Priority Setting Research Articles

A systematic review of the financial issues of higher education institutions (HEIs) and possible strategies to cope with them

The field of higher education has not only been for elites since the last three decades. It has also included the general masses in it. That’s why the transformation of the socio-economic status and general awareness in the present age owes to higher education. On the other hand, challenges have also emerged and set conditions on the path to sustainability. Thus, higher education has faced problems, especially financial problems. These issues further give birth to some other issues. This study is an attempt to understand the issues caused by financial issues. The study also aimed to propose strategies to deal with these issues. Based on the systematic literature review, the problems have been categorized as lack of internet, digitalization, and online teaching; underdeveloped infrastructure for STEAM; lack of priorities; and quality issues. These findings create hurdles in achieving the quality of HEIs. To cope with these issues, clear policy and setting priorities were proposed as the top most important strategies to bring about quality and achieve HEIs’ organizational objectives. It can be concluded that HEIs need appropriate strategic and financial managers and administrators who can align their strategy with the vision and mission of the institutions.

Assessing progress towards viral hepatitis B and C elimination in prisons in the European region

Abstract Background In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies. Objectives We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data. Methods We adapted the WHO M&E framework for viral hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). Results In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators. Lessons Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&E framework tailored to this specific setting is needed to foster data collection and systematic monitoring. Key messages • Micro-elimination strategies in prison context contribute to the global health goals achievement. • A coordinated and standardized M&V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.

Severity and Temporality in Healthcare Priority Setting - A Case for A Condition-specific Affectable Time-neutral Approach.

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the 'shape' of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting.

Introduction: Mobilizing during COVID-19: social movements in times of crisis

ABSTRACT Early 2020 saw the beginning of a pandemic that triggered an unprecedented global health crisis and economic turmoil. The COVID-19 pandemic also crucially affected the dynamics of political mobilization in social movements. This introduction seeks to reflect on such effects. In particular, we ask: How did the pandemic change or hinder existing struggles? To what extent did new activist networks, issues, and forms of action emerge? Drawing on the special issue’s contributions, we highlight how the pandemic gave way to new incentives and forms of mobilization, in particular the anti-lockdown protests with covid-specific claims, and actor constellations that often brought together people with diverse ideological orientations. These mobilizations were crucially facilitated by social media, bringing together previously disconnected people and harnessing heightened emotions of fear, anger, distrust, uncertainty, and anxiety. At the same time, existing movements continued their work on longer standing issues and often effectively adapted their organizational infrastructures, repertoires of action, or goals to a new set of priorities and circumstances. As in other crises, the pandemic spurred mutual aid and solidarity activism for those most affected by the pandemic.

Adult day programs and their effects on individuals with dementia and their caregivers (ADAPT-DemCare): a realist synthesis to develop program theories on the how and why

BackgroundAdult day programs aim to facilitate aging in place by supporting the health and well-being of persons with dementia and providing respite to their caregivers. However, studies on the effects of day programs are inconclusive, and we especially lack insights into the context conditions and mechanisms of day programs that may produce different outcomes for different groups of persons with dementia and their caregivers. Our objective was to conduct a realist review, synthesizing research on day programs to develop program theories explaining how and why day programs do or do not produce positive or negative outcomes for different groups of persons with dementia, and caregivers.MethodsWe identified 14 literature reviews (including 329 references published between 1975 and 2021) on adult day programs. From this initial pool of studies, we will include those that focused on day program attendees with dementia or meaningful cognitive impairment, and/or their caregivers, and that report how day program contexts (C) and mechanisms (M) bring about outcomes (O) for attendees and caregivers. We will extract CMO statements (i.e., narratives that explain how and why day programs do or do not bring about certain outcomes for whom and under what circumstances). Using additional focused searches, citation mapping, citation tracking, and discussions with our researcher and expert team members, we will identify additional references. CMO statements will be synthesized, transformed into hypotheses, and linked and visualized to form program theories. Using focus groups and the James Lind Alliance Priority Setting Partnership method, we will discuss and prioritize our CMO statements and refine our program theories with 32 experts (older adults, caregivers, Alzheimer societies, caregiver organizations, day program staff and managers, and health system and policy decision makers). DiscussionBy identifying essential elements and processes of day programs and related knowledge gaps, this study will generate much-needed knowledge to leverage the full potential of day programs so they can provide appropriate care, preventing premature institutionalization, and unnecessary acute and primary care use. This will ultimately improve the quality of life of persons with dementia and their caregivers, alleviate caregiver burden, and reduce social costs. Systematic review registrationPROSPERO CRD42024504030

Online availability of antibiotics from within the UK: shifting patterns from 2016 to 2023

Abstract Background We previously reported a cross-sectional analysis of online pharmacy practices and processes. Since then, the demand for and context of online healthcare has changed. However, the current state of access to and usage of antibiotics obtained online remains poorly understood. Objectives This study aimed to: (i) determine the legality of online pharmacies selling antibiotics in the UK; (ii) describe processes for obtaining antibiotics online; (iii) identify antimicrobial stewardship (AMS) and patient safety issues; and (iv) compare data with those obtained in 2016 to understand changes in context, and set priorities for targeted research in antibiotic access and usage. Methods Searches for ‘buy antibiotics online’ were conducted using ‘Google’ and ‘Yahoo’. The first 10 websites with unique URL addresses for each were reviewed. Analyses were conducted on evidence of pharmacy registration, prescription requirement, whether choice was ‘prescriber-driven’ or ‘consumer-driven’, and whether information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase. Results Twenty unique URL addresses were analysed. Those evidencing UK location (n = 20; 100%) required a prescription and were appropriately registered. For 11 (55%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, but not for dose or duration; contrasting with 2016 when for most (n = 16; 80%), decisions were consumer-driven for antibiotic choice, dose and quantity. Conclusions Variation continues to exist in relation to antibiotic practices online. We make several key recommendations for lawmakers and stakeholders. Targeted research, improved public engagement, professional education and new best practice guidelines are urgently needed for online UK antibiotic suppliers.

Gambling-related attitudes and dimensional structure of the GABS-15 in outpatient addiction care patients: associations with gambling disorder

IntroductionIndividuals with gambling disorder (GD) harbor cognitive distortions and dysfunctional beliefs about gambling that may foster problematic gambling behaviour. Evidence on particularly detrimental attitudes and beliefs is however lacking. To close this knowledge gap, we analysed associations between gambling attitudes and beliefs (Gambling Attitudes and Beliefs Survey (GABS-15)) and severity of gambling disorder (DSM-5 criteria met) in a German cohort of 123 individuals receiving outpatient gambling treatment.MethodsData from the "Katamnese-Study" covering a 36-months timeframe with 5 assessment points was pooled. The multidimensional structure of the GABS-15 was examined using explorative and confirmatory factor analyses, followed by mixed-effect regression models using different operationalizations of the GABS-15.ResultsA three-factorial structure comprising “attitudes while gambling”, “sensation-seeking / excitement”, and "gambling fallacies” demonstrated better fit indices than the GABS-15 sum score. Only the "gambling fallacies " factor (1.00, p<0.05; 15.36, p < 0.01) was significantly associated with increased severity of GD.DiscussionAs a one-dimensional conceptualization of gambling-related attitudes and beliefs might not sufficiently guide staff of outpatient treatment facilities regarding priority setting in gambling care, evidence on attitudes with particularly detrimental associations is highly warranted. Here, focussing on mitigating "gambling' fallacies" by tailored treatment strategies appears promising.

Institutional Mechanisms for Enhancing Production of Doctoral Research Outputs at Makerere University

In the contemporary knowledge society, research production is being re-purposed in terms of not just its academic value, but also its wider societal value. As such, doctoral research ought to be produced in the context of application. Therefore, universities have a responsibility to enhance the uptake and use of doctoral research outputs. This necessitates institutional mechanisms for enhancing the production of doctoral research outputs for uptake and use beyond the academia. We examined the institutional mechanisms for enhancing production of doctoral research outputs at Makerere University using the research knowledge infrastructure (RKI) framework as the analytical lens. This was in light of the dismal uptake and use of research produced at Makerere University by students and staff. We used qualitative single case study research design. We collected data through interviewing and review of documents. We interviewed 10 doctoral program coordinators, three managers of research and graduate training and 13 PhD students we selected purposively. We reviewed seven institutional documents pertaining graduate training at Makerere University: two plans, three policies, one framework and one guideline. We used thematic data analysis to make sense of the data. The findings revealed that due to policy-practice gaps and funding constraints, mechanisms to enhance doctoral research production to facilitate uptake and use of doctoral research outputs beyond the academia were not adequately integrated into doctoral research training. This was shown by the lack of mechanisms to enhance doctoral research commissioning and execution, and gaps in priority setting. Opportunities for productive interactions between doctoral researchers and potential users were missed. As such, doctoral research outputs largely remained within the scholarly community. We recommend that the university should establish interface structures and co-creation spaces to leverage doctoral research commissioning, execution and priority setting to facilitate the uptake and use of doctoral research outputs beyond the scientific community

Building locally anchored implementation science capacity: the case of the adolescent HIV implementation science alliance-supported local iS alliances.

The Fogarty International Center-led Adolescent HIV Implementation Science Alliance (AHISA) supports region-/country-specific implementation science (IS) alliances that build collaborations between research, policy, and program partners that respond to local implementation challenges. AHISA supported the development of seven locally-led IS alliances: five country-specific (i.e., Kenya, South Africa, Tanzania, Uganda, and Zambia), one in Central and West Africa, and one with youth researchers. This article outlines the aims, activities, and outcomes of local alliances, demonstrating how they enhance sustainable IS activities to address local challenges. We conducted a desk review of each alliance's funding applications, reports, and data from the initial findings of a larger AHISA evaluation. The review analyzes common approaches, highlights their local relevance, and summarizes initial outcomes. The local alliances have a common goal: to expand implementation of successful interventions to improve adolescent HIV. We identified four overarching themes across the local alliances' activities: capacity building, priority setting, stakeholder engagement, and knowledge dissemination. Research capacity building activities include long-term mentorship between junior and senior researchers and short-term training for non-research partners. Setting priorities with members identifies local research needs and streamlines activities. Alliances incorporate substantial engagement between partners, particularly youth, who may serve as leaders and co-create activities. Dissemination shares activities and results broadly. Local IS alliances play a key role in building sustainable IS learning and collaboration platforms, enabling improved uptake of evidence into policy and programs, increased IS research capacity, and shared approaches to addressing implementation challenges.

The Eczema Bathing Study: Weekly versus daily bathing for people with eczema? Protocol of an online, randomised controlled trial

Background A priority setting partnership for eczema (syn atopic eczema, atopic dermatitis) has identified that bathing frequency is a key area of patient interest. However, there are nolarge, high-quality randomised controlled trials (RCTs) investigating this. The Rapid Eczema Trials project is a novel programme of research that aims to deliver multiple online RCTs, using a citizen science approach. This project involves working with members of the public to co-design and conduct studies that answer questions of importance to them. The first trial to be conducted through this project is assessing the impact of bathing frequency on eczema. Methods This is an online, two-arm, parallel-group superiority RCT with internal pilot phase. People aged ≥1 year with eczemaliving in the United Kingdom are eligible. Exclusion criteria are: people with other types of eczema such as venous eczema, hand eczema and contact eczema; recently started a new eczema treatment; taking part in another eczema trial; Patient Oriented Eczema Measure (POEM) ≤2; planning to swim more than twice a week; unable/unwilling to change bathing practices. Participants are allocated 1:1 to either the weekly bathing group (bathe 1 or 2 times a week) or the daily bathing group (bathe 6 or more times a week) for 4 weeks. The primary outcome is POEM, assessed weekly over 4 weeks. Secondary outcomes include skin specific quality of life, eczema control, itch severity, use of usual eczema treatments, proportion who achieve an improvement in POEM of ≥3 points, global change in eczema and safety outcomes. A sample of participants will also be invited to a semi-structured interview to discuss their experience. The primary comparative analysis will be according to randomised allocation regardless of actual frequency of bathing. The trial will be reported in accordance with CONSORT guidelines. The study has received ethical approval by the London - Surrey Research Ethics Committee (2 Redman Place, London, E20 1JQ, United Kingdom) on 11/10/2023 ( approval number: 23/PR/0899). Trial registration ISRCTN12016473, 22/11/2023, https://doi.org/10.1186/ISRCTN12016473

An assessment of the coverage of live-birth registration across space in Nigeria

ABSTRACT Birth registration is an important channel that allows children to be documented, providing them with legal identity and nationality early in life and protecting them against violence, abuse and exploitation. However, this privilege has been denied to millions of children, particularly in developing countries. Registration is limited in Nigeria with about three in every five births unregistered. Using data from three waves of the Nigeria Demographic and Health Survey, we adopt a geostatistical model to assess the space-time variations in registration coverage across Nigeria and compute the exceedance maps at different probabilities. The findings indicate a North-South divide in coverage but with improved coverage over time across the country. The probability of attaining about 60% coverage is low in the northern part of the country. The generated maps provide guiding tools to the Nigerian government to set priorities in order to scale up birth registration coverage in the country.

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

An Alternative Approach to Measuring Health Inequality in Norway and Implications for Municipal Priority Setting

An Alternative Approach to Measuring Health Inequality in Norway and Implications for Municipal Priority Setting

Consolidation of Higher Education in Upstate New York: The SUNY Chancellor Under Pressure to Set Priorities for an Integration Task Force

Consolidation of Higher Education in Upstate New York: The SUNY Chancellor Under Pressure to Set Priorities for an Integration Task Force

Institutional Mechanisms for Enhancing Production of Doctoral Research Outputs at Makerere University

In the contemporary knowledge society, research production is being re-purposed in terms of not just its academic value, but also its wider societal value. As such, doctoral research ought to be produced in the context of application. Therefore, universities have a responsibility to enhance the uptake and use of doctoral research outputs. This necessitates institutional mechanisms for enhancing the production of doctoral research outputs for uptake and use beyond academia. We examined the institutional mechanisms for enhancing production of doctoral research outputs at Makerere University using the research knowledge infrastructure (RKI) framework as the analytical lens. This was in light of the dismal uptake and use of research produced at Makerere University by students and staff. We used qualitative single case study research design. We collected data through interviewing and review of documents. We interviewed 10 doctoral program coordinators, three managers of research and graduate training and 13 PhD students we selected purposively. We reviewed seven institutional documents pertaining graduate training at Makerere University: two plans, three policies, one framework and one guideline. We used thematic data analysis to make sense of the data. The findings revealed that due to policy-practice gaps and funding constraints, mechanisms to enhance doctoral research production to facilitate uptake and use of doctoral research outputs beyond the academia were not adequately integrated into doctoral research training. This was shown by the lack of mechanisms to enhance doctoral research commissioning and execution, and gaps in priority setting. Opportunities for productive interactions between doctoral researchers and potential users were missed. As such, doctoral research outputs largely remained within the scholarly community. We recommend that the university should establish interface structures and co-creation spaces to leverage doctoral research commissioning, execution and priority setting to facilitate the uptake and use of doctoral research outputs beyond the scientific community.

Priority setting for mental health in Gaza

Priority setting for mental health in Gaza

UK research priority setting for childhood neurological conditions.

UK research priority setting for childhood neurological conditions.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:<0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: <0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

Treatment burden in multimorbidity: an integrative review

BackgroundPeople living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments.MethodsThis integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed.ResultsThirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual’s circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks.ConclusionsWe developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people’s resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes.Trial registrationDOI: https://doi.org/10.17605/OSF.IO/UF46V

Ethics in humanitarian settings-relevance and consequences for dialysis and kidney care.

With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings.