission of State Regulated Medication Administration Documentation

ABSTRACT Regulatory compliance guidelines within human service settings are designed to ensure health and safety of those served via a set of minimum standards of care. Due to the complexity of overseeing compliance, many supervisors report the task to be burdensome. The purpose of this study was to evaluate how performance management strategies can be embedded into current organizational systems to increase regulatory compliance related to the timely submission of medication administration documentation. During the study, each participant was asked to complete a short checklist based on their medication administration caseload, and attend a bi-weekly check-in meeting at which feedback was provided by their supervisor. Results of the study showed that the use of the checklist and feedback system was effective in increasing compliance among all participants. The results extend current literature related to the effectiveness of using in-house supervisors to implement performance management strategies.

Genomic Literacy among Nurses in Jordan: A Population-based Study.

The current study aimed to measure genomic literacy among Jordanian nurses by evaluating their understanding of key genomic concepts and how they view genomics in nursing practice. Descriptive, Cross-sectional, and Correlational designs were used in this study. A descriptive design was used using the Genomic Nursing Concept Inventory (GNCI©), a 31-item instrument. Data were collected from a total of 751 participants. A total of 406 participants were female, and 395 (52.6%) were single. The mean score of the genome basics was 2.33, ranging from 0 to 13. The mean score of the knowledge about mutation was 0.57, ranging from 0 to 3. At the same time, the mean score for inheritance and genomic healthcare was 1.74 and 1.53, respectively. Nurses working in the oncology center had the highest genomic knowledge score (mean = 7.05, SD = 4.24) compared with nurses in other healthcare sectors (p = < .001). There is a low level of genomic literacy among Jordanian nurses. Nurses must have sufficient genomic literacy to provide the best nursing care to patients, their families, and the community. Jordanian nurse authorities must develop competencies representing a minimum standard of care to provide competent genomic and genetically focused care.

Facilitating pain assessment and communication in people with deafness: a systematic review

BackgroundPain is a common reason for seeking out healthcare professionals and support services. However, certain populations, such as people with deafness, may encounter difficulties in effectively communicating their pain; on the other side, health care professionals may also encounter challenges to assess pain in this specific population.AimsTo describe (a) the state of the research in the field of pain assessment in individuals with deafness; (b) instruments validated; and (b) strategies facilitating the pain communication or assessment in this population.MethodsA systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were performed, searching Medline, CINAHL, Scopus, Embase and PsycInfo databases, from their initiation to July 2023. Primary and secondary studies, involving adults with deafness and investigating pain assessment and communication difficulties, facilitators, or barriers, were eligible. The included studies were assessed in their methodological quality with the Quality Assessment for Diverse Studies tool; data extraction and the narrative synthesis was provided by two researchers.ResultsFive studies were included. Two were validation studies, while the remaining were a case report, a case study and a qualitative study. The interRAI Community Health Assessment and the Deafblind Supplement scale have been validated among people with deafness by reporting few psychometric properties; in contrast, instruments well established in the general population (e.g. Visual Analogue Scale) have been assessed in their usability and understandability among individuals with deafness, suggesting their limitations. Some strategies have been documented as facilitating pain communication and assessment: (a) ensuring inclusiveness (the presence of family members as mediators); (b) ensuring the preparedness of healthcare professionals (e.g. in sign language); and (c) making the environment friendly to this population (e.g. removing masks).ConclusionsThe research regarding pain in this population is in its infancy, resulting in limited evidence. In recommending more research capable of establishing the best pain assessment instrument, some strategies emerged for assessing pain in which the minimum standards of care required to offer to this vulnerable population should be considered.

Multi-Centre Audit Of Myotonic Dystrophy In the UK: How Can We Improve Access to Care? (S11.001)

<h3>Objective:</h3> To conduct a multi-centre audit on patient care in a cohort of DM1 patients attending tertiary neuromuscular centres in the UK, based on 2018 consensus-based care recommendations. To assess the impact of an implementation of a change in practice to improve the access to care. <h3>Background:</h3> Myotonic Dystrophy Type 1 (DM1) is the most common muscular dystrophy in adults. Structured multi-disciplinary care is essential for managing the multi-system involvement in DM1 to improve patient safety and to reduce mortality and morbidity. Access to care can be variable dependent on geographical area and proximity to specialised services and time available to the neurologist. <h3>Design/Methods:</h3> Standardised audit tool was developed by consensus to enhance collection of practically important aspects of DM1 care retrospectively. Four tertiary neuroscience centres geographically distant, in the UK, were selected. <h3>Results:</h3> Total of 375 patients (197 (53%) female, mean age 47 years (range 1–84)) with DM1 were analysed. 62% had adult-onset disease. Neurology teams reviewed 64% of patients at least once a year. Cardiology review was performed annually for 30% of DM1 patients; of patients with respiratory needs, only 12% were reviewed as per recommendations; Swallowing function was assessed in only 44% of those required; assessment of cognitive-impairment was conducted only in 12%. Next we implemented an allied health care professional (AHP) led DM1-clinic in one centre and we analysed the data from 35 DM1 patients over three months: Total of 35 patients were reviewed. Cardiology review rates increased to 68%(22/35) where 100% of DM1 patients had respiratory and swallowing assessments. <h3>Conclusions:</h3> This multi-centre UK audit identifies several significant areas of care that need optimising in DM1, even within dedicated neuromuscular clinics. This highlights an opportunity for a national initiative to establish minimum care standards. However innovative utilisation of available resources can at least improve some aspects of, timely access to care. <b>Disclosure:</b> Dr. Hewamadduma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Hewamadduma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ARENX. Dr. Hewamadduma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BIOGEN. Dr. Hewamadduma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ROCHE. The institution of Dr. Hewamadduma has received research support from Neurocare . The institution of Dr. Hewamadduma has received research support from Sheffield Charitable Trust. Dr. Hewamadduma has received personal compensation in the range of $5,000-$9,999 for serving as a Adult Expert with National Health Service England (NHSE). Mr. Lilleker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Mr. Lilleker has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Mr. Kelly has nothing to disclose. Miss White has nothing to disclose. Mr. Whiter has nothing to disclose. Dr. Islam has nothing to disclose. Dr. Campbell has nothing to disclose. Dr. Mehboob has nothing to disclose. Dr. Vonberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Prova Health. Dr. Shanmugarajah has nothing to disclose. Dr. Grote has nothing to disclose. Dr. Viegas has nothing to disclose. Dr. Turner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dyne Therapeutics. Dr. Turner has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Turner Partnership. The institution of Dr. Turner has received research support from MDUK.

History and Role of Quality Accreditation.

Accreditation has played a major role in the evolution of health care quality as well as the structure and organization of American medicine. In its earliest iterations, accreditation aimed to set a minimum standard of care, and now more prominently sets standards for high quality, optimal patient care. There are several institutions that provide accreditations that are relevant to colorectal surgery including the American College of Surgeons (ACS) Commission on Cancer, National Cancer Institute Cancer Center Designation, National Accreditation Program for Rectal Cancer, and the ACS Geriatrics Verification Program. While each program has unique criteria, the aim of accreditation is to assure high-quality evidenced-based care. In addition to these benchmarks, these programs provide avenues for collaboration and research between centers and programs.

Obstetric anaesthesia manpower and service provision issues (introduction and European perspective)

Global health is an important and far-reaching concept in which health and access to surgical and anaesthetic care is crucial. Universal access to anaesthesia is a challenge in many countries. Manpower shortages are an important cause of difficulties and each European country has found different ways of facing a lack of healthcare professionals. In obstetric anaesthesia, the availability of competent anaesthesiologists has been related to the morbidity and mortality outcomes of patients.In this narrative review, authors from different European countries explain how manpower is managed in obstetric anaesthesia in delivery suites and obstetric operating rooms in different settings. To address manpower difficulties and issues, the goals are to achieve a minimum standard of care and at the same time, to promote clinical excellence through training, delegation to younger or less experienced colleagues, direct or at-a-distance supervision, or other means.The experience of sharing knowledge about the way in which manpower and service provision are organised in other healthcare settings is a significant opportunity to develop strategies for advancing tomorrow’s obstetric anaesthesia in the world. While taking into account the level of socio-economic development in different countries, the aim is to standardise practice and workload organisation. Co-operative international projects in training and education in obstetric anaesthesia are ways in which better obstetric patient care can be achieved in the future.

The Need for a Legal Standard of Care in the AI Environment

Artificial intelligence (AI) has risen to legal debate over legal liability in-volved in an incident. An intelligent machine can learn through experience and adapts its decisions accordingly. As such, if an intelligent machine’s be-haviour causes harm, the developer and the machine's owner may argue that the autonomous nature of AI systems has broken the causal link. The diffi-culty of determining who is liable for a harmful behaviour of an AI system is accentuated by the fact that tracing back the decision-making process of an AI system is not always possible. This paper aims to put forward a definition of a duty of care for developers and users of AI systems that could be the basis for the investigation of liability while seeking predictability of the allo-cation of legal liability in many cases involving AI incidents. The paper ex-amines some guidelines on ethics for AI to discern essential elements of the duty of care in the AI environment. The paper argues that a uniform minimum standard of care should be adopted internationally through model laws or even an international convention. A uniform standard of care should be enforced by State control rather than self-regulation by the AI industry. A licensing or certification requirement for AI products should be implemented to verify that the elements of the duty of care have been satisfied to control AI production and import/export relations. Violation of the standard of care can be an objective ground to negate or allocate negligence, especially when verifying errors in the design of the relevant software or if explaining the AI system's behaviour is not possible. A clear standard of care would, this paper assumes, help promote AI development and use and would not create imped-iments to investment in AI production.

Future Care Pathways – A report from the 1st workshop of the EHC Think Tank Workstream on Future Care Pathways

Abstract Introduction A care pathway is defined as “a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period.” The European Haemophilia Consortium (EHC) established a Think Tank Workstream on Future Care Pathways to identify and address key challenges in shaping future pathways that meet the needs of people with rare diseases while remaining practicable and affordable to healthcare providers in countries with different budgets and resources. This workstream is particularly timely as the introduction of innovative therapies is adding to the complexity of care pathways in some rare conditions. Identifying key challenges During the first virtual workshop of the Future Care Pathways Workstream on 14 February 2023, stakeholders, including healthcare providers, patient groups, researchers, and industry representatives, agreed to focus on four workable themes/challenges: 1. Prioritisation (cost and evidence); 2. Agreeing on a baseline; 3. Digital health; 4. Fragmentation of healthcare. Summary Prioritisation relates to economic and financial challenges in justifying the optimisation of a care pathway for a rare disease within the context of other healthcare priorities. Currently, there is too much emphasis on costs to healthcare systems, and not enough on real-life patient experience and indirect costs to patients and their families. Innovation in pathways is generally considered unaffordable, and cost-effectiveness models are difficult to apply to rare diseases. Agreeing on a baseline for a minimum standard of care in a pathway should take into account variability in patient needs, agency and healthcare system resources. A baseline needs to be agreed upon for each stage of a pathway: first clinical presentation, diagnosis, treatment, and monitoring and follow-up. Lack of awareness, gender and resource inequalities and gaps in evidence are among the issues that need to be addressed. Digital health holds promise but also brings challenges for future care pathways and must be considered from the viewpoint of all major stakeholders: patients, healthcare providers, tech companies and payers. Digital health systems are often developed in silos and do not allow for effective integration and sharing of data. Collaboration from the beginning is essential to the successful integration of digital tool as in healthcare. Fragmentation of healthcare can arise because people with rare diseases may access care pathways through multiple entry points in primary and secondary care, and they may not experience holistic care that takes account of all their needs. Poor communication at multiple levels (e.g. between clinical stakeholders and between clinicians and patients) is a common problem leading to inadequate treatment and care. Fragmentation may also arise when care pathways do not allow for a patient’s evolving needs when he/she is already on a pathway.

‘Women’s right to health in detention’: United Nations Committee Observations since the adoption of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok Rules)

Abstract Approximately 11.7 million people are detained globally, with an observed rise in the female prison population in recent years. A range of human rights treaties, and non-binding minimum standards of care (2016 Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules), 2010 Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules)) protect the rights of prisoners. States however have discretion in defining humane treatment and adequate medical care in detention settings. In this Review Essay, we focus on the right to health of detained women based on an environment conducive to adequate health, and access to gender-responsive, non-discriminatory healthcare in detention equivalent to that in the community. We scrutinized all United Nations Committee on the Elimination of Discrimination against Women and Committee against Torture Concluding Observations published since 2010, and provide a global illustration of violations of women’s health rights in detention settings to date. We document the inadequate accommodation and standards of detention of women, and inadequate access to healthcare services while detained, particularly relating to HIV and reproductive health, and mental health and drug dependence treatment in some countries. Human rights violations identified in the Concluding Observations reflect 39 countries and are presented as: the United Nations Committee description of their concern pertaining to a country’s treatment of women in detention; and collectively in terms of the particular Bangkok Rule (5, 6, 9, 10, 12, 14–16, 34, 35, 48 and 51). Our investigation raises general questions around the continued lack of resourcing of female detention settings and gender-responsive healthcare programming, the lack of data and advocacy on behalf of detained women, and the lack of routine scrutiny of the unique health rights assurances of women within independent monitoring and inspection in detention settings all over the world.

“Children in the prison nursery”: Global progress in adopting the Convention on the Rights of the Child in alignment with United Nations minimum standards of care in prisons

BackgroundOut of the 11 million detained in prisons globally, the female prison population of 740,000 has increased by 50 % since 2000. 410,000 children are in detention. 19,000 live in prison with their mother. ObjectiveTo conduct a socio legal assessment of global progress in adopting the Convention on the Rights of the Child since 2010, and alignment with United Nations (UN) normative standards of care in prisons. Participants and settingChildren detained with their mothers at the global level. MethodsA comprehensive search of all published Concluding Observation reports of the UN Committees on the Rights of the Child (CRC), Elimination of Discrimination Against Women (CEDAW), Against Torture (CAT) and Human Rights (CCPR) since 2010 (n = 905). 316 CRC, 246 CEDAW, 173 CAT and 170 CCPR reports were scrutinised to examine the situation of children living with detained mothers against UN normative standards of care. Results51 reports (24 CRC, 13 CEDAW, 12 CAT, 2 CCPR) representing 43 countries (majority in Africa) contained direct violations of the best interests of the child. These include the treatment of children as prisoners, difficulties in securing identity documents, poor detention conditions, exposure to violence, lack of access to child-appropriate healthcare, and lack of transparent data. Countries differed in durations of time permitting children to stay in prison (6 months to 8 years, with Eritrea observing no limit). ConclusionsAchieving a balance between protection of the child and punishment of the mother is inconsistent globally, and exacerbates the multiple vulnerabilities of the child.

Governance of Assisted Living in Singapore: Lessons for Aging Countries.

A global trend toward aging populations means that the challenge of providing adequate long-term care to older people looms large in many countries. In Singapore, a public discourse revolving around the expansion of assisted living to create age-friendly environments in long-term care has emerged. This study examines Singapore's experience in developing regulations for assisted living by documenting the different levels of regulation in place and by identifying the regulatory gaps remaining to govern assisted living. Anchoring in a conceptual framework on the governance of assisted living, different regulatory components of assisted living at the micro-, meso-, and macro-levels are analyzed. Using a case study method, primary and secondary data examining the experiences of governing and implementing assisted living in Singapore were collected. Analysis was conducted using a thematic analysis approach. Micro- and some macro-level regulations, which include admission assessment, staffing, and infrastructural requirements for assisted living, are maturing and evolving, while meso-level regulations, such as operational management, the monitoring framework, and stipulations for training requirements for staff, remain a work-in-progress in Singapore. The regulations for assisted living are currently primarily guided by soft laws, such as practice guidelines; the government has committed toward enacting permanent regulations for all long-term care facilities with the phased implementation of the Health Care Services Act from 2021 to 2023. We conclude that assisted living, despite the early stage of its development in Singapore, is a viable care model that should be expanded to meet the rising demand for care on the part of a majority of older people, who fall in the middle of the care continuum (that is, they can neither live independently nor need complete institutionalization). We also propose five policy recommendations for all aging countries to strengthen the governance of assisted living in long-term care. These include establishing (i) clear provisions on care quality assessment and the redress of grievance, (ii) minimum standards of care, (iii) differential regulations for assisted living, (iv) routine care assessment, and, (v) applying technology in assisted living facilities to address a shortage of care workers.

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

IntroductionThe aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker...