General Hospital Services Research Articles

Effectiveness of an educational strategy in increasing the prescription of adequate thromboprophylaxis in the internal medicine service of general hospital

Objetivo: Determinar el impacto de una intervención educativa sobre la frecuencia de prescripciones médicas adecuadas de tromboprofilaxis en un servicio de medicina de un hospital general. Material y métodos: Estudio quasi experimental, en el cual en la fase pre-intervención se obtuvieron las frecuencias de indicación de tromboprofilaxis adecuada por parte de los médicos del servicio de medicina. Se realizó una intervención educativa de 8 semanas a este mismo grupo de médicos. En la fase post intervención se midió la frecuencia de la tromboprofilaxis adecuada a los 2 y 4 meses después de la intervención. Resultados: La intervención educativa se implementó en 112 médicos residentes de las especialidades de medicina. La totalidad de prescripciones fueron hechas por los médicos residentes de primer año y refrendadas por su médico supervisor. Previamente a la intervención se obtuvieron 47 (44,35%) prescripciones adecuadas, 13 (12,26%) subóptimas, 4 (3,77%) inadecuadas y 42 (39, 62%) ausencia de prescripción. Luego de la intervención se obtuvieron a los 2 meses subsiguientes: 78 (75,72%) prescripciones adecuadas, 7 (6,79%) subóptimas, 4 (2,91%) inadecuadas y 15 (14,58%) ausencias de prescripción, habiendo diferencia significativa con el nivel basal. A los 4 meses subsiguientes postintervención se obtuvieron:  86 (83,49%) adecuada, 5(4,85%) subóptima, 2 (1,94%) inadecuada y 10 (9,72%) ausencia de prescripción, habiendo diferencia significativa con el nivel basal. No hubo aumento en la frecuencia de sobre uso. Conclusiones: La aplicación de una estrategia educativa al personal médico fue efectiva en el incremento de las prescripciones de tromboprofilaxis correctamente indicadas en un servicio de medicina. No se encontró sobreuso de la tromboprofilaxis luego de la intervención.

Experiences of physical healthcare services in Māori and non-Māori with mental health and substance use conditions.

Inequities in physical health outcomes exist for people with mental health and substance use conditions and for Indigenous populations (Māori in Aotearoa New Zealand). These inequities may be partly explained by poorer quality of physical healthcare services, including discrimination at systemic and individual levels. This study investigated the experiences of people with mental health and substance use conditions accessing physical healthcare and differences in service quality for non-Māori relative to Māori. A cross-sectional online survey of people with mental health and substance use conditions in New Zealand asked about four aspects of service quality in four healthcare settings: general practice, emergency department, hospital and pharmacy. The quality domains were: treated with respect; listened to; treated unfairly due to mental health and substance use conditions; mental health and substance use condition diagnoses distracting clinicians from physical healthcare (diagnostic and treatment overshadowing). Across the four health services, pharmacy was rated highest for all quality measures and emergency department lowest. Participants rated general practice services highly for being treated with respect and listened to but reported relatively high levels of overshadowing in general practice, emergency department and hospital services. Experiences of unfair treatment were more common in emergency department and hospital than general practice and pharmacy. Compared to Māori, non-Māori reported higher levels of being treated with respect and listened to in most services and were more likely to report 'never' experiencing unfair treatment and overshadowing for all health services. Interventions to address discrimination and poor-quality health services to people with mental health and substance use conditions should be tailored to the physical healthcare setting. More needs to be done to address institutional racism in systems that privilege non-Māori.

A Cross-Sectional Study about Demographic and Medical Characteristics of Hypertensive Pregnant Women in Two Secondary Healthcare Facilities, in Ilorin, Nigeria

Background Hypertension is one of the major causes of related maternal deaths worldwide and it is one of the most common medical disorders encountered during pregnancy. Aim This study aimed at assessing the demographic and medical characteristics of hypertensive pregnant women in two secondary healthcare facilities, in Ilorin, Nigeria Method This was a cross-sectional study among 104 pregnant women with hypertension attending the outpatient department of General Hospital and Civil Service Clinic, Ilorin between March and May 2021. A validated self-administered questionnaire was used to obtain information on sociodemographics. Data on the medical characteristics of the respondents and their medications were extracted from the respondent's medical files. Ethical approval was obtained from the Ministry of Health and General Hospital, Ilorin. For statistical analysis for categorical measurements, the frequencies and percentages were computed. Results Seventy-five percent of the correspondents were below 36 years old, 97% were married, 79% had tertiary education, and 74% were above 24 weeks of gestation. About 68% of the correspondents had blood pressure more than or equal to 140/90 and 10% had blood pressure more than 160 mm Hg systolic or more than 100 mm Hg diastolic. About 78.8% of the correspondents had a family history of hypertension, 13.5% had a family history of diabetes mellitus, and 22.1% had a family history of obesity. About 27.9% had pre-existing hypertension, 61.5% developed hypertension before the end of 20 weeks of gestation, and 10.6% developed hypertension after 20 weeks of gestation. About 24% had their antihypertensive medication changed during pregnancy, 38.5% were treated with methyldopa, 31.7% with nifedipine, and 27% with nifedipine and methyldopa. Majority (83.6%) of the respondents were not adherent to their medications. Conclusion Two-third of the patients had poor blood pressure control irrespective of the fact that all were under drug therapy. Family history and large body mass index are the main risk factors for the development of hypertension during pregnancy. Noncompliance may play a significant role in no drug response.

Diversity of kidney care referral pathways in national child health systems of 48 European countries.

Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

Determinants of workload-related clinician stress levels in general hospital consultation liaison psychiatry services during the COVID-19 pandemic in England and Ireland. Short report

ObjectiveTo explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. MethodsData were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. Dependent variable: workload-related stress levels in CLP services due to COVID-19 (0–10 point scale). Independent variables: hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. ResultsThere was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). ConclusionOur findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

Connecting with Rough Sleepers: Community Volunteer Training and Partnership

Background: A nationwide study on homelessness in 2019 reported high prevalence of poor health among rough sleepers in Singapore. There are rough sleepers supported by volunteers and community partners within Singapore General Hospital service boundary.  Community nursing team engaged Ministry of Social and Family Development (MSF) Partners Engaging and Empowering Rough Sleepers (PEERS) Network and Homeless Heart, a volunteer group, to reach out to this vulnerable population and to understand challenges faced by volunteers.  The learning needs survey among 39 volunteers was conducted and showed that less than 8% of them were equipped with basic healthcare knowledge and skills. The top three learning needs were i) healthcare resource for homeless (92.1 %), ii) mental Health (68.4%), iii) basic triaging skills (68.4%).
 Interventions: A virtual volunteer training programme was developed based on survey findings and inputs from PEERS Network during COVID-19. It was further extended to shelter operators supporting rough sleepers. The training was conducted by community nurses on alternate weekend from February to March 2022. The mode of delivery included didactic teaching and case discussion. A referral process to community nursing for rough sleepers requiring assistance in chronic disease monitoring was established to ensure care continuity. 
 Outcomes: A total of 46 participants attended training. All found the program content was useful, relevant to their volunteer activities, and easy to understand. Nearly 80% will recommend this program to their peers. Till date, a total of 5 referrals to Community Nurse Posts were made by volunteers. Nurses conducted health coaching and medication re-consolidation to rough sleepers and also guided volunteers for the subsequent follow up.
 Learning Points and Future Plan: It is the first training programme provided by community nurses to volunteers and staff supporting rough sleepers. The programme was tailored to meet participants’ experience and learning needs. Community nursing will further collaborate with PEERS for outreach events and provide onsite training to facilitate effective learning experience. Moving forward, community nurse team will extend the  training program to other community service provides and grassroots volunteer, to support the residents’ physical and psychological well-being  in the community .

ANALISIS PELAYANAN RUMAH SAKIT UMUM DENGAN PERBANDINGAN ANTARA METODE ALGORITMA KMEANS, DAN K-MEDOIDS CLUSTERING

Hospitals are part of a health system that aims to provide comprehensive individual health services. Services include inpatient, outpatient, and emergency care. Hospitals must provide high-quality services according to existing standards and serve all levels of society. Understanding customers' needs, wants, and demands will provide Another factor that affects the quality of health services is the availability of resources and service facilities during the insurance period. Lack of continuity of service affects the efficiency and quality of the relationship. The quality of health services is also strongly influenced by the ease of information and timeliness of public hospital services. Based on data from 341 hospital service quality surveys, the results obtained from the K-Means algorithm method are 2.701288, while the results obtained in the K-Methoids Clustering method are 2.17, where the General Hospital service questionnaire is a very satisfied category. A comparison of the results of the K-Means and K-Medoids methods aims to make it easier to measure customer satisfaction.

169 Cost-effectiveness analysis of geriatrician-led perioperative services in district general hospitals

Abstract Background Perioperative care for Older People undergoing Surgery (POPS) services using Comprehensive Geriatric Assessment (CGA) and optimisation methodology in the perioperative setting are clinically and cost effective. Originally described within a tertiary centre, the POPS model has been successfully translated to district general hospital (DGH) settings. The aim of this project was to deliver a cost-effective, CGA-based perioperative service for older people at an NHS trust operating across two geographically separate district general hospitals, with support from the newly established POPS Network, an initiative designed to scale up POPS services across the NHS. Methods A POPS service had been informally provided by two consultant physicians since 2017, but the service was formalised through the NHS Elect POPS network in 2021. Data were collected from 50 consecutive patients reviewed in POPS outpatient clinic, over a six-week period. Patients with polypharmacy (defined as prescription of five or more drugs) were identified and the number of medications deprescribed was catalogued. The number of specialty referrals or additional outpatient appointments avoided by early CGA was also recorded. Additionally, prospective data on drugs deprescribed on 90 consecutive surgical inpatients were analysed. Economic evaluation was conducted by the trust’s financial and pharmacy departments. Results For POPS outpatients, through prevention of onward specialty referral or other outpatient appointments (mean 2.54 per patient), cost saving was calculated at £803 per patient. This generated an extrapolated annual saving of £385,440 at each site. For inpatients, pharmacological optimisation led to an estimated annual cost saving of £239,000, with on average two medications deprescribed per patient. Subsequent benefits realisation analysis at 18 months demonstrated that these results remain consistent. Conclusion POPS services within DGHs, when delivered by clinicians who practise holistically, have a significant positive financial impact through pharmacovigilance and by preventing unnecessary specialty referrals and outpatient appointments. These cost savings of over £500,000 have easily funded the substantive service.

Developing prognostic models for health care utilization in patients with work-related mental health problems

BackgroundThe long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization.MethodsFrom the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 − 3 years before, 2 years before/after, and 3–5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3–5 years after assessment assessing both calibration and discrimination.ResultsPrevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 − 3 years prior to assessment, then rising during the 2 years before/after. At 3–5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 − 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination.ConclusionsPrevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3–5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis.Trial registrationThe study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses.

Spatial Analysis of The Influence of Residential Density on The Spread of Tuberculosis Cases in Pasar Rebo General Hospital Service Area

Spatial Analysis of The Influence of Residential Density on The Spread of Tuberculosis Cases in Pasar Rebo General Hospital Service Area

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: Results of an international survey

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: Results of an international survey

Identifying individuals with complex and long-term health-care needs using the Johns Hopkins Adjusted Clinical Groups System: A comparison of data from primary and specialist health care

This study aimed to present the Johns Hopkins Adjusted Clinical Groups (ACG) System risk stratification profile of a total adult population of somatic health-care users when using data from either general practitioners (GPs) or hospital services and to compare the number and characteristics of individuals identified as having complex and long-term health-care needs in each data source. This was a registry-based study that included all adult residents (N=168,285) in four municipalities in Central Norway who received somatic health care during 2013. Risk profiles were generated using the ACG System based on age, sex and diagnoses registered by GPs or the local hospital. ACG output variables on number of chronic conditions, frailty and concurrent resource utilisation were chosen as indicators of complexity. Nearly nine out of 10 (83.9%) of the population had been in contact with a GP, and 35.4% with the hospital. The mean number of diagnoses (3.0) was equal in both sources. A larger proportion of the population had higher risk scores in all variables except frailty when comparing hospital data to GP data. This was also found when comparing individuals identified as having complex and long-term health-care needs. A similar proportion of the population was found to have complex and long-term health-care needs (hospital 6.7%, GP 6.3%), but only one in five (21.5%) were identified in both data sets. As data from GPs and hospitals identified mostly different individuals with complex and long-term health-care needs, combining data sources is likely to be the best option for identifying those most in need of special attention.

Discovering risk patterns in people with affective disorder-induced disabilities associated with their healthcare delay.

People with affective disorder-induced disabilities (ADIDs) often experience complex needs that delay their healthcare. Discovering hidden patterns in these people for real-world use of health services is essential to improve healthcare delivery. A cross-sectional study population (2501 adults with ADIDs) was obtained from the Australian national representative survey of disability in 2015, including 21 demographic, health and social characteristics and healthcare delay information in general practice, specialist and hospital services. The Self-Organising Map Network was used to identify hidden risk patterns associated with healthcare delay and investigate potential predictors of class memberships by means of simple visualisations. While experiencing disability avoidance showed across different healthcare delays, labour force appeared not to have any influence. Approximately 30% delayed their healthcare to general practice services; these were young, single females in great need of psychosocial support and aids for personal activities. Those who delayed their healthcare commonly presented a lack of social connections and a need for contact with family or friends not living in the same household. The pattern evidence provides an avenue to further develop integrated care strategies with better targeting of people with ADIDs, considering social participation challenges facing them, to improve health service utilisation.

Overwhelming number of refugees in Poland - which strategy is being pursued

AbstractBy the decision of the Polish Government, all persons arriving in the territory of the Republic of Poland after the commencement of the Russian aggression against Ukraine have free access to public psychiatric assistance, including reimbursement of pharmacological treatment on the same terms as Polish citizens. According to the UHNR data over 4 million displaced people, refugees, came to Poland so far and some of them benefited from such help.Displaced individuals suffer from the consequences of traumatic events, exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders or relapses of psychotic episodes.The lecture will present data from the Interdisciplinary War in Ukraine Research Laboratory by pointing out the most important problems faced by Ukrainian refugees in Poland, why they chose Poland when escaping the war, how they evaluate Polish help, what their integration in Poland looks like. The survey also measured the level of war trauma (RHS-15). The results of the analysis show that most refugees present post-traumatic stress disorder symptoms (76 %), while only 0.15% of this population was treated in public psychiatric facilities.Mental healthcare services are suddenly faced with major challenges and need to develop or expand strategies to address them. The Polish Ministry of Health prepared and started implementation of a reform of the mental health care system for adult as well as children and adolescent psychiatry. This fundamental reform should comprise three main actions, i.e. integration of mental health services into primary healthcare; establishment of community psychiatric services together with the provision of inpatient services in general hospitals; and limitation of the role of mental hospitals to specific tasks only (long-term or specialist treatment).Disclosure of InterestNone Declared

SISTEM PAKAR DIAGNOSIS PENYAKIT PADA BALITA DENGAN METODE FORWARD CHAINING

Children under the age of 1 year (toddlers) are more susceptible to disease, which causes the environment to greatly affect the health of toddlers. Children's health is one of the most important things, especially when the child is in its infancy. The importance of SOP is one of the assessments of the quality of health services for both government and private agencies. There is input from patients as service users so that the importance of SOP for General Hospital services as service guidelines so that patient satisfaction is obtained. The purpose of this study was to see how useful the SOPs were compiled and the compliance of doctors in providing services based on SOPs on the quality of service received by patients. The method used is the Forward Chaining Method which is a method for reasoning from a problem by providing a solution. This research is an applied technology product that is expected to provide benefits as a media for consultation or instructor for the community in general, as well as for doctors and paramedics at public hospitals. The design of this system has been carried out through data collection activities, design rules, process design and system testing. From the collection of data and information found disease facts, complaints, symptoms and suggestions for treatment. The results obtained from testing the system using the PHP MySQl application show that the results of diagnoses and diseases of children at Tanjung Balai General Hospital have as many as 10 patient data that have been studied by experts and have carried out system testing to achieve an accuracy of 80%. Keywords: SOP, Forward chaining, rules, PHP MySQl, Expert System, disease diagnosis.

Diabetes during the COVID-19 pandemic: are people getting access to the right level of care?

IntroductionAvoidance of health services, in particular hospital and community services, is problematic for people with diabetes. Evidence has demonstrated that such missed attendances are associated with worse health, faster declines in functioning, and higher rates of mortality long-term.This paper investigated the impact of the pandemic on healthcare access across community and hospital care, including Virtual Care (VC) using several large datasets of General Practice (GP) and hospital services in western Sydney.MethodsA retrospective cohort study using a time-series database of 173,805 HbA1c tests done at Blacktown and Mt Druitt hospitals and 1.8 million recorded consultations at GP clinics in the region was undertaken.ResultsThe average rate of diabetes in Emergency Department fell from 17.8% pre-pandemic to 11% after January 2020 (p < 0.001). This rate varied substantially over time, and correlated well with large outbreaks of COVID-19 in the state. Conversely, attendances of people with diabetes to GP clinics, especially using VC services, increased substantially over the pandemic period.Discussion/ConclusionDuring the pandemic there was a substantial avoidance of hospital care by patients with diabetes. However, this may have been replaced by VC offered in the community for those with less severe diseases.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond

ObjectiveThe COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. MethodsCross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. ResultsOf the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. ConclusionOver 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Medico-socio-economic perspective of congenital hydrocephalus patients treatment in dr. Soetomo Academic General hospital, Surabaya, Indonesia

Background: Hydrocephalus is a brain disease that requires prompt treatment. The outcome of hydrocephalus is dependent on early detection and treatment. This study was conducted to analyze the medico-socio-economic perspective on the delayed treatment of hydrocephalus patients, which aimed to advance the practice of neurosurgery in the socio-neurosurgery field, including both preventive and therapeutic aspects. Method: This was an observational analysis study. The study subjects were all patients with congenital hydrocephalus treated in dr. Soetomo Academic General Hospital between January 2017 and December 2019. The study was carried out on January 2017 to December 2019 at the Inpatient Surgery ward, dr Soetomo Academic General Hospital, neurosurgery outpatient unit, and home visits. Research data consists of both primary and medical record data. Data on patient characteristics were obtained through direct interviews with the sample using prepared questionnaires, medical record data, and radiological data of both patients examined at dr. Soetomo Academic General Hospital and other health services. Bivariate correlation analysis was performed to assess the effect of each risk factor on the incidence of delay in treatment, and multivariate logistic regression analysis was performed to assess the magnitude of the effect of risk factors. Result: The number of cases was 101 subjects. A total of 101 patients included as research samples were congenital hydrocephalus patients who received the first treatment at dr. Soetomo Academic General Hospital from January 2017 to December 2019. Up to 50 individuals (49.5%) were delayed in treatment. The data analysis with Chi-square did not reveal a statistically significant correlation between delay in treatment and level of parent's education (p=0.0951), delay in treatment and economic status ((p=0.4955). Delays in the treatment of congenital hydrocephalus were statistically significant and correlated with Posyandu's role (p=0.0012), health insurance ownership (p=0.0001), family support (p=0.0130), and professional medical decisions (p=0.0001). Health insurance ownership has the smallest p-value (0.000) and largest wald (16.545) in the multivariate logistic regression analysis calculation using the enter method. The insurance ownership variable has the most significant and largest partial influence on the delay in treating congenital hydrocephalus. Conclusion: There were 101 patients included, and up to 50 individuals (49.5%) were delayed in treatment. Parents' education level and socioeconomic status were not associated with delayed treatment of congenital hydrocephalus. Delays in managing congenital hydrocephalus were influenced by Posyandu's role, health insurance ownership, family support, and professional medical decisions.           

Implantação e implementação de serviços em cuidados paliativos

Abstract Since expanding palliative care services within general hospitals in Brazil involves confronting obstacles and establishing strategies to enable their implementation in the health system, this study sought to identify the process around establishing and implementing palliative care services in Brazilian general hospitals. An integrative literature review of four articles identified the following steps for establishing and implementing palliative care services: protocol development, humanized care, multidisciplinarity, and education. As for the obstacles, the analysis highlighted the lack of training and education in palliative care, difficulty in reaching consensus on palliative practices, communication, drug supply, and government support. In conclusion, public policy development is essential to guarantee the implementation of palliative care in hospitals.

The Relationship between Patient Centered Care Implementation and the Quality of Health Services at the Regional General Hospital Dr. RM Djoelham Binjai 2022

Hospitals are services that have an important role in people's lives in the health sector, Patient Centered Care (PCC) is related to seven patient safety standards that can improve health services in general hospitals, at the Dr. RM Djoelham Binjai has been accredited Plenary and has implemented PCC, but it has not been carried out optimally and has never been studied before regarding the relationship between PCC implementation and the quality of health services in the Inpatient Room of Dr. Hospital. RM Binjai, the purpose of the study was to determine whether the relationship between the implementation of patient centered care and the quality of health services at the Dr. RM Djoelham Binjai in 2022. This research uses this type of research using direct observation, using a cross sectional research approach, the study population was all patients who were hospitalized at the Regional General Hospital Dr. RM Djoelham Binjai in 2022 as many as 63 patients, the sample in the study was total sampling, the research technique used the chi square formula (kai squared). The results of this study show that there is a significant relationship between the implementation of Patient Centered Care and the Quality of Health Services at the Dr. Regional General Hospital. RM Djoelham Binjai in 2022, with p value = 0.002 (p&lt;0.05). The conclusion in this study from these results. There is a significant relationship between the implementation of Patient Centered Care with the Quality of Health Services at the Dr. Regional General Hospital. RM Djoelham Binjai, suggestions for health workers need to do training related to information and communication to patients and families