Quality Of Health Care System Research Articles

Involving different stakeholders in prioritising outcomes to assess healthcare systems response for type 1 diabetes management: Using co-creation approaches in Peru.

Engaging diverse stakeholders in developing core outcome sets (COSs) can produce more meaningful metrics as well as research responsive to patient needs. The most common COS prioritisation method, Delphi surveys, has limitations related to selection bias and participant understanding, while qualitative methods like group discussions are less frequently used. This study aims to test a co-creation approach to COS development for type 1 diabetes (T1DM) in Peru. Using a co-creation approach, we aimed to prioritise outcomes for T1DM management in Peru, incorporating perspectives from people with T1DM, caregivers, healthcare professionals, and decision-makers. A set of outcomes were previously identified through a systematic review and qualitative evidence synthesis. Through qualitative descriptive methods, including in-person workshops, each group of stakeholders contributed to the ranking of outcomes. Decision-makers also discussed the feasibility of measuring these outcomes within the Peruvian healthcare system. While priorities varied among participant groups, all underscored the significance of monitoring healthcare system functionality over mortality. Participants recognized the interconnected nature of healthcare system performance, clinical outcomes, self-management, and quality of life. When combining the rankings from all the groups, metrics related to economic impact on the individual and structural support, policies promoting health, and protecting those living with T1DM were deemed more important in comparison to measuring clinical outcomes. We present the first COS for T1DM focused on low-and-middle-income countriesand show aspects of care that are relevant in this setting. Diverse prioritisation among participant groups underscores the need of inclusive decision-making processes. By incorporating varied perspectives, healthcare systems can better address patient needs and enhance overall care quality.

URINARY CONTINENCE RESTORATION THROUGH AN ENDOURETHRAL DEVICE: A 3-MONTH PILOT STUDY ON TEN PATIENTS.

BACKGROUNDː Stress urinary incontinence (SUI) is a widespread and frustrating condition that affects millions of people worldwide, with severe consequences on patients' quality of life and healthcare systems' costs. Currently, the most severe cases of SUI are treated using implanted (and rather invasive) extraurethral artificial sphincters. The authors propose an innovative, minimally invasive endourethral device for the treatment of SUI. METHODSː Ten patients with SUI were enrolled in three Italian centers and underwent device implantation. After 10, 30, 60 and 90 days, correct device position was confirmed by ultrasonography. Improvements in continence and quality of life were evaluated through a 24 h pad-test, an International Consultation on Incontinence Questionnarie- Short Form (ICI-Q) and a custom checklist. The device was explanted after 90 days. RESULTSː The proposed device was successfully implanted and explanted in 8 out of 10 patients. The results of the pad-test, ICI-Q and custom checklist demonstrated remarkable improvements in continence (median improvement: 82% with respect to the initial condition) and quality of life (mean reduction of the impact of urine losses on the quality of life: 61%). No major pain or discomfort was reported. CONCLUSIONSː The results demonstrate the efficacy of the proposed endourethral artificial sphincter in addressing SUI. The proposed device was successfully implanted and explanted in a short time (~ 10 min) without intrinsic side effects and without triggering pain or discomfort.

Scoping review of qualitative studies on family planning in Uganda.

Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.

Caring for Older Patients: Quality and Efficiency of Australia's Healthcare System

AbstractWith population ageing and increased longevity, Australia faces pressing policy issues on caring for older people. As Medicare turns 40, it is timely to assess how the system has been performing, and what changes are needed to modernise Medicare. This article examines the quality and efficiency of care using hospital administrative data. We find that the current system provides good quality and efficient care for older patients, except for those living in residential aged care homes. These patients receive lower quality care yet stay longer in hospitals. We suggest alternative approaches designed around bundled payments and a single budget holder to provide incentives for integrated team‐based care.

Addressing Thalassaemia Management from Patients' Perspectives: An International Collaborative Assessment.

Background and Objectives: The effective management of chronic diseases, particularly hereditary and rare diseases and thalassaemia, is an important indicator of the quality of healthcare systems. We aimed to assess healthcare services in different countries for thalassaemia patients by using publicly available health indicators and by surveying thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources, and we used a structured patient-tailored self-completed questionnaire to survey thalassaemia patients and their caregivers in 2023. Results: A total of 2082 participants were surveyed (mean age, 27 years; males, 42%). About 1 in 4 respondents did not complete high-school education, while 24% had a bachelor's degree. About a third of respondents were married and were in either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 and 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of services provided, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and that their access to treatment was difficult or very difficult due to traveling expenses and the high cost of treatment. Conclusions: Important improvements in the care of thalassaemia patients have been documented during the past few decades. Nevertheless, additional focus is required through national healthcare systems to effectively address the many unmet needs revealed by our recent survey, as well as to achieve satisfactory patient outcomes.

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

BackgroundQuality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs.MethodsArticles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats.ResultsA total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections.ConclusionThe scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

Innovation in Healthcare Through Information Technologies: A Review

The application of innovative information technologies in healthcare can definitely subside the present limitations of the healthcare industry through better affability and accessibility. It encompasses the use of artificial intelligence, big data, biomedical research including drug invention, medical education, innovative/robotic surgical technology, cutting-edge equipment, telemedicine, virtual consultation, online supportive platforms, etc. The present review is an attempt to identify and analyse the impact of these innovative information technologies and explore the potential scope of improvement in the Indian healthcare system. The database search was performed in Scopus, Web of Science, PubMed, ProQuest, Google Scholar and Wiley Online Library. Initially, 319 articles related to innovative digital healthcare technologies have been sourced. However, 105 articles were taken into consideration for the review due to various exclusion criteria. Through an extensive review of previously published articles, the present study concludes that undoubtedly information technologies and their applications aid providers reduce inefficiencies, increasing quality, increasing access, removing human errors, reducing costs and making diagnosis, treatment and medicine more personalised for patients. It has really improved the quality, quick and convenient healthcare system.

Rethinking antipsychotic use in dementia: a literature review on efficacy, safety, and alternatives

Background an objectives. Dementia and its associated behavioral and psychological symptoms (BPSD) significantly impact patients’ quality of life, healthcare systems, and caregivers. Current treatments often include antipsychotic medications; however, their efficacy and safety profiles require careful evaluation. This review aimed to examine the use of antipsychotics in dementia, focusing on their role, efficacy, adverse effects, and clinical monitoring guidelines. Materials and methods. We conducted a thorough literature review in PubMed and Medline databases, using search terms like “dementia”, “BPSD”, “antipsychotics”, “adverse effects”, and “clinical guidelines”. Our analysis encompassed a range of research studies, including meta-analyses, randomized controlled trials, observational studies, and clinical practice guidelines. Results. While antipsychotics can be effective in managing severe BPSD symptoms like agitation and psychosis, their use carries an increased risk of mortality, stroke, and other adverse effects. Therefore, strict adherence to clinical guidelines and close monitoring are crucial to minimize these risks. Importantly, non-pharmacological interventions should always be the first-line treatment for BPSD whenever possible. Conclusions. Antipsychotics may be necessary for severe BPSD when nonpharmacological approaches are insufficient. Clinicians must carefully weigh the potential benefits against significant risks, utilizing the lowest effective doses, strict monitoring protocols, and considering alternative pharmacological options when possible. Unveiling safer and more specific BPSD treatments is a critical area for continued research.

Effects of Probiotic Supplementation during Chronic Rhinosinusitis on the Microbiome.

Probiotics are live microorganisms that induce health benefits to the host. The consumption of probiotics can result in both prophylactic and therapeutic effects. Chronic rhinosinusitis (CRS) is an inflammatory condition that has a significant health and economic impact worldwide. Despite its great burden on the health-care system and patients' quality of life, the variety of therapy options for CRS is currently limited. Inflammation, mucociliary dysfunction and changes in the microbial environment are thought to be the main factors causing the disease. Probiotics are a relatively new intervention, with a focus on the probiotic qualities and adaptive elements required for a bacterial strain to have a positive impact on CRS. The aim of this review was to review studies evaluating the potential beneficial effects of probiotics in the treatment of chronic rhinosinusitis. Future prospects and difficulties for probiotics in CRS are also highlighted.

Factors associated with workplace violence against Chinese healthcare workers: an online cross-sectional survey.

Workplace violence (WPV) against healthcare workers (HCWs) has reached significant levels globally, impeding the quality and accessibility of healthcare systems. However, there is limited available knowledge regarding the determinants linked with WPV among HCWs and the discrepancies observed across various levels of hospitals in China. The objective of the present research was to investigate the factors linked to WPV and job satisfaction among HCWs in China. A self-developed questionnaire based on WeChat was employed to collect data. The questionnaire consisted of demographic information as well as occupational factors. To measure WPV, the Chinese version of the Workplace Violence Scale was utilized. Career satisfaction was assessed through two questions regarding career choices. The collected data was analyzed using descriptive analyses, chi-square tests, and multivariate logistic regressions. A total of 3,781 valid questionnaires (1,029 doctors and 2,752 nurses) were collected. Among all participants, 2,201 (58.2%) reported experiencing at least one form of WPV in the past year, with emotional abuse being the most frequent occurrence (49.7%), followed by threats (27.9%). The multivariate logistic regression analysis revealed several risk factors associated with WPV, including male gender, shift work, senior professional title, bachelor's degree education, employment in secondary-level hospitals, and working over 50 h per week (p < 0.05). Career satisfaction among HCWs who experienced high levels of WPV was low, with only 11.2% remaining confident in their profession, and a mere 2.0% supporting their children pursuing careers in healthcare. WPV poses a significant challenge within the Chinese healthcare system. Efforts should be made to address the identified risk factors and promote a safe and satisfying working environment for HCWs.

DIAGNOSTIC IMAGING OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A TEN YEARS SYSTEMATIC REVIEW

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) impose a great burden on patients’ quality of life and healthcare systems. In addition to causing significant increases in mortality and disease progression, exacerbations of COPD amount to $18 billion in direct costs annually, as well as further spending associated with care and losses in productivity. Newer modalities such as OCT and MRI have distinct advantages to CT in such areas as image resolution and functional assessment of lung tissue. The aim: The aim of this study to show about diagnostic imaging of chronic obstructive pulmonary disease. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 100 articles, whereas the results of our search on SagePub get 1608 articles, on Google Scholar 3870 articles. Records remove before screening are 4887, so we get 691 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: Imaging and image analysis offers new insight into pulmonary disease processes that were previously available only on tissue necropsy. Current techniques can offer detailed measures of lung structure and with newer modalities previously immeasurable things like regional lung function. Imaging in the context of clinical investigation may offer the ability to define more homogeneous subsets of subjects with COPD and to potentially provide an intermediate biomarker of disease progression in lieu of a declining FEV.

Performance Evaluation of Hospitals under Data Uncertainty: An Uncertain Common-Weights Data Envelopment Analysis.

In the context of healthcare systems, the performance evaluation of hospitals plays a crucial role in assessing the quality of healthcare systems and facilitating informed decision-making processes. However, the presence of data uncertainty poses significant challenges to accurate performance measurement. This paper presents a novel uncertain common-weights data envelopment analysis (UCWDEA) approach for evaluating the performance of hospitals under uncertain environments. The proposed UCWDEA approach addresses the limitations of traditional data envelopment analysis (DEA) models by incorporating the uncertainty theory (UT) to model the inherent uncertainty in input and output data. Also, by utilizing a common set of weights (CSW) technique, the UCWDEA method provides a more robust and reliable assessment of hospital performance. The main advantages of the proposed UCWDEA approach can be succinctly summarized as follows. Firstly, it allows for the comparison of all hospitals on a consistent basis to calculate a realistic efficiency score, rather than an overly optimistic efficiency score. Secondly, the uncertain common-weights DEA approach exhibits linearity, enhancing its applicability. Thirdly, it possesses the capability to extend its utility under various other prevalent uncertainty distributions. Moreover, it enhances the discriminatory power of results, facilitates the ranking of hospitals in the presence of data uncertainty, and aids in identifying the sensitivity and stability levels of hospitals towards data uncertainty. Notably, in order to showcase the pragmatic application and efficacy of the uncertain common-weights DEA model, a genuine dataset has been utilized to evaluate the efficiency of 20 public hospitals in Tehran, all of which are affiliated with the Iran University of Medical Sciences. The results of the experiment demonstrate the efficacy of the UCWDEA approach in assessing and ranking hospitals amidst uncertain conditions. In summary, the research outcomes can offer policymakers valuable insights regarding hospital performance amidst data uncertainty. Additionally, it can provide practical recommendations on optimizing resource allocation, benchmarking performance, and formulating effective policies to augment the overall efficiency and effectiveness of healthcare services.

