Health Care Services In Settings Research Articles

Influence of the social determinants of health on access to healthcare services among refugees in Australia.

Refugees in Australia are not fully utilising the healthcare system for several reasons and this may be affecting their overall health outcomes. This qualitative systematic review examined the influence of the social determinants of health on refugees' access to healthcare services in Australia. Electronic databases were searched using terms relating to refugees, social determinants, healthcare services, barriers, enablers and Australia. Only peer-reviewed studies published in English since 2006, which focused on refugees and specifically discussed social determinants influencing refugees' access to healthcare services in Australia, were included. The studies were critically analysed using standard Critical Appraisal Skills Programme Tools. Eight studies were included in the review. Findings reveal multiple factors influence refugees' access to healthcare in Australia, and these can be conceptualised within a social-ecological model of health; that is, they operate across individual, interpersonal, environmental, organisational and policy levels. The novel finding of this review was the re-occurrence of similar influences across multiple healthcare service settings in Australia. The prevalence and re-occurring nature of the social determinants of health suggests that refugees are experiencing multilayered barriers to accessing Australian healthcare. All levels of a social-ecological model must be addressed in any attempt to break down these barriers.

Human rights and mental health in post-apartheid South Africa: lessons from health care professionals working with suicidal inmates in the prison system

BackgroundDuring the era of apartheid in South Africa, a number of mental health professionals were vocal about the need for socio-economic and political reform. They described the deleterious psychological and social impact of the oppressive and discriminatory Nationalist state policies. However, they remained optimistic that democracy would usher in positive changes. In this article, we consider how mental health professionals working in post-apartheid South Africa experience their work.MethodsOur aim was to describe the experience of mental health professionals working in prisons who provide care to suicidal prisoners. Data were collected from in-depth semi-structured interviews and were analyzed using thematic content analysis.ResultsFindings draw attention to the challenges mental health professionals in post-apartheid South Africa face when attempting to provide psychological care in settings where resources are scarce and where the environment is anti-therapeutic. Findings highlight the significant gap between current policies, which protect prisoners’ human rights, and every-day practices within prisons.ConclusionsThe findings imply that there is still an urgent need for activism in South Africa, particularly in the context of providing mental health care services in settings which are anti-therapeutic and inadequately resourced, such as prisons.

Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey.

This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals’ gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients’ satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed moderately with concerns towards THC centres. 96.5% of participants would like high decision-making power concerning treatment-associated decisions. The results demonstrate the importance of patient-centred THC that takes patients' individual needs and realities into consideration and involves patients in decision-making processes.

The Influence of Politeness Behavior on User Compliance with Social Robots in a Healthcare Service Setting

Particularly in the healthcare service domain, social robots are expected to be good assistants, advisers, or practitioners. To increase the effectiveness of healthcare services provided by social robots, patients must comply with their requests. Research is plentiful on what makes patients comply with healthcare advice. In this paper, which is based on Bulgurcu’s study of rationality-based beliefs, command-compliance theory, and social exchange theory, we propose a research model of compliance during interaction with social robots, examining beliefs about and overall assessments of the consequences of complying with robot requests and extending the findings of previous studies to the setting of healthcare services. We specifically investigate the perceived level of politeness in robots’ speech and gestures as a determinant of compliance intention. Using a social robot, NAO, as a provider of healthcare services, we conducted an experiment. The results suggest that the aforementioned theories are useful in understanding user behaviors toward social robots in a healthcare service setting. Interestingly, and unlike in other settings, the perceived level of politeness of a social robot in a healthcare service setting negatively affects the perceived benefit of compliance, and, hence, intention to comply. A lower politeness level is closer to a command or strong recommendation than a suggestion or causal recommendation, which is common in shopping, tourism, or convention settings. The findings of this study imply that polite behavior from a social robot is an important factor in the compliance of healthcare service users. Direct speech with polite gestures is the most effective way to increase patient compliance in with healthcare advice provided by social robots in healthcare settings. However, higher levels of politeness do not always increase patients’ intention to comply.

Effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bengaluru, southern India: a prospective cohort study

BackgroundThe mental health status of a pregnant woman and its consequent impact on foetal well being is not given much importance compared to the risk imposed by obstetric complications and medical conditions. Maternal psychological distress is a major public health problem and needs timely detection and intervention to prevent any adverse pregnancy outcome. There is ample evidence from literature that justifies the association of prenatal maternal mental stress and elevated cortisol with delayed infant motor and cognitive development; evidence from India being rather limited. The study aim is to prospectively assess the association of maternal psychological distress and cortisol level with motor and cognitive development of the infant.MethodsA sample of 2612 eligible pregnant women who have been registered for antenatal care at selected public sector hospitals in Bengaluru will be recruited after obtaining written informed consent. They will be assessed for the presence of maternal psychological distress in the form of depression and anxiety using appropriate scales and saliva samples will be collected for cortisol estimation during early, mid and late pregnancy. Follow up visits after delivery will be done on day 10, 3 months, 8 months and 12 months. The Bayley Scales of Infant and Toddler Development [BSID] (Third edition) will be used to measure both motor and mental milestones in terms of Psychomotor Development Index (PDI) and Mental Development Index (MDI). Logistic regression model will be used to determine the association between the exposure variables and outcomes which will be reported as Odd’s Ratio (OR) and 95% confidence intervals (CI).DiscussionOur study findings could add to the growing evidence that maternal psychological distress during pregnancy adversely influences growth and development in the offspring and subsequent development of the child. While maternal anxiety and depression can be measured by using self reporting instruments, estimation of maternal endogenous cortisol levels could serve as a biomarker of prenatal psychological stress. Findings from this study could be used to focus upon the burden of mental health problems during pregnancy and to consider steps to scale up prenatal mental health services in health care settings.

Antecedents of customer aggressive behavior against healthcare employees

PurposeThe purpose of the research was to develop a tool for measuring antecedents of customer aggressive behavior (CAB) in healthcare service settings, by identifying its roots in organizational and interpersonal dynamics.Design/methodology/approachFour studies were conducted. In Studies 1 and 2, antecedents of CAB were identified through analysis of internet reader comments and a questionnaire was distributed to students. In Study 3, scenarios were used to validate the findings of the previous studies. Finally, in Study 4, a scale was developed and validated for measuring organization- and person-related triggers of CAB using samples of 477 employees and 579 customers.FindingsThe concept of CAB was conceptualized and validated. In total, 18 items were identified across five dimensions: personal characteristics, uncomfortable environment, aggressive role models, reinforcement of aggressive behavior and aversive treatment. The scale demonstrated good psychometric results.Research limitations/implicationsThe research relies mainly on customer perspective. Employees and additional stakeholders should be included to achieve more accurate information that could contribute to a better understanding of CAB and its roots.Practical implicationsExploring social and organizational antecedents that trigger CAB could help healthcare managers evaluate and proactively manage CAB and its implications within their organization.Originality/valueThis measurement scale is the first comprehensive tool, based on Bandura’s social learning theory (1973), that may identify and measure antecedents of CAB, and could be used to reduce CAB in healthcare service settings.

Catalyzing Implementation of Evidence-Based Interventions in Safety Net Settings: A Clinical-Community Partnership in South Los Angeles.

This study is a process evaluation of a clinical-community partnership that implemented evidence-based interventions in clinical safety net settings. Adoption and implementation of evidence-based interventions in these settings can help reduce health disparities by improving the quality of clinical preventive services in health care settings with underserved populations. A clinical-community partnership model is a possible avenue to catalyze adoption and implementation of interventions amid organizational barriers to change. Three Federally Qualified Health Centers in South Los Angeles participated in a partnership led by a local community-based organization (CBO) to implement hypertension interventions. Qualitative research methods were used to evaluate intervention selection and implementation processes between January 2014 and June 2015. Data collection tools included a key participant interview guide, health care provider interview guide, and protocol for taking meeting minutes. This case study demonstrates how a CBO acted as an external facilitator and employed a collaborative partnership model to catalyze implementation of evidence-based interventions in safety net settings. The study phases observed included initiation, planning, and implementation. Three emergent categories of organizational facilitators and barriers were identified (personnel capacity, professional development capacity, and technological capacity). Key participants and health care providers expressed a high level of satisfaction with the collaborative and the interventions, respectively. The CBO's role as a facilitator and catalyst is a replicable model to promote intervention adoption and implementation in safety net settings. Key lessons learned are provided for researchers and practitioners interested in partnering with Federally Qualified Health Centers to implement health promotion interventions.

The Cost of Conscience.

The spread of demands by physicians and allied health professionals for accommodation of their private ethical, usually religiously based, objections to providing care of a particular type, or to a particular class of persons, suggests the need for a re-evaluation of conscientious objection in healthcare and how it should be regulated. I argue on Kantian grounds that respect for conscience and protection of freedom of conscience is consistent with fairly stringent limitations and regulations governing refusal of service in healthcare settings. Respect for conscience does not entail that refusal of service should be cost free to the objector. I suggest that conscientious objection in medicine should be conceptualized and treated analogously to civil disobedience.

PLoS Medicine Issue Image | Vol. 13(10) October 2016

In this month's Editorial Chris Beyrer and colleagues reflect on an underappreciated trend in multiple African, Asian, and Caribbean settings, where the provision of HIV and other essential health services for sexual and gender minorities are expanding despite challenging legal and social environments. The authors argue that while the legal, human rights, and LGBT advocacy communities work to advance structural reforms, such as overturning sodomy statutes, community-based clinical and service providers have vital roles to play in the realization of more immediate rights and benefits—including the right to dignity, safety, and equitable access to services in health care settings. Image Credit: Vinayak Das, Flickr

Understanding Work-Related Stress and Practice of Professional Self-Care – An Innovative Pedagogical Approach

Social workers experience tremendous work-related stress - particularly among those providing direct services in healthcare settings. A review of related literature summarized several critical challenges faced by social workers who work with highly difficult clients in these settings, including (a) clients who engage in manipulative high-risk behaviors; (b) clients with serious illness who have multiple relapses; (c) clients who attempt or commit suicide; and (d) those who perpetrate violent or aggressive acts against themselves or others. This paper described and evaluated three sets of experiential learning activities with graduate level social work students, designed to increase their self-awareness and understanding of work-related stress, establish professional boundaries with difficult clients, and practice professional self-care. Major themes covered in these activities include: (a) increasing self-awareness and therapeutic competence; (b) becoming emotionally present and accepting limits; and (c) assessing traumatic stress and self-care. Selected journals from 26 students who took a clinical social work practice in health care elective course and the instructor’s blogs were content analyzed. An evaluation survey was administered with 43 students to gather their overall feedback about the course activities. Results indicated that students felt that course activities increased the amount and quality of interaction they had with other students and the instructor. Many students showed an increase of self-awareness and their own abilities in managing work-related stress. Overall, the findings support the use of experiential learning activities and self- reflective journals, as an innovative pedagogical approach, to enhance students’ self-awareness and abilities to manage work-related stress.

Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV.

BackgroundNurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis.ObjectivesTo determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH.MethodA cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data.ResultsA total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622).ConclusionThe study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses.

Boredom in the Workplace: Reasons, Impact, and Solutions

Boredom in the workplace is not uncommon, and has been discussed widely in the academic literature in relation to the associated costs to individuals and organizations. Boredom can give rise to errors, adverse patient events, and decreased productivity—costly and unnecessary outcomes for consumers, employees, and organizations alike. As a function of boredom, individuals may feel over-worked or under-employed, and become distracted, stressed, or disillusioned. Staff who are bored also are less likely to engage with or focus on their work. In this article, we consider the nature of boredom and also the reasons why employees, including mental health nurses, become bored in the workplace. We also discuss the role that can be taken by employees and employers to recognise and address the problem of boredom and we consider how best to develop sustainable workplaces that are characterised by engaged employees who provide the best possible service in healthcare settings.

Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria.

The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, with data from 15,474 individuals. Statistical methods used were descriptive tests, regression models and the calculation of synergistic effects. Both chronic back pain and psychological distress had a positive association with the utilization of the primary (OR for chronic back pain 1.53 and psychological distress 1.33) and secondary (OR for chronic back pain 1.32 and psychological distress 1.24) levels of the health care sector. In the fully adjusted model, the synergistic effect of chronic back pain and psychological distress was significant for the secondary level of care (S 1.99, PAF 0.20), but not for the primary level of care (S 1.16, PAF 0.07). Synergistic effects and associations for chronic back pain and psychological distress on the utilization of both the primary and secondary levels of the ambulatory health care sector were observed, particularly for the secondary level of care. Our results demonstrate the utilization of health care services settings by individuals with these conditions, and offer opportunities to consider reorganization and structuring of the Austrian health care system.

A Systematic Review of Librarian-Provided Services Delivered in Healthcare Settings Finds a Positive Effect on Clinician and Patient Relevant Outcomes and Identifies Gaps in the Evidence

A Review of:
 Perrier, L., Farrell, A., Ayala, A. P., Lightfoot, D., Kenny, T., Aaronson, E., . . . Weiss, A. ( 2014). Effects of librarian-provided services in healthcare settings: A systematic review. Journal of the American Medical Informatics Association, 21(6), 1118-1124. http://dx.doi.org/10.1136/amiajnl-2014-002825
 
 Abstract
 
 Objective – To assess the effects of librarian-provided services, in any healthcare setting, on outcomes important to patients, healthcare providers, and researchers.
 
 Design – Systematic review and narrative synthesis.
 
 Setting – MEDLINE, CINAHL, ERIC, LISA, and CENTRAL databases; library-related websites, conference proceedings, and reference lists of included studies.
 
 Subjects – Twenty-five studies identified through a systematic literature search. 
 
 Methods – In consultation with the review team, a librarian designed a search to be run in MEDLINE that was peer-reviewed against a published checklist. The team then conducted searches in the five identified databases, adapting the search as appropriate for each database. Authors also checked the websites of library and evidence based healthcare organisations, along with abstracts of relevant conference proceedings, to supplement the electronic search. Two authors screened the literature search results for eligible studies, and reached agreement by consensus. Studies of any librarian-delivered service in a healthcare setting, directed at either patients, clinicians of any type, researchers, or students, along with studies reporting outcomes relevant to clinicians, patients, or researchers, were eligible for inclusion. The authors assessed results initially on the titles and abstracts, and then on the full-text of potentially relevant reports. The data from included studies were then extracted into a piloted data extraction form, and each study was assessed for quality using the Cochrane EPOC risk of bias tool or the Newcastle-Ottawa scale. The results were synthesised narratively.
 
 Main Results – The searches retrieved a total of 25 studies that met the inclusion criteria, comprised of 22 primary papers and 3 companion reports. Authors identified 12 randomised trials, 4 controlled before-and-after studies, 3 cohorts, 2 non-randomised trials, and 1 case-control study. They identified three main categories of intervention: librarians teaching search skills; providing literature searching as a service; and a combination of the teaching and provision of search services. The interventions were delivered to a mix of trainees, clinicians, and students. None of the studies examined services delivered directly to patients or to researchers. The quality assessment found most of the studies had a mid- to high-risk of bias due to factors such as lack of random sequence generation, a lack of validated tools for data collection, or a lack of statistical analysis included in the study.
 
 Two studies measured patient relevant outcomes and reported that searches provided by librarians to clinicians had a positive impact on the patient’s length of stay in hospital. Five studies examined the effect of librarian provided services on outcomes important to clinicians, such as whether a literature search influenced a clinical decision. There was a trend towards a positive effect, although two studies found no significant difference. 
 
 The majority of studies investigated the impact of training delivered to trainees and students on their literature search skills. Twelve of these studies found a positive effect of training on the recipients’ search skills, while three found no difference. The secondary outcomes considered by this review were satisfaction with the service (8 studies), relevance of the answers provided by librarians (2), and cost (3). The majority reported good satisfaction, and relevance. A cost benefit was found in 2 of 3 studies that reported this outcome. 
 
 Conclusion – Authors report a positive effect of training on the literature search skills of trainees and students, and identified a benefit in the small number of studies that examined librarian services to clinicians. Future studies should use validated data collection tools, and further research should be conducted in the area of services provided to clinicians. Research is needed on the effect of librarian-provided services to patients and researchers as no studies meeting the inclusion criteria examining these two groups were identified by the literature search.

Improving access to health services – challenges in Lean application

Purpose– Healthcare organisations face significant productivity pressures and are undergoing major service transformation. The purpose of this paper is to disseminate findings from a Lean healthcare project using a National Health Service Single Point of Access environment as the case study. It demonstrates the relevance and extent that Lean can be applied to this type of healthcare service setting.Design/methodology/approach– Action research was applied and Lean tools used to establish current state processes, identify wastes and develop service improvement opportunities based upon defined customer values.Findings– The quality of referral information was found to be the root cause of a number of process wastes and causes of failure for the service. Recognising the relationship and the nature of interaction with the service’s customer/supplier lead to more effective and sustainable service improvement opportunities and the co-creation of value. It was also recognised that not all the Lean principles could be applied to this type of healthcare setting.Practical implications– The study is useful to organisations using Lean to undertake service improvement activities. The paper outlines how extending the value stream beyond the organisation to include suppliers can lead to improved co-production and generation of service value.Originality/value– The study contributes to service productivity research by demonstrating the relevance and limitations of Lean application in a new healthcare service setting. The case study demonstrates the practical challenges of implementing Lean in reciprocal service design models and adds validity to existing contextual models.

“Like Drawing Into Sand”: Acceptability, Feasibility, and Appropriateness of a New e‐Mental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People

Cross‐cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence‐based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e‐mental health resource (the Australian Integrated Mental Health Initiative [AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi‐structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e‐mental health approaches for Aboriginal people among the remote health workforce. It is likely that e‐mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence‐based, structured interventions to improve well‐being for Aboriginal and Torres Strait Islander clients.

Effects of librarian-provided services in healthcare settings: a systematic review.

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case.

Hospital language service programs: a closer look at translation practices.

Much of the information we have about the delivery of language services for patients with limited English proficiency (LEP) relates to interpreter services. Very little is known about hospitals' experiences responding to LEP patients' needs for written materials in their preferred languages. This study describes the translation practices of 35 hospitals with large interpreter services programs to inform guidance for the effective delivery of translation services in health care settings. We conducted in-depth telephone interviews with hospital staff members responsible for overseeing translation services at their hospitals. Translation practices varied considerably among study participants, with participants relying on a combination of interpreters serving as translators and contract translators to translate between 5 and 5,000 documents per year. This study showcases examples of hospitals with surprisingly robust translation service programs despite limited external funding. The variance in translation practices underscores a lack of guidance in this area.

Reductions in glycemic and lipid profiles in hypertensive patients undergoing the Brazilian Dietary Approach to Break Hypertension: a randomized clinical trial

Hypertensive patients often have an unfavorable lipid and glucose profile. The main goal of dietary treatment for these patients is to achieve adequate control of blood pressure and reducing cardiovascular morbidity and mortality. The aim of this study was to evaluate whether the Brazilian Dietary Approach to Break Hypertension (BRADA) based on Dietary Approaches to Stop Hypertension but with both low sodium and glycemic index foods could reduce lipid and glycemic profiles in hypertensive patients who were seeing primary health care providers in a low-income region of Brazil. A randomized study of 206 individuals were followed up for the duration of 6 months. The experimental group received orientation and planned monthly menus from the BRADA diet. In the control group, counseling was based on standard care and mainly focused on salt intake reduction. Differences in all biochemical parameters were compared at the baseline and at the 6-month follow-up period. The mean age was 60.1 (±12.9) years old, and 156 subjects (119 females) completed the study. An intention-to-treat analysis showed that both groups reduced fasting plasma glucose, glycated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol concentrations; however, statistically significant between-group differences were found for these parameters. The mean difference in fasting glucose was −7.0 (P < .01), −0.2 for HbA1c (P < .01), −28.6 for TC (P < .01), and −23.8 for LDL-c (P < .01) for the experimental group compared with the control group. This study showed the efficacy of the BRADA diet to treat hypertension on biochemical parameters tested in a primary health care service setting.

Mejoramiento de los procesos en el quirófano mediante la aplicación de la metodología Lean de Toyota

Healthcare is in need of fundamental change if we are going to make significant improvements in outcomes while limiting costs. Lean methods, initially developed in the manufacturing industry, have been shown to deliver real improvements in quality, productivity, and safety while using fewer resources in healthcare service settings. These tools, management practices and philosophies have been successfully adapted in operative services at SC. They can transform your system and culture through engagement of frontline staff into a continuously improving service with real and sustainable enhancements in clinical outcomes.