Regional Health Research Articles

Mediating effect of knowledge sharing between participative decision making, transformational leadership and organization performance

This is the era of information economy. Performance of the organization is credited to knowledge and information. Intellectual capital is considered to be the most important assets. But dilemma is that only some organization focus on generation and preservation of knowledge. Participative decision making and transformational leaders are great tools of successful implementation of Knowledge management practices. This study is intended to study the impact of the impact of Knowledge Sharing, Participative Decision Making and Transformational Leadership on Organization Performance. A survey instrument covering knowledge sharing (KS), participative decision making (PDM), transformational leadership (TL), and organizational performance was developed. Data was collected by postal and personal surveys from health, education, manufacturing, telecom, and financial sector of Gujranwala and Lahore region of Pakistan using stratified random sampling technique. Sample size was 300 and 245 complete questionnaires were received back with response rate of 81.7%. The survey instrument used for the study was shown to be valid and reliable. Statistical analytical tools like (kindly mention all the tools) were used. Results of data analysis proposed a correlation between  This study is probably the first to understand the impact of KM practices on organizational performance. It offers valuable information about KM to all the organizations particularly those operating in Pakistan.

Small Cell Lung Cancer in Norway: Patterns of Care by Health Region and Survival Trends

Introduction/BackgroundThere has been a marked survival improvement for patients with non–small-cell lung cancer. We describe the national trends in characteristics and survival, and geographical differences in diagnostic workup, treatment, and survival for patients with small-cell lung cancer (SCLC). Materials and MethodsPatients registered with SCLC at the Cancer Registry of Norway in 2002 to 2022 were included. Trends in overall survival were estimated for all SCLC patients, patients with limited stage SCLC, patients undergoing surgery, and by health region. Adjusting for case-mix, a multivariable Cox regression was performed examining the association between health region and death. ResultsThe study included 8374 patients. The stage distribution remained unchanged during the study period. The 5-year overall survival increased from 7.7% to 22.8% for patients with limited stage. The use of multidisciplinary team meetings varied from 62.5% to 85.7%, and the use of positron emission tomography-computer tomography varied from 70.4% to 86.2% between the health regions. Treatment patterns differed markedly between the health regions, with the proportion dying without any registered treatment ranging from 1.2% to 10.9%. For limited stage patients in 2018 to 2022, the median overall survival ranged from 16.5 to 25.5 months across health regions, and the 5-year overall survival ranged from 18.7% to 28.7% (P = .019). ConclusionThe survival for patients with SCLC remains poor. The use of diagnostic procedures, treatment modalities, and survival differed between regions, warranting investigations to further explore the reasons.

Frequency and Cost of Anti-neural Antibody Testing for Autoimmune Encephalitis in a Large Canadian Health Region (S4.010)

Frequency and Cost of Anti-neural Antibody Testing for Autoimmune Encephalitis in a Large Canadian Health Region (S4.010)

Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory.

Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians' work while respecting the eligibility when ordering waiting lists. A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.

Impact of Direct Transport to Thrombectomy-Capable Center vs. Nearby/Distant Local Stroke Centers on Stroke Outcome in Patients Undergoing Thrombectomy: A Real-Life Study.

Our aim was to compare the stroke outcomes of a direct transfer (DT) to a thrombectomy-capable center vs. initial care at two local stroke centers: a nearby hospital (NH, 36 km) and a distant hospital (DH, 113 km). Patients who underwent a mechanical thrombectomy were analyzed (February 2017-October 2021), and the outcome was considered favorable if the modified Rankin scale (mRS) score was ≤ 2 at three months. A total of 300 patients were included, 55 of which were transferred from the NH and 58 from the DH. There was a difference in the median (IQR) transfer time of 39 min between the hospitals (149 min for the NH vs. 188 min for the DH, p = 0.003). After adjusting for confounding variables, a secondary transfer from the DH, compared to a DT, was associated with a lower functional independence: mRS score ≤ 2 (OR = 0.37, 95% CI = 0.14-0.97, p = 0.043), without significant differences in the mortality between the groups. These differences were not observed in patients from the NH. Conclusions: A secondary transfer from a distant hospital was associated with a poorer functional outcome at 3 months. This unfavorable outcome was not observed among patients transferred from a nearby hospital. These findings highlight the importance of categorizing the suitability of one transfer model over another based on the proximity of hospitals to the thrombectomy center, but also in accordance with organizational and geographic characteristics that vary within each health region.

Utilizing geospatial artificial intelligence to map cancer disparities across health regions

We have developed an innovative tool, the Intelligent Catchment Analysis Tool (iCAT), designed to identify and address healthcare disparities across specific regions. Powered by Artificial Intelligence and Machine Learning, our tool employs a robust Geographic Information System (GIS) to map healthcare outcomes and disease disparities. iCAT allows users to query publicly available data sources, health system data, and treatment data, offering insights into gaps and disparities in diagnosis and treatment paradigms. This project aims to promote best practices to bridge the gap in healthcare access, resources, education, and economic opportunities. The project aims to engage local and regional stakeholders in data collection and evaluation, including patients, providers, and organizations. Their active involvement helps refine the platform and guides targeted interventions for more effective outcomes. In this paper, we present two sample illustrations demonstrating how iCAT identifies healthcare disparities and analyzes the impact of social and environmental variables on outcomes. Over time, this platform can help communities make decisions to optimize resource allocation.

Intervention for reducing the overuse of upper endoscopy in patients

Utilisation rates for healthcare services vary widely both within and between nations. Moreover, healthcare providers with insurance-based reimbursement systems observe an effect of social determinants of health on healthcare utilisation...

Telemedicine Utilization in Tertiary, Specialized, and Secondary Hospitals in Thailand.

COVID-19 has accelerated the adoption of telemedicine for counseling, follow-up examination, and treatment purposes. The official guidelines in Thailand were launched to regulate or frame the protocols for health care professions and teams in different organizations. To explore the trend of telemedicine utilization in selected hospitals in Thailand and to understand the characteristics of patients who used telemedicine from 2020 to 2023. This retrospective secondary data analysis was conducted in four hospitals in Thailand: two tertiary care (T1 and T2) hospitals, one secondary care (SN) hospital, and one specialized (SP) hospital. Data were routinely collected when services were provided and were categorized into telemedicine outpatient department (OPD) visits or onsite OPD visits. The data included demographic information (age, sex), date and year of service, location (province and health region), and primary diagnosis (using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes). Descriptive analysis was conducted using R and STATA software. All four hospitals reported an increase in telemedicine use from 2020 to 2023. The majority of telemedicine users were female (>65%) at all hospitals except for the SP hospital (44%). Participants aged 25-59 years reported greater utilization of telemedicine than did the other age-groups. The within-hospital comparison between OPD visits before and after telemedicine was significant (p < 0.001). The situation during the COVID-19 pandemic and the transition to the post-COVID-19 era impacted telemedicine utilization, which could support national monitoring and evaluation policies. However, further studies are needed to explore other aspects, including changes in telemedicine utilization over time for longer timeframes, effectiveness of telemedicine, and consumer satisfaction.

Assessment of Culicidae collection methods for xenomonitoring lymphatic filariasis in malaria co-infection context in Burkina Faso.

Entomological surveillance of lymphatic filariasis and malaria infections play an important role in the decision-making of national programs to control, or eliminate these both diseases. In areas where both diseases prevalence is low, a large number of mosquitoes need to be sampled to determine vectors infection rate. To do this, efficient mosquito collection methods must be used. This study is part in this framework, to assess appropriate mosquito collection methods for lymphatic filariasis xenomonitoring in a coexistence context with malaria in Burkina Faso. Mosquito collections were performed between August and September 2018 in four villages (Koulpissi, Seiga, and Péribgan, Saptan), distributed in East and South-West health regions of Burkina Faso. Different collection methods were used: Human Landing Catches (HLC) executed indoor and outdoor, Window Exit-Trap, Double Net Trap (DNT) and Pyrethrum Spray Catches (PSC). Molecular analyses were performed to identify Anopheles gambiae s.l. sibling species and to detect Wuchereria bancrofti and Plasmodium falciparum infection in Anopheles mosquitoes. A total of 3 322 mosquitoes were collected among this, Anopheles gambiae s.l. was the vector caught in largest proportion (63.82%). An. gambiae s.l. sibling species molecular characterization showed that An. gambiae was the dominant specie in all villages. The Human Landing Catches (indoor and outdoor) collected the highest proportion of mosquitoes (between 61.5% and 82.79%). For the sampling vectors infected to W. bancrofti or P. falciparum, PSC, HLC and Window Exit-Trap were found the most effective collection methods. This study revealed that HLC indoor and outdoor remained the most effective collection method. Likewise, the results showed the probability to use Window Exit-Trap and PSC collection methods to sample Anopheles infected.

Health care providers’ perceptions of barriers, facilitators, and acceptability of an eHealth resource: Descriptive study

Introduction: Women often experience breastfeeding difficulties leading to premature supplementation and cessation. Implementing evidence-informed eHealth resources in clinical interactions with health care providers (HCPs), both in the health department and hospitals throughout a health region may help address this longstanding clinical issue. However, the provision of an eHealth resource alone is not sufficient to increase breastfeeding rates and health literacy, as the effective implementation of the eHealth resource in clinical practice is required. As such, our study objective was to conduct a needs assessment with HCPs to determine the barriers, facilitators, and perceived acceptability of the eHealth resource. Methods: A non-experimental descriptive study was used to examine HCPs’ perceptions of barriers and facilitators to the implementation of an eHealth resource in clinical settings. HCPs completed an online questionnaire to determine barriers and facilitators informed by the Consolidated Framework for Implementation Research (CFIR). Results: HCPs (n=44) completed the survey and agreed the resource was credible (86%), up to date (84%), covered relevant topics (91%), would ease their ability to provide breastfeeding education (82%), and would increase consistent messaging (86%). They agreed it would increase parents’ breastfeeding health literacy (91%) and help parents meet their breastfeeding goals (86%). Concerns were expressed regarding how this would be used in clinical interactions due to challenges with navigation, searchability, and the large amount of content. Implications and Conclusion: HCPs rated the eHealth resource highly; however, adaptations to the local context are required. For effective implementation of interventions in clinical settings, HCPs’ perceptions should be explored to determine their specific needs and determine how to best adapt the intervention to their setting to increase acceptability and facilitate use in clinical interactions.

Abstract 5150: An immunohistochemical survey of predictive biomarkers for immunotherapy in ampullary carcinoma identifies strata with unique prognostic signatures

Abstract Introduction: Carcinomas located in the ampulla of Vater are a low incidence malignancy. Therapeutic options for early stage disease largely consist of pancreaticoduodenectomy followed by adjuvant chemotherapy with or without radiation. We explored the localization of CD8 and CD3 positive cells in addition to PDL-1 staining and mismatch repair deficiency markers to gain insight into the potential applicability of immunotherapy for patients with this disease. Methods: Excess material from clinically diagnosed cases collected between 1997 - 2013 were used to construct a duplicate 0.6mm core tissue microarray (TMA). All cases were derived from the Vancouver Coastal Health Region. Immunohistochemical staining was performed with the following markers: CD8, CD3, PD-L1, and the mismatch repair (MMR) markers: MSH2, MSH6, MLH1 and PMS2. CD3 and CD8 were quantified using localization within the tissue. PD-L1 was considered positive with &amp;gt;1% of cells stating positive. MMR markers were confirmed using full section and cases with convincing loss of any MMR marker were considered MMR deficient. Univariable disease specific survival analysis was performed to identify unique prognostic signatures and contingency analysis was performed to identify co-expression of the aforementioned biomarkers. Results: Ninety-eight cases were evaluable for all markers. The median age of the cohort was 69 [41 - 84] years. Forty-two percent were female. Adjuvant chemotherapy was provided to 15% of patients with the remainder undergoing post-surgical observation. Almost 90% were pT3 or pT4 and 48% had regional lymph node metastasis. CD3+ T-cells were either localized in the tumor stroma only (59%) or in both the stroma and epithelial compartments (41%). CD8+ T-cells were principally located in the stroma (66%) and both the epithelial and stroma (24%). Ten percent of cases had no CD8+ T-cells. PD-L1 staining was found in 10% of cases. MMR deficiency was found in 5% of cases. Improved prognostic signatures were found for cases with CD3+ and CD8+ T-cells in both the epithelial and stromal compartments (p &amp;lt;= 0.02). A trend towards a negative prognostic signature was observed for MMR deficient cases and for PD-L1 positive cases. The only significant positive association between biomarkers was found for CD3+ and CD8+ in both the epithelial and stromal compartments. Conclusions: The results of this analysis suggest that enhancement of an immune response yielding an increase CD3+ and CD8+ T-cells in the epithelial compartment may have a beneficial effect on prognosis. The relative scarcity of MMR deficiency in this disease is within the expected prevalence supported by other studies. Further exploration of the potential role of immunotherapy in immune enhanced subgroups of ampullary cancers is warranted. Citation Format: Steve E. Kalloger, Joanna Karasinska, James Topham, Daniel J. Renouf, David F. Schaeffer. An immunohistochemical survey of predictive biomarkers for immunotherapy in ampullary carcinoma identifies strata with unique prognostic signatures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5150.

Laboratory Data Timeliness and Completeness Improves Following Implementation of an Electronic Laboratory Information System in Côte d'Ivoire: Quasi-Experimental Study on 21 Clinical Laboratories From 2014 to 2020.

The Ministry of Health in Côte d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President's Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation. This evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment. This evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS. There was an immediate 5-fold increase in timeliness (OR 5.27, 95% CI 4.33-6.41; P<.001) and an immediate 3.6-fold increase in completeness (OR 3.59, 95% CI 2.40-5.37; P<.001). These immediate improvements were observed starting after OpenELIS installation and then maintained until 72 weeks after OpenELIS adoption. The weekly improvement in the postimplementation trend of completeness was significant (OR 1.03, 95% CI 1.02-1.05; P<.001). The improvement in validity was not statistically significant (OR 1.34, 95% CI 0.69-2.60; P=.38), but validity did not fall below pre-OpenELIS levels. These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in health care. These findings highlight the importance of OpenELIS in Côte d'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems.

Abstract P381: Geographic Variation in Financial Strain and Food Insecurity After the COVID-19 Pandemic: Implications for Cardiovascular Health Equity

Reduced food security is associated with higher healthcare expenditures and increased risk of coronary heart disease, angina, heart attacks, and hypertension. State-level responses to the COVID-19 pandemic and support policies may contribute to regional differences in financial strain and food insecurity, which could have implications for cardiovascular outcomes. Hypothesis: We assessed the hypothesis that there is geographic variation in financial strain and food insecurity in the United States three years after the start of the pandemic. Methods: This study utilizes weighted data from the U. S. Census Bureau’s Household Pulse Survey Phase 3.10 conducted from August 23 - September 4, 2023. We organized data responses according to the Department of Health and Human Services regions - Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. Food insecurity was measured using a single survey item about having sufficient food to eat in the last 7 days. Financial strain was defined as difficulty paying expenses in the last seven days. Results: There were 254,966,752 adults in the total sample population, (59%) reported difficulty with expenses due to the COVID-19 pandemic. The Atlanta region reported the most financial strain (13%), while the Denver region reported the least (2%), p-value=0.000. The rate of food insecurity was highest in the Atlanta region at 8% compared with 5% or less in other regions, p-value=0.000. Among the 8 states in the Atlanta region, Black individuals were disproportionately more likely to be food insecure, with the greatest difference for Kentucky, Florida, Tennessee, and South Carolina. All states in the Atlanta region had similar odds of food insecurity, but Mississippi residents were nearly twice as likely to experience food insecurity than residents of other states (OR 1.87, p =0.016). Conclusions: The Atlanta region (i.e., the “Deep South”) consists of the most populous states for non-Hispanic Black people and is experiencing the worst food insecurity and financial strain post-pandemic. The economic toll of the pandemic and post-pandemic inflation may contribute to worsening food insecurity and cardiovascular outcomes in a region that is already burdened by poor cardiovascular health. Multilevel intervention is needed to support full pandemic recovery and avoid exacerbating inequities in cardiovascular disease.

The Impact of COVID-19 on Thailand’s Public Health Emergency Management System: A Case Study

Purpose: This phenomenological qualitative research investigates Public Health Emergency Management (PHEM) in response to COVID-19, with a specific focus on the case of Thailand’s Health Region 9 (Nakhon Ratchasima) and its program known as COVID-19 Back Home. Method: The study gathers data through in-depth interviews with four groups comprising a total of 112 individuals from three Thai provinces. The collected data is subjected to content analysis, and the findings are analyzed using a framework based on system theory. Results and conclusion: The successful management of subjects returning home is highlighted, resulting in saving numerous patients' lives. The study identifies various suggestions and success factors for each phase of the management process. The research sheds light on PHEM situations in response to COVID-19, specifically examining Health Region 9's COVID-19 Back Home program. Implications of the research: The study provides valuable insights into the inputs, activities, and processes involved in managing such situations, showcasing successful strategies, collaborative efforts, and behavioral changes. Originality/value: The identified suggestions and success factors can inform and improve future management approaches.

A qualitative examination of primary care team's participation in the distribution of the COVID-19 vaccination.

Primary health care (PHC) has historically led and implemented successful immunization programs, driven by strong relationships with patients and communities. During the COVID-19 pandemic, Canada began its vaccination strategy with mass immunizations that later included local efforts with PHC providers. This study seeks to understand how PHC contributed to the different phases of the COVID-19 vaccination rollouts in Ontario, Canada's most populous province. We conducted a descriptive qualitative study with focus groups consisting of PHC providers, administrators, and staff in Ontario. Eight focus groups were held with 39 participants representing geographic diversity across the six Ontario Health regions. Participants reflected a diverse range of clinical, administrative, and leadership roles. Each focus group was audio-recorded and transcribed with transcriptions analyzed using thematic analysis. With respect to understanding PHC teams' participation in the different phases of the COVID-19 vaccination rollouts, we identified five themes: (i) supporting long-term care, (ii) providing leadership in mass vaccinations, (iii) integrating vaccinations in PHC practice sites, (iv) reaching those in need through outreach activities; and (v) PHC's contributions being under-recognized. PHC was instrumental in supporting COVID-19 vaccinations in Ontario, Canada across all phases of the rollout. The flexibility and adaptability of PHC allowed teams to participate in both large-scale and small-scale vaccination efforts.

Study of Factors Associated with Inappropriate Complementary Feeding Among Children Aged 6 to 23 Months, Western Health Region of the Gambia, 2020

Introduction: Inappropriate complementary feeding practices are a major cause of morbidity and mortality in the first two years of life. The aim was to investigate factors associated with inappropriate complementary feeding practices among mothers of children aged 6-23 months in the Western Health Region of The Gambia. Methodology: This was a cross-sectional, descriptive and analytical study conducted from 14 September to 14 October 2020. The study population consisted of mothers of children aged 6 to 23 months attending reproductive and child health clinics and enrolled in the &amp;quot;Every Child Counts - My Child Project&amp;quot; immunization and vaccination program. Simple random sampling was used to select participants using the project. Data were collected by means of a questionnaire administered by telephone interview and concerned the socio-demographic characteristics of the mothers, the professional and economic characteristics of the parents, the socio-demographic characteristics of the children, diet and complementary feeding practices. Results: The mean age of the mothers was 28.3 (±5.4) years and that of the children 14.2 (±4.8) months. Minimum dietary diversity was 33.3%, minimum meal frequency 88% and minimum acceptable dietary intake 14.5% for all children aged 6-23 months. Non-respect of minimum dietary diversity was associated with the child&amp;apos;s female sex, with an OR = 16.3 [1.83-145.7], with the occurrence of both diarrhea and Acute Respiratory Infection (ARI) in the two weeks preceding the survey, with an OR = 27.2 [4.26-39.8], and with the child&amp;apos;s birth in a public health facility, with an OR = 55.1 [1.53-197.7]. Children whose mothers were aged between 25 and 34 and whose fathers did not work had a higher risk of non-respect of the dietary diversity, with OR = 54.1 [2.4 6- 118.5] and OR = 22.5 [2.32 - 31.9] respectively. The factors associated with non-respect of the minimum meal frequency were the advanced age of the children: 12 to 17 months with an OR= 28.6 [1.65 - 49.5] and 18 to 23 months with an OR= 18.9 [1.67 - 215.0] and a history of both ARI and diarrhea with an OR=. 52,9 [1,61 - 173,7]. Non-respect of the minimum acceptable dietary intake was associated with older children aged 18 to 23 months OR= 14.4 [2.25- 93.0] and those whose mothers had vocational training OR=.24.2 [1.27- 46.3]. Conclusion: Complementary feeding practices are not very satisfactory. It is important to strengthen nutrition education in order to improve infant and young child feeding practices.

Analysis of the Influence of Education, Health, and Gross Regional Domestic Product (GRDP) on Poverty in Central Maluku Regency

This thesis aims to analyze the influence of education, health, and Gross Regional Domestic Product (GRDP) on the poverty level in Central Maluku Regency, both partially and simultaneously related to the Social Welfare Program. The research employs a conceptual framework consisting of three main dimensions: education, health, and GRDP. Through quantitative and qualitative approaches, the impact of education on poverty is elaborated, the role of health in reducing the poverty rate is investigated, and the relationship between GRDP and poverty levels is explored in depth. The research methods used include primary and secondary data collection, statistical analysis, and interviews with local stakeholders. The research results are expected to provide a holistic insight into the factors contributing to poverty in Central Maluku Regency. The results of this study illustrate that education, health, and GRDP variables partially influence poverty in Central Maluku Regency. This can be seen from the probability values of each variable, which are less than 0.01 %. This research is expected to provide conceptual and practical contributions to poverty alleviation efforts at the local level. Policy implications are expected to guide strategic steps to improve education, health, and economic growth to reduce poverty levels in this region. In conclusion, this thesis contributes to a better understanding of the complexity of poverty issues in Central Maluku Regency and provides a basis for the development of more effective intervention strategies to address these challenges.

Evaluating the Association between the Implementation of the PoET (Prevention of Error-Based Transfers) Southwest Spread Project and Palliative Care Provision: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data

ObjectivesThe PoET (Prevention of Error-based Transfers) project seeks to align long-term care (LTC) home informed consent practices to existing legislation, thereby reducing consent-related error-based transfers to acute care. We sought to measure changes in resident-level palliative care provision after participating in the PoET Southwest Spread Project (PSSP), and to identify patient and LTC home characteristics associated with palliative care provision. DesignQuasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. SettingSixty LTC homes (PSSP = 30; Control = 30) in Ontario, Canada, from November 2019 to December 2021. MethodsWe matched 30 PSSP to 30 control homes and described incidence rates for resident-level palliative care provision (ie, physician palliative care encounters and palliative medication prescriptions) during the 7-month postimplementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and palliative care provision during the postimplementation period. We adjusted for resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent subcohort to measure palliative care provision patterns during the last 2 months of life. ResultsWe captured a matched cohort of 8894 residents (PSSP = 4103; Control = 4791). Incidence rates of palliative care encounters increased during the postimplementation period for PSSP (82.6 to 85.4 per 100 person-months) but not for control residents (68.8 to 65.3 per 100 person-months). After adjusting for key covariates, PSSP exposure was associated increased palliative care provision (incidence rate ratio 2.47, 95% CI 2.31-2.64) and palliative care medication prescription (1.16, 95% CI 1.12-1.20). Larger home size, certain health regions, and higher number of comorbidities were associated with increased physician palliative care encounters. Conclusions and ImplicationsBy promoting correct informed consent practices in LTC, PSSP participation increased palliative care provision for PSSP LTC residents across all settings.

Ophthalmology workforce over a decade in the Kingdom of Saudi Arabia: demographics, distribution, and future challenges

BackgroundThe ophthalmology workforce is an integral component of any health care system. However, the demand for eye care has imposed a heavy burden on this system. Hence, this study aimed to estimate the trends, demographic characteristics, distribution, and variation between Saudi and non-Saudi ophthalmologists and the future challenges of the ophthalmology workforce in the Kingdom of Saudi Arabia (KSA).MethodsThis study was conducted in the KSA and included ophthalmologists practicing from 2010 to 2023. From the Saudi Commission for Health Specialties, we obtained the number, gender, nationality, and rank of ophthalmologists. The geographic distribution of ophthalmologists in the KSA was obtained from the Ministry of Health Statistical Yearbook 2021.ResultsAs of January 2023, the KSA had a total of 2608 registered ophthalmologists, with approximately 81.06 ophthalmologists per 1,000,000 people. Only 38% of all ophthalmologists in the country were Saudis. The percentage of Saudi female graduates increased from 13.3% to 37.2% over 12 years [Sen’s estimator of slope for median increase per year = 1.33 (95% CI 1.22–1.57) graduates; trend test P < 0.001). Additionally, we found that the geographic distribution of ophthalmologists varied (test for homogeneity of rates, P < 0.0001), with the larger regions having a higher concentration of ophthalmologists than the smaller regions (75.6 in Riyadh versus 42.8 in Jazan per 1,000,000 people). However, the World Health Organization's target for the ophthalmologist-to-population ratio has been achieved in all 13 health regions of KSA.ConclusionThe recommended ophthalmologist-to-population ratio has been achieved in the KSA, and the number of Saudi ophthalmologists has almost doubled over the past 8 years. However, the majority of ophthalmologists are still non-Saudi, as Saudi ophthalmologists constitute approximately one-third of the ophthalmology workforce in the KSA. The geographical distribution of ophthalmologists varies, which might affect access to care in peripheral regions. In response to the growing demand for eye care in the KSA, several more effective measures might need to be considered.

Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis.

Neonatal deaths contribute significantly to under-5 mortality worldwide with Sub-Saharan Africa (SSA) alone accounting for 43% of global newborn deaths. Significant challenges in the region's health systems evidenced by huge disparities in health facility deliveries and poor planning for preterm births are major contributors to the high neonatal mortality. Many neonates in the region are delivered in suboptimal conditions and require transportation to facilities equipped for specialized care. This review describes neonatal transport across the subregion, focusing on low-cost interventions employed. We conducted a systematic review of studies on neonatal transport in SSA followed by a narrative synthesis. A search in the databases CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar was performed from inception to March 2023. Two authors reviewed the full texts of relevant studies to determine eligibility for inclusion which was subsequently cross-checked by a third reviewer using a random 30% overlay. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A total of 20 studies were included in this review involving 11,895 neonates from 10 countries. All studies evaluated the transfer of neonates into referral centers from the peripheries. Most neonates were transferred by public transport (n = 12), mostly in the arms of caregivers with little communication between referring facilities. Studies reporting on ambulance transfers reported pervasive inadequacies in both human resources and transport equipment. No study reported on the use of Kangaroo mother care (KMC) in the transfer process. The neonatal transport system across the SSA region is poorly planned, poorly resourced, and executed with little communication between facilities. Using cost-effective measures like KMC and improved training of community health workers may be key to improving the outcomes of transported neonates.