CIRMQUAL: a conceptual framework of healthcare service quality

PurposeThe scope of this study is to explore and summarize the pool of dimensions, models and measurement techniques of service quality used in healthcare services and to propose a comprehensive conceptual model for practitioners and researchers.Design/methodology/approachThis research employs a comprehensive review of available literature by using multiple keywords on different electronic repositories using the recommendations of the PRISMA approach for the selection of articles. A critical analysis of available studies helped in compiling a list of core service quality dimensions in healthcare services.FindingsThis paper presents a comprehensive account of different dimensions and their measurement items used by various researchers to assess service quality in healthcare systems. Most of the researchers have used SERVQUAL model either in its original or modified form while the others have proposed and used totally different dimensions to assess the service quality in healthcare. Many dimensions are just an existing dimension of SERVQUAL that has undergone a name change while others are completely new. The dimensions used by many researchers have items drawn from more than one dimension of SERVQUAL model. The availability of so many dimensions and models adds to the confusion that researchers and practicing managers experience when determining the appropriate model to be used in their work. To mitigate this confusion, there is a need to develop a comprehensive model; the current work is an attempt to meet this need. Through our analysis, we identify four major service quality dimensions: clinical quality, infrastructural quality, relationship and managerial quality and propose a model named CIRMQUAL.Originality/valueAfter exploring all available models in the domain of healthcare, this research presents the best possible areas to enhance the quality of healthcare services. It also enhances the research insights for academicians and working professionals by developing and proposing a comprehensive model for measuring healthcare service quality. The proposed model covers almost all of the service quality dimensions used by other researchers and will make the choice of dimensions/model easy for the future researchers/practitioners interested in measuring and improving the quality of services offered by their healthcare units. Such a comprehensive model has not been developed by any researcher thus far.

Waste generation and macroeconomic drivers: a panel study for European countries and regions

PurposeThe vast amounts of waste generated today threaten economies and societies due to high environmental and management costs. The aim is to investigate the short- and long-term patterns of municipal waste generation (MWG) in response to socio-economic and demographic growth variables at national and regional levels.Design/methodology/approachA panel data approach employing ordinary least squares (OLS), fixed effects (FE), random effects (RE), fully modified least squares (FMOLS) and error correction model (ECM) techniques. A sample of 28 European countries (2000–2020) and 44 European Union (EU) regions (2000–2018) were selected.FindingsDuring periods of economic growth and higher employment rates, consumer confidence tends to increase, leading to elevated levels of consumer spending and consumption. Intensification in the production factors, specifically capital and employment, results in an upsurge in MWG, thereby creating a cycle where waste generation becomes deeply entrenched in the economic system in both the short and long terms. Rapid population growth, attributed to higher fertility rates, is associated with increased MWG. At the regional level, a double-aging process and a shift toward an aging population exert less pressure on MWG in both the short and long term. Promoting higher levels of environment-oriented human development yields various benefits, including the generation of greater knowledge spillovers, enhanced environmental literacy, a shift toward circular thinking and the promotion of greener entrepreneurship. Increased R&D expenditures facilitate the development of innovative waste reduction technologies, fostering improvements in waste management techniques, recycling processes and the utilization of sustainable materials.Research limitations/implicationsThe research examines the short- and long-term adjustments of MWG in response to changes in macroeconomic variables from low aggregation (countries) to high aggregation (regions). By analyzing the relationship between economic growth, urbanization, healthcare system quality, labor market functioning, demographic trends, educational level, technological advancement and MWG, the study fills a research gap and enhances understanding of waste management interventions. However, data availability and waste statistics accuracy should be considered. Future research could explore the relationship between macroeconomic variables and waste generation in sectors beyond MWG, such as industrial or construction waste, for a more comprehensive understanding of waste generation as a whole.Practical implicationsThe positive correlation between economic activity levels and waste generation in both the short and long terms, emphasizes the criticality of investing in waste reduction and recycling infrastructure to mitigate landfill waste. The negative correlation between population density and waste generation stresses the importance of strategic waste facility placement in low-density areas. To effectively manage higher MWG, tailored waste collection systems and initiatives promoting healthy lifestyles are of immense importance. The positive relationship between employment rates and waste generation underscores the necessity of waste reduction programs that generate employment opportunities. The positive correlation between fertility rates and waste generation emphasizes the need for the expansion of extended producer responsibility programs to include products and materials specifically associated with families and child-rearing. Education campaigns and governmental support for research and development (R&D) in waste reduction technologies are also integral components of an effective waste management strategy.Originality/valueThe short- and long-term adjustments of MWG reacts to shifts in macroeconomic variables from low aggregation (countries) to high aggregation (regions). Previous research has neglected the long-term information contained in variables by not incorporating the lagged error correction term (ETM). Neglecting this aspect could result in imprecise estimates of the elasticities.

Efficacy and safety of platelet-rich plasma in the treatment of venous ulcers: A systematic review and meta-analysis of randomized controlled trials.

Considering the substantial impact of venous ulcers on quality of life and healthcare systems, this study evaluated the efficacy and safety of platelet-rich plasma (PRP) in comparison to conventional therapy. A systematic review of four databases identified 16 randomized clinical trials, including 20 study groups. PRP significantly enhanced complete ulcer healing, exhibiting an odds ratio (OR) of 5.06 (95% confidence interval [CI]: 2.35-10.89), and increased the percentage of healed ulcer area by a mean difference of 47% (95% CI: 32%-62%). Additionally, PRP shortened the time required for complete healing by an average of 3.25 months (95% CI: -4.06 to -2.43). Although pain reduction was similar in both groups, PRP considerably decreased ulcer recurrence rates (OR = 0.16, 95% CI: 0.05-0.50) without increasing the risks of infection or irritative dermatitis. These results suggest PRP as a viable, safe alternative for venous ulcer treatment, providing significant improvements in healing outcomes.

Health Outcome and Economic Growth: The Case of Malaria in Nigeria

This inquiry delved into the intricate interplay between health outcomes and economic growth, with a specific focus on the impact of malaria in Nigeria. This research endeavours to delve into the profound intricacies inherent in the interconnection between health outcomes and economic growth. The multifaceted exploration entails a meticulous scrutiny of pivotal determinants, encompassing the intricate tapestry of current health expenditure, gross capital formation, the prevalence of malaria in Nigeria, secondary school enrolment (spanning post-primary and secondary education), and the discerning trajectory of real gross domestic product, serving as an illuminating proxy for the profound dynamics governing economic growth. Econometric analysis is employed to investigate the study using an autoregressive distributed lagged model (ARDL). The findings show that current health expenditure has an inverse relationship with economic growth in Nigeria. Meanwhile, gross capital formation and secondary school enrolment, parameters used, showed a positive influence on economic growth in Nigeria. Thus, the policy proffered is that the federal government should invest deliberately in the health sector. There may be a need to double government expenditure in the health sector with a view to making the people have access to a quality healthcare system at a very cheap and affordable rate and also making social services such as education free from the primary to secondary level.

Formatting patient knowledge and channelling participation: how patient organisations work under authoritarianism

AbstractPatient experiential knowledge is important for the quality and responsiveness of healthcare systems. However, it is not rare for patients to struggle to have their knowledge recognised as credible and valuable. This study explores how patient organisations work to adjust patient knowledge to formats recognisable and acceptable by healthcare governance decision-makers. Using the case of patient organisations in Russia, we show that such formatting involves changes in language, practices, and materiality that contribute to channelling patient participation into specific routes and forms while marginalising others. Channelling of patient participation, then, rather than being a result of direct coercion, emerges as a distributed process continuously co-produced by a multitude of actors, such as state administration, patient organisations themselves, patient surveys, consultative spaces, and normative acts.

Exploring the proficiency of ChatGPT-4: An evaluation of its performance in the Taiwan advanced medical licensing examination.

Taiwan is well-known for its quality healthcare system. The country's medical licensing exams offer a way to evaluate ChatGPT's medical proficiency. We analyzed exam data from February 2022, July 2022, February 2023, and July 2033. Each exam included four papers with 80 single-choice questions, grouped as descriptive or picture-based. We used ChatGPT-4 for evaluation. Incorrect answers prompted a "chain of thought" approach. Accuracy rates were calculated as percentages. ChatGPT-4's accuracy in medical exams ranged from 63.75% to 93.75% (February 2022-July 2023). The highest accuracy (93.75%) was in February 2022's Medicine Exam (3). Subjects with the highest misanswered rates were ophthalmology (28.95%), breast surgery (27.27%), plastic surgery (26.67%), orthopedics (25.00%), and general surgery (24.59%). While using "chain of thought," the "Accuracy of (CoT) prompting" ranged from 0.00% to 88.89%, and the final overall accuracy rate ranged from 90% to 98%. ChatGPT-4 succeeded in Taiwan's medical licensing exams. With the "chain of thought" prompt, it improved accuracy to over 90%.

External urology consultation quality at a third-level public hospital in Mexico

IntroductionPatient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. ObjectiveTo identify the quality of care in the Urology outpatient department of a third-level hospital. Materials and methodsThe NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. ResultsAccording to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11−20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. ConclusionsThe use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions.

About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002-2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10-73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.