State-owned Hospitals Research Articles

There is a lack of information about medical waste management in Iraq. This study aims to monitor and evaluate the current situation of medical waste management in Baghdad as it represents the capital and the biggest populated city in Iraq. About 32% of hospitals are located in Baghdad. Ten state-owned hospitals in Baghdad with the biggest bed capacity were investigated. The study used structured interviews with staff in charge of waste management in the sampled hospitals to collect data. The results showed that the generation rate of medical waste in the ten hospitals was 0.5 kg/(bed·day). The study also found that there were insufficient, ineffective, and improper isolation, collection, storing, processing, and safe disposal of medical wastes in the sampled public hospitals of Baghdad. The study recommended that the Iraqi Ministry of Health takes extensive and quick effective measures to better monitor and evaluate medical waste management and provide ongoing training to personnel responsible for waste management in the hospitals.

Background: This descriptive, analytic study aimed to compare the costs of 10 types of Global Budget Payment System (GBPS) surgery in Imam Reza Hospital, Mashhad City, Iran, in 2016 with the prices in the GBPS. Methods: From hospital-discharge data and patients’ bills, we identified 10 types of GBPS surgeries performed in Imam Reza hospital. The patients were grouped according to the surgical procedures performed in the 10 GBPS category. Data on hospital charges and cost-to-charge ratios were used to assess charges and costs for specific resources, as well as for the hospitalization overall. The researcher received training from the experts in the field of hospital accounting to learn how to determine the charge of GBPS surgeries. Results: The results showed that in some surgeries such as hysterectomy, natural delivery, C-section, tonsillectomy, hernia repair, and appendectomy, charges of services were higher than their average prices GBPS and in arteriovenous anastomosis surgery, cholecystectomy, tympanoplasty, and thyroidectomy were lower than average prices GBPS. One of the main goals of Iran’s Ministry of Health in developing GBPS was to provide a unified framework for managing admission and treatment costs in state-owned hospitals. The obtained data were analyzed by the Wilcoxon signed-rank test and the independent samples t test with 0.05 statistical significance. The results of this study and similar works show that most hospitals have completely neglected this aspect of GBPS. Conclusion: A fact that is reflected in the wide-ranging variations in the charge of GBPS surgeries in different hospitals despite their being paid based on the same rates and guidelines.

Background/Aims Maternal, fetal and child health are of key public health concerns, globally. Both pregestational body mass index and gestational weight gain are critical players in maternal health, fetal development and delivery outcome. This study investigated the association between maternal assumed pregestational body mass index, gestational weight gain and outcomes of deliveries among puerperal mothers in the Tamale metropolis of Ghana. Methods A cross-sectional randomised descriptive study was conducted at the postnatal and neonatal intensive care units of the state-owned hospitals in the Tamale metropolis. The mothers' body mass index at their first antenatal care clinic was assumed to be their pregestational body mass index. Maternal gestational weight gain was calculated using the last gestational weight before onset of labour. Participants also responded to structured questionnaires with questions on their sociodemographic characteristics and intra-pregnancy behaviours. Additionally, information on their obstetric and gynaecological history, and their delivery outcome were collected. Data were analysed using descriptive statistics and chi-squared tests, with significance set at P<0.05. Results A total of 450 puerperal mothers were involved in this study with a mean age of 29±1.79 years. Maternal body mass indexes at first antenatal clinic visit were predominantly typical (41.8%) or overweight (42.0%). At delivery, 46.4% of mothers had typical gestational weight gain, while the majority (53.6%, P=0.0387) had anomalous gestational weight gain. Strikingly, 72.9% of mothers who had a healthy body mass index at the first antenatal clinic visit experienced anomalous gestational weight gain. Caesarean section delivery was significantly prevalent among pregnant women who had typical gestational weight gain (P=0.0014). Also, episiotomy was significantly linked to typical gestational weight gain (P=0.0448), but not mothers who were overweight before conception (P=0.2692), irrespective of their gestational weight status. Conclusions Anomalous gestational weight gain is high among puerperal mothers in the Tamale metropolis, and suggests contributory roles in adverse maternal and fetal health. A comprehensive gestational weight management education programme for women in the metropolis could help curb the burden of anomalous gestational weight gain.

Objective: we investigated previous literatures for documentation of the trend in Sokoto, Nigeria and found none. We deemed it fit to determine the frequency of linezolid resistance mediated by cfr gene among MRSA isolates from Sokoto State-owned hospitals. Methods: Bacterial species identification was carried out with Microgen™ Staph-ID System kit (Microgen, Surrey, UK). Disc agar diffusion method (Modified Kirby-Bauer’s) following Clinical and Laboratory Standards Institute (CLSI 2018) guidelines was used in antimicrobial susceptibility testing. The results were interpreted and managed using WHONET 5.6 software (WHO, Switzerland). Oxacillin resistant screening agar base (ORSAB) culture was used to determine phenotypic methicillin resistance. Polymerase chain reaction (PCR) was carried out to determine the presence of cfr-gene. Results: A total of 81 S. aureus isolates were phenotypically identified. Of this number, 46.91% (38/81) were MRSA; Healthcare workers (39.5%), Outpatient (28.9%), In patient (21%), Security men and Cleaners (5.3% each). Importantly linezolid resistance rate among the MRSA isolates was 44.7%. Analysis of antimicrobial susceptibility profile also showed a multiple antibiotics resistance burden of MDR (5.9%), possible XDR (47.1%), XDR (41.1%) and PDR (5.9%) amongst LR-MRSA. About 52.9% (9/17) of LR-MRSA harbored the cfr gene. Conclusions: This is the first report to document cfr gene in LR-MRSA strains in Sokoto. The cfr gene was found among the studied LR-MRSA strains and if cfr-mediated linezolid resistance is not properly checked, its phenotypic expression may result in an outbreak of multiple antibiotic resistant strains.

Management engineering is often done in the industrial world, especially factories and manufacturing companies. In this research, management engineering will be applied in hospitals, especially in the emergency department, why is it done in this department, because in previous studies data collection has been carried out and it is concluded that nurses in this department have a high degree of flexibility, so can cause errors while working. Almost the same as the application of fatigue in the manufacturing industry that the level of fatigue on the operator can reduce work productivity. This research will apply a macro ergonomic approach, in which the model used is the System Engineering Initiative for Patient Safety (SEIPS) model at the Hospital. This approach uses interview and observation techniques. Through this approach the causal factors will be seen and, in the future, seen how the solution to overcome this fatigue factor. This method uses a survey system that involves a large state-owned hospital in the city of Medan by using 83 nurse respondents and 7 respondents from the hospital.

Since the first known case of a COVID-19 infected patient in Wuhan, China on 8 December 2019, COVID-19 has spread to more than 200 countries, causing a worldwide public health crisis. The existing literature fails to examine what caused this sudden outbreak from a crisis management perspective. This article attempts to fill this research gap through analysis of big data, officially released information and other social media sources to understand the root cause of the crisis as it relates to China’s current management system and public health policy. The article draws the following conclusions: firstly, strict government control over information was the main reason for the early silencing of media announcements, which directly caused most people to be unprepared and unaware of COVID-19. Secondly, a choice between addressing a virus with an unknown magnitude and nature, and mitigating known public panic during a politically and culturally sensitive time, lead to falsehood and concealment. Thirdly, the weak autonomous management power of local public health management departments is not conducive for providing a timely response to the crisis. Finally, the privatization of many state-owned hospitals led to the unavailability of public health medical resources to serve affected patients in the Wuhan and Hubei Province. This article suggests that China should adopt a Singaporean-style public health crisis information management system to ensure information disclosure and information symmetry and should use it to monitor public health crises in real time. In addition, the central government should adopt the territorial administration model of a public health crisis and increase investment in public health in China.

This study aims to determine the effect of work discipline on employee performance in state-owned hospitals in Medan. To determine the effect of training on employee performance at government-owned hospitals in Medan. To determine the effect of organizational culture on employee performance in government-owned hospitals in Medan. To determine the effect of organizational culture moderating work discipline on employee performance in government-owned hospitals in Medan. To determine the effect of organizational culture moderating training on employee performance in government-owned hospitals in Medan. In this study the object of study was permanent employees at a government-owned hospital in Medan with a sample of 75 people. The study in this case conducted a sampling technique because the total population was used as the number of samples so this study was a sample study. Data collection techniques in this study is to use a questionnaire (Questionnaire). While the data analysis technique used is to test classical assumptions, multiple linear regression, hypothesis, coefficient of determination and moderation.

Building upon the tripartite model of anxiety and depression, the current study aims to examine mechanisms of comorbidity between anxiety and depression using the ProQOL (Professional Quality of Life; including the constructs of burnout, secondary traumatic stress, and compassion satisfaction) in a sample of Chinese health-care clinicians. A randomized cross-sectional survey was distributed to 1620 participants who were recruited from eight state-owned hospitals in a city in southern China between January and May 2017. A total of 1562 questionnaires were returned (a response rate of 96.4%). After the cases with more than 10% missing variables and multivariate outliers being removed, 1423 valid cases remained. Multiple mediator models were used for mediation analysis that was conducted using the PROCESS v3.1 macro for SPSS. The indirect effects of anxiety upon depression through burnout (a1 = . 601 (95% confidence interval (CI): .552, .650), p < .001; b1 = .137 (95% CI: .101, .174), p < .001) and compassion satisfaction (a3= -.297 (95% CI: -.352, -.241), p < .001; b3 = -.069 (95% CI: -.100, -.039), p < .001) were significant, while there was no evidence that anxiety influenced depression by changing secondary traumatic stress. The indirect effects of depression upon anxiety through secondary traumatic stress (a2 = . 535 (95% CI: .483, .588), p < .001); b2 = .154 (95% CI: .120, .188), p < .001) were both positive and significant, while there was no evidence that depression influenced anxiety by changing burnout and compassion satisfaction. In the current sample, burnout and compassion satisfaction mediated the effect of anxiety upon depression and secondary traumatic stress mediated the effect of depression upon anxiety. The findings of the current study offer support to the tripartite model.

Prevalence, Risk Factors and Antimicrobial Susceptibility Profile of Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; (MRSA) Obtained From Nares of Patients and Staff of Sokoto State-Owned Hospitals in Nigeria

Prevalence and Antimicrobial Susceptibility Profile of Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; (MRSA) Obtained From Nares of Patients and Staff of Sokoto State-Owned Hospitals in Nigeria

To improve access to maternal health services, Benin introduced in 2009 a user fee exemption policy for caesarean sections. Similar to other low- and middle-income countries, its implementation showed mixed results. Our study aimed at understanding why and in which circumstances the implementation of this policy in hospitals succeeded or failed. We adopted the realist evaluation approach and tested the initial programme theory through a multiple embedded case study design. We selected two hospitals with contrastive outcomes. We used data from 52 semi-structured interviews, a patient exit survey, a costing study of caesarean section and an analysis of financial flows. In the analysis, we used the intervention-context-actor-mechanism-outcome configuration heuristic. We identified two main causal pathways. First, in the state-owned hospital, which has a public-oriented but administrative management system, and where citizens demand accountability through various channels, the implementation process was effective. In the non-state-owned hospital, managers were guided by organizational financial interests more than by the inherent social value of the policy, there was a perceived lack of enforcement and the implementation was poor. We found that trust, perceived coercion, adherence to policy goals, perceived financial incentives and fairness in their allocation drive compliance, persuasion, positive responses to incentives and self-efficacy at the operational level to generate the policy implementation outcomes. Compliance with the policy depended on enforcement by hierarchical authority and bottom-up pressure. Persuasion depended on the alignment of the policy with personal and organizational values. Incentives may determine the adoption if they influence the local stakeholder’s revenue are trustworthy and perceived as fairly allocated. Failure to anticipate the differential responses of implementers will prevent the proper implementation of user fee exemption policies and similar universal health coverage reforms.

The study was to compare perception of conflict determinants in state and federal hospitals in South-South Nigeria with implications for healthcare service delivery. The setting cuts across Edo and Bayelsa States. A total of 181 respondents were purposively sampled from both hospitals and they comprised doctors, nurses and others. The instrument for data collection was the researchers’ developed structured questionnaire which was validated by 2 experts in management and policy. Data collected were analyzed using descriptive statistics. Chi square test statistic was used to determine levels of statistical significant difference in perception. There were more female respondents (n = 126, 70%) than male respondents (n = 55, 30%), and a mean age of 39.7 in the study. Perception of wrong application of management principles based on predefined conflict determinants in the state-owned hospital (M = 47.0) and in the federal owned-hospital (M = 45.0) was reported but there was no evidence of statistical significant difference between the two hospitals (X 2 = 0.112; 1df, p &gt; 0.05). Conclusively, the need for positive adjustment in the management of public hospitals is advised by the research outcome.

El presente trabajo explora los modelos de gestión en instituciones hospitalarias. