Service Provision For Patients Research Articles

IMPACT organizational survey highlighting provision of services for patients with locally advanced and recurrent colorectal cancer across Great Britain and Ireland.

Locally advanced and recurrent colorectal cancer represents a complex clinical entity, which requires multidisciplinary decision-making and management. The aim of this work is to understand the provision of clinical services in this cohort of patients across Great Britain and Ireland (GB&I) as a key essential step to help facilitate future service development and improvement. A cross-sectional, organizational survey was sent to all colorectal cancer multidisciplinary teams (MDTs) across GB&I. It consisted of 12 key questions addressing the provision of specialist services and advanced surgical techniques. Results are reported in line with the CHERRIES guideline. One hundred and seventy-five MDTs across GB&I participated, with 142 English, 13 Welsh, 14 Scottish, 3 Northern Irish and 3 Irish MDTs. The overall response rate was 93.5% (175/187). Ninety (51.4%) hospital sites reported having a specialist dedicated or subsection MDT. Specialist advanced nursing support was available in 46 (26.2%) hospitals, with a dedicated advanced colorectal cancer outpatient clinic available in 31 (17.7%) hospitals. One hundred and thirteen MDTs (64.5%) offered surgery for advanced colonic cancer, 82 (46.8%) for recurrent colonic cancer, 58 (33.1%) for advanced rectal cancer and 39 (22.2%) for recurrent rectal cancer. A variable number of MDTs offered specialist surgical techniques, including distal sacrectomy [33 (18.9%)], high sacrectomy [16 (9.1%)], complex vascular resection ± reconstruction [33 (18.9%)] and extended lymphadenectomy (pelvic sidewall or para-aortic) [44 (25.1%)]. The IMPACT organizational survey highlights the current variation in the delivery and provision of clinical services for patients with advanced and recurrent colorectal cancer across Great Britain and Ireland.

Exploring Barriers Faced by Community Pharmacists in Serving Patients with Disabilities in Saudi Arabia: Recommendations for Enhancing Healthcare Provisions.

A mixed-methods cross-sectional phenomenological study was conducted among community pharmacists in Saudi Arabia between March and April 2022. Both closed- and open-ended questions were utilized to identify themes related to community pharmacists' barriers and experiences when providing care to individuals with disabilities. A total of 40 community pharmacists participated in this study. Among them, 57.5% reported encountering difficulties when caring for patients with disabilities, with 65% indicating a lack of specialized services at their respective community pharmacies. Three major themes emerged from the findings: the need for pharmacist training and awareness, technology-guided methods for overcoming communication barriers, and improving overall pharmacy accessibility. This study reveals a significant gap in the provision of services for patients with disabilities in Saudi Arabia. Addressing physical accessibility, providing targeted training, and leveraging technology can enhance care delivery and promote inclusivity. Further research is warranted to assess the effectiveness of technological solutions and the integration of artificial intelligence in improving communication and patient-centered care for individuals with disabilities.

The Field Hospital's Responsibility For Patient Autonomy When A Medical Dispute Occurs

Public institutions that have a focus on managing and providing patient services to the community are hospitals. Field hospitals (field hospitals) are service units created to assist the function of referral health services (outpatient, inpatient, emergency unit, operating room, laboratory , etc.) which is carried out in emergency conditions. The aim of this research is to find out how to protect patients in field hospitals in the event of a medical dispute, and who is responsible if a medical dispute occurs in the field hospital. This research method uses a qualitative phenomenological method aimed at describing or explaining a person's personal experience, including the experience of relationships with other people, using literature study as a data collection procedure. The results of the research are that the Field Hospital has not yet regulated or there are no regulations in the event of a medical dispute. in field hospitals, resulting in harm to patients, and in Law Number 17 of 2023, there are no regulations regarding Field Hospitals, which means it creates a legal vacuum, so far there has been no legal review regulating responsibility for medical disputes in hospitals field because the author conducted this literature study research.

Establishing kidney transplantation in a low-income country: a case in Tanzania

BackgroundSub-Saharan African countries, including Tanzania, have a high burden of chronic kidney diseases (CKDs) and limited capacity for the provision of services. Tanzania and other countries in the region have made significant improvements in the provision of services for patients with CKD, including hemodialysis. Few countries are offering kidney transplantation services, which is the definitive treatment for patients with CKD and kidney failure. This study was conducted to review the steps taken by Muhimbili National Hospital (MNH) to establish a kidney transplantation service in Tanzania.MethodsThis study was based on the review of the activities that were undertaken to establish kidney transplantation services at Muhimbili National Hospital in Dar es Salaam, Tanzania. It was conducted by reviewing key documents developed for kidney transplantation and interviewing key personnel who were involved in the process.ResultsKidney transplantation services at MNH were established in November 2017; several steps were taken in the preparatory phase including training of personnel, infrastructural modifications, and procurement of equipment and supplies. Capacity building was achieved through international collaboration with several international and local institutions, including three Hospitals in India. The transplant team, which included nephrologists, urologists, anesthesiologists, radiologists, nurses, laboratory technicians, a transplant coordinator, and a lawyer, underwent short-term training at BLK Hospital in India. Initial transplant procedures were carried out with support from visiting personnel from BLK, Sakra, and Seifee hospitals. In total, 72 transplant surgeries were conducted, of which 39 (54.2%) were performed with visiting teams and 31 (45.8%) by the local team independently. Of the initial 39 recipients, 56.4% were males and 43.5% were aged above 46 years. About half of the donors were brothers/sisters, and 43.5% had human leukocytic antigen haplomatch. Induction immunosuppression included basiliximab in the majority (64.1%) of recipients, and all recipients received prednisolone, tacrolimus, and mycophenolate mofetil/myfortic.ConclusionsEstablishing kidney transplantation in lower-income countries, such as Tanzania, is feasible; however, it requires dedicated efforts. Collaboration with local and international institutions provided an enabling environment for the transfer of skills and access to necessary supportive services.

Purpose in life, loneliness and depression among patients with substance use disorders in the psychiatric hospitals in Ghana.

Substance use disorder is a global mental health issue. Purpose in life, Loneliness and depression are key indicators of poor mental health, and people with substance use disorder are more likely to experience low purpose in life, depression, and loneliness. This study aims to further the understanding of purpose in life, depression and loneliness among substance use disorders (SUD) patients in three hospitals in Ghana. It uses a cross-sectional survey design. A total of 425 SUD inpatients were screened. Beck Depression Inventory-II, the revised UCLA Loneliness Scale, and the Purpose in Life Test were utilised to measure depression, loneliness, and purpose in life respectively. Data were analysed using the SPSS version 23 for Windows. Data from 378 participants were collected for this study using a cross sectional survey design; after data cleaning, frequency tables (for categorical variables) and descriptive statistics (for continuous variables) were used to summarise the demographics and the three outcome variables depression, purpose in life, and loneliness. Our findings indicate that overall, participants are more likely to experience low sense of purpose in life, depression, and loneliness compared to the general population. There was no statistically significant relationship between depression and loneliness (r = 0.030, p = 0.567). There was a statistically significant negative relationship between depression and purpose in life (r = -0.514, p < 0.001). There was a statistically significant positive relationship between purpose in life and loneliness (r = 0.147, p = 0.004). There was no gender difference in depression, purpose in life, and loneliness among SUDs patients in psychiatric hospitals. There were no significant differences in purpose in life, depression and loneliness based on marital status. It is anticipated that the findings of this study will inform policies and clinical practice regarding service provision for patients with SUDs.

Legal Protection for Patients in Therapeutic Agreements According to Islamic Law

A therapeutic agreement is an agreement formed as a result of an agreement between a doctor and a patient. This research examines the legal aspects of therapeutic agreements between doctors and patients in health services. This research aims to provide a legal protection mechanism for patients as one of the parties in a therapeutic agreement between a patient and a doctor. This research is useful for providing legal stability and patient protection in therapeutic agreements between patients and doctors. Apart from that, it can also be used as an effort for patients and doctors to understand their rights and obligations. The nature of the agreement between the doctor and the patient in providing patient services is that the aim of the agreement is an effort or therapy to cure the patient; Doctor-patient agreements have unique characteristics that differentiate them from other types of agreements; and an agreement between a doctor and a patient is not a resulting agreement because it does not concern the outcome of the medical services provided by the doctor or the conduct or treatment of those services. There are several principles of agreement in Islamic sharia law, including the principles of monotheism, permissibility, freedom of contract, justice, equality, honesty, trust, benefit and benefit, consensualism, binding promises, balance of performance, legal certainty, and personality.

Private Hospital Obstacles are Linked to Law No. 17 Of 2023 Concerning Health. in the Third Part Concerning the Hospital

Public institutions that focus on organizing and providing patient services to the community are hospitals. Private hospitals are health service bodies managed by foundations or certain groups of organizations together with educational institutions. The aim of this research is to find out what kind of constraints or barriers are experienced by private hospitals, especially those which are then linked to Law no. 17 of 2023 concerning health. This research method uses a qualitative phenomenological method aimed at describing or explaining a person's personal experiences, including experiences of relationships with other people, using literature study as a data collection procedure. The results of this research are that private hospitals in Indonesia are still not optimal in their efforts to fulfill the general provisions regarding hospitals that have been stipulated in Law no. 17 of 2023 concerning health. Due to the obstacles faced in its operations, such as the Bunda Lhokseumawe Hospital which is hampered by the lack of specialist doctors at the hospital which results in less than optimal treatment services at the hospital, then the Surya Husadha Nusa Dua Hospital which is located in Bandung, with problems. delays in the distribution of food preferences, as well as three private hospitals in Yogyakarta which were hampered by lack of medicine stock in these hospitals

Factors Affecting the Meaning of Life in Breast Cancer Patients at Malang City, Indonesia

The meaning of life is considered to affect breast cancer patients positively. Finding meaning in life is key to improving well-being during and after experiencing a traumatic event such as cancer. Previous research was still rare to explore the factors affecting the meaning of life in breast cancer patients. The study aimed to analyze the factors influencing the meaning of life of breast cancer patients. This study was an analytical observational method with a cross-sectional design. The inclusion criteria of the respondents were breast cancer patients who had obtained at least one cycle of chemotherapy. We used purposive sampling, and the total sample in this study was 135 respondents. Questionnaires were used to collect the data. Data were analysed by multivariate test, namely a linear regression test with a significance level of p ≤ 0,05. The result showed only two variables affect the meaning of life, communication of health workers and spirituality, respectively. The strongest variable was the communication of health workers. The equation from the analysis showed that 11 % explained the phenomenon. The spirituality and communication of health workers positively affected the meaning of life. Application of therapeutic communication as well as spiritual support are needed in nurses to patients while undergoing therapy. Therefore, nurses must pay attention to spirituality and good therapeutic communication when providing patient services.

Examining the care of noncommunicable diseases at the first level of providing services during the COVID-19 pandemic.

Providing services for patients with noncommunicable diseases is one of the main responsibilities of health systems. During the COVID-19 pandemic, the care of these patients faced problems. This study investigates the ways of providing optimal care to patients during pandemics like COVID-19. This study was conducted in 2021 in Tehran province using an analytical cross-sectional method. Six hundred participants were selected for the study. In order to examine the challenges and solutions for receiving services, a questionnaire was completed and its reliability and validity were checked; finally, a telephone interview was completed over a period of 3 months. Among study participants, 68.2% were female, and the highest percentage was in the age group of 50-60 years. Fifty-four percent were illiterate or had primary education, 48.8% had diabetes, 42.8% had high blood pressure, and 8.3% had both diseases. Forty-three percent of the interviewees had not used health care services during the COVID-19 pandemic, the main reason for which was the fear of contracting COVID-19. The outbreak of coronavirus disease had affected the care of noncommunicable diseases for 63% of the interviewees. The fundamental need for changes in the health system was revealed by the COVID-19 pandemic. The need for flexibility in the health system will inevitably arise when similar cases occur, and policymakers and managers should consider necessary measures in this regard. The use of new technologies is one of the ways to replace traditional models.

ProKnow: Process knowledge for safety constrained and explainable question generation for mental health diagnostic assistance.

Virtual Mental Health Assistants (VMHAs) are utilized in health care to provide patient services such as counseling and suggestive care. They are not used for patient diagnostic assistance because they cannot adhere to safety constraints and specialized clinical process knowledge (ProKnow) used to obtain clinical diagnoses. In this work, we define ProKnow as an ordered set of information that maps to evidence-based guidelines or categories of conceptual understanding to experts in a domain. We also introduce a new dataset of diagnostic conversations guided by safety constraints and ProKnow that healthcare professionals use (ProKnow-data). We develop a method for natural language question generation (NLG) that collects diagnostic information from the patient interactively (ProKnow-algo). We demonstrate the limitations of using state-of-the-art large-scale language models (LMs) on this dataset. ProKnow-algo incorporates the process knowledge through explicitly modeling safety, knowledge capture, and explainability. As computational metrics for evaluation do not directly translate to clinical settings, we involve expert clinicians in designing evaluation metrics that test four properties: safety, logical coherence, and knowledge capture for explainability while minimizing the standard cross entropy loss to preserve distribution semantics-based similarity to the ground truth. LMs with ProKnow-algo generated 89% safer questions in the depression and anxiety domain (tested property: safety). Further, without ProKnow-algo generations question did not adhere to clinical process knowledge in ProKnow-data (tested property: knowledge capture). In comparison, ProKnow-algo-based generations yield a 96% reduction in our metrics to measure knowledge capture. The explainability of the generated question is assessed by computing similarity with concepts in depression and anxiety knowledge bases. Overall, irrespective of the type of LMs, ProKnow-algo achieved an averaged 82% improvement over simple pre-trained LMs on safety, explainability, and process-guided question generation. For reproducibility, we will make ProKnow-data and the code repository of ProKnow-algo publicly available upon acceptance.

Healthcare Professionals' Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study.

Methods A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors' rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors' and carers' long-term needs.

Prevalence factors and strategies for handling health workers’ anxiety in providing health services for COVID-19 variants

Introduction: Analysis of health workers' anxiety in providing patient services towards the COVID-19 variant has never been done well. Therefore, this study analyzes factors that affect anxiety among health workers because it has the potential to interfere with health services. The purpose of the study is to analyze the factors that affect the prevalence of anxiety among health workers in providing patient services variant of COVID-19. Methods: Participants involves health workers who handle patient variant of COVID-19. The data collection was approved by the research ethics committee of Surabaya Islamic Hospital A.Yani. Data source taken in Surabaya and surrounding areas in June 2021 namely N= 300-400 data breeding techniques is purposive sampling, research instrument is in the form of questionnaires by sharing to social media using a google form, data in the univariate analysis is done descriptively to see the respondents' characteristics and bivariate analysis is used to analyze factors affecting anxiety in statistical tests used is regression ordinal. Results: The results of statistical analysis obtained factors that affect anxiety, namely: female sex obtained = 0.02), age 30 years obtained results= 0.00, working in public health center = 0.08, nursing profession= 0.25, unmarried= 0.00, works outside Surabaya= 0.00, has a child and 2-3 children= 0.00. Conclusions: The study was conducted to analyze the prevalence factors of health care workers' anxiety in providing care for patients with COVID-19 variants and how the anxiety management strategies that resulted in this greatly contributed to the condition of health workers with psychological problems, namely anxiety.

Stakeholders’ Views about the Management of Stable Chronic Conditions in Community Pharmacies

The role of the community pharmacist has evolved to include the provision of more clinical services for patients. Those people who have stable chronic conditions will be managed in community pharmacies. This qualitative study used semi-structured in-depth interviews to understand the potential of providing additional patient-centred care for patients with stable chronic conditions in community pharmacies and identify potential limitations of this approach. Participants were recruited from Welsh Government, Local Health Boards (LHBS), Community Pharmacy Wales (CPW) and the Royal Pharmaceutical Society Wales (RPSW). The interviews were audio-recorded, transcribed verbatim, and analysed thematically. Eight interviews were conducted. The identified themes were as follows: (1) inconsistency and bureaucracy in commissioning pharmacy services; (2) availability of funding and resources; (3) disagreement and uncertainty about the contribution of the community pharmacy sector; (4) continuity of patient medical information and fragmented care; (5) accessibility, capacity and facilities in community pharmacy; (6) pharmacy education and clinical expertise, and (7) patient acceptability. It was clear that the potential benefit of managing stable chronic diseases in community pharmacies was recognised; however, several limitations expressed by stakeholders of pharmacy services need to be considered prior to moving forward.

Experience and Reflection From Inpatient Staff at an Intellectual Disability Hospital During COVID-19

AimsThe COVID-19 pandemic and the associated impact on the NHS led to particular challenges for Intellectual Disability (ID) inpatient hospitals across the country. The aim of this Research Project is to gather the experience of Inpatient staff in our local ID Hospital following the first wave of COVID-19 pandemic in July 2020.MethodsWe gathered data by means of survey from inpatient staff including ‘staff nurses’ and ‘health care support workers’ from 2 cute assessment and treatment units and 1 rehabilitation unit over the preceding 3 months. We obtained 15 responses. We gathered quantitative data via a questionnaire on the views of staff regarding the service provision for patients and staff during COVID-19. We also gathered qualitative data on learning points and how things would have been done differently in hindsight.ResultsThe responses were anonymised, directly transcribed, coded and grouped into themes. 67% of staff stated appropriate type and quantity of Personal Protective Equipment was available. 60% of staff stated it was ‘easy’ to access a General Practitioner for patient reviews. 60% of staff stated, there was a change in arrangements for Do Not Resuscitate/Escalation plans during COVID-19. 47% of staff stated there was availability of virtual or face-to-face clinical training support. 67% of staff did not take sickness leave due to symptoms or contact with a COVID-19 patient. 67% of staff did not receive or found it difficult to access a COVID-19 test. 47% of staff reported a negative impact of the pandemic on their physical and mental health well being. 13% of staff found the Counselling/emotional Support helpful.Some of the key themes that emerged in the qualitative data analysis included the importance of being grateful for personal health and well being, move lives could be saved if earlier and more frequent testing was available during the first wave, delays in the arrival of PPE in the hospital and ideas to mitigate risk by designating members of staff to a fixed work area to reduce mixing.ConclusionA wide range of reflections, suggestions and feedback were obtained during the research project which will be helpful to plan and organise services moving forward should future waves of COVID-19 emerge.

Multidisciplinary Care of Patients with Inherited Metabolic Diseases and Epilepsy: Current Perspectives

More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Care coordination is indispensable to ensure smooth transitions of care across life and disease stages, including management of emergencies, transition from pediatric to adult services and palliative care. Care pathways are highly diverse and have to find the right balance between highly specialized and locally provided services. While multidisciplinary teams consist of many professionals, a named supervising physician in a highly specialized healthcare setting and a care coordinator are highly important. As the greatest burden of care always falls onto the shoulders of patients and/or families, patient empowerment should be a part of every care pathway and include provision of required information, involvement into common decision-making, patient’s and family’s education, support for self-management, liaison with peer support groups and emotional/ psychological support. Due to the rarity and complexity of these diseases, sufficient expertise may not be available in a national healthcare system and cross-border services (virtual or physical) in the recently developed European Reference Networks should be ensured through the proper organization of referral systems in each EU and EEA country. Finally, digital technologies are particularly important in the provision of services for patients with rare diseases and can significantly increase the availability of highly specialized services and expertise.

Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study.

BackgroundTraumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available.ObjectiveThis study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts.MethodsThis is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected.ResultsThe project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022.ConclusionsThis study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation.International Registered Report Identifier (IRRID)DERR1-10.2196/25980

Work System and Process Designs for Community Pharmacy-Medical Clinic Partnerships to Improve Retention in Care, Antiretroviral Adherence, and Viral Suppression in Persons with HIV.

The objective of this project was to collect and analyze information about work systems and processes that community pharmacy-medical clinic partnerships used for implementing the Patient-Centered HIV Care Model (PCHCM). Paired collaborations of 10 Walgreens community pharmacies and 10 medical clinics were formed in 10 cities located throughout the United States that had relatively high HIV prevalence rates and existing Walgreens HIV Centers of Excellence. Patient service provision data and most significant change stories were collected from key informants at each of the clinic and pharmacy sites over an 8 week period in 2016 and through in-depth phone interviews. Written notes were reviewed by two authors (J.C.S. and O.W.G.) and analyzed using the most significant change technique. The findings showed that half of the partnerships (n = 5) were unable to fully engage in service implementation due to external factors or severe staff turnover during the project period. The other half of the partnerships (n = 5) were able to engage in service implementation, with the most impactful changes being related to strong patient care systems, having a point person at the clinic who served as a connector between sites, and having pharmacists integrated fully into the health care team.

Effect of Nurse Therapeutic Communication on Patient Satisfaction in the Installation of Genreral Hospital in Massenrempulu, Enrekang District

Therapeutic communication is one of the important keys in providing patient services in hospitals. Nurses who have communication skills, not only will easily establish a relationship of trust with patients, also prevent illegal problems, and increase satisfaction in the hospital. This study aims to analyze the effect of nurses' therapeutic communication with patient satisfaction in the inpatient installation at Massenrempulu District Hospital Enrekang. The method used is this research is an observational analytic with cross sectional study design. The population in this study were patients in the inpatient hospital of Massenrempulu District Hospital. The research sample of 75 people. The technique of determining the sample is to use the accidental sampling method. Analysis of the data used is chi square and multiple logistic regression. The results showed that the majority of respondents aged 40-49 years (25.3%), were female (61.3%), had elementary / equivalent education (30.7%) and worked as farmers (36.0%). The analysis showed that there was a statistically significant relationship between the variable respect (0.002), positive attitude (0.019) and not a meaningful relationship opening up (0.239) with patient satisfaction. The results of multivariate analysis with multiple logistic regression tests showed that the positive attitude of Exp (B) or Odds Ratio was 0.595. The most dominant variable influences patient satisfaction in the inpatient installation of Massenrempulu District Hospital, Enrekang Regency.

Analysis of the transfusion situation in Albania

The National Blood Transfusion Center in Albania was established in 1951. The establishment of the NBTC was followed by the creation of 26 blood banks near each hospital to provide patient services at every hospital. The National Blood Transfusion Center (NBTC) has developed a legal and regulatory framework beginning with the first law on blood transfusion approved in 1995. Blood donation in Albania began as a remunerated practice. The first attempts at voluntary and nonremunerated blood donation (VNRBD) began in 1994 with cooperation between NBTC and the Albanian Red Cross, but without a clear definition of a promotional strategy. In 2004, the NBTC realized the need for voluntary nonremunerated blood donors, and with the technical assistance of the WHO, NBTC drafted the National Strategy for a Safe Blood Transfusion. The strategy laid the foundation for standardization of two of the main blood safety factors; qualitative donors and qualitative testing. The implementation of this strategy and the law marked continued success in the work of NBTC by recording increase in VNRBD and reduction in remunerated blood donations. Centralized testing of infectious agents was started in NBTC Tirana, with the implementation of fully automated testing. A new strategy will be launched this year aiming for 100% voluntary nonremunerated blood donors.

Peer-assisted teaching at the University of Zimbabwe, College of Health Sciences: A prospective observational study

Objectives: We describe the effects of peer-assisted learning, focusing on the practical proficiency of the trainees to perform one particular regional anaesthesia technique. We also describe the effect the peer assisted learning had on patient service provision. Design: This was a prospective observational study of the23 students in the department at the time. It was conducted at the two teaching hospitals Parirenyatwa and Harare Central Hospitals in 3 stages. Stage 1 Initial assessment of the trainees and audit of theatre registers, stage 2 the setup and implementation of the module and stage 3 reassessment after the setup and implementation. The Data was analysed using a Students t test, Chi square test and descriptive statistics used to report. Setting: Special Referral Hospital. Subjects: Medical students in the department of Anaesthesia and Critical Care Medicine. Main Outcome Measures: Performance of the Supraclavicular Brachial Plexus Block. Results: There was a statistically significant increase in the number of trainees who had performed a supraclavicular brachial plexus block from 2 (8.7%) to 15 (65.3%), [p=0.001]. The number of blocks performed increased from 0-47.6% [p=0.000] and 1.7%-20.8% [p=0.0005] at Parirenyatwa and Harare Central Hospitals respectively. Twenty two of the 23 students thought the module beneficial. Conclusion: Introduction of a peer assisted learning module improved learning of fellow trainees and ensured more had acquired the skill. This resulted in more patients in whom the technique was indicated receiving the beneficial service. Thus peer assisted teaching functioned as a good adjunct to traditional methods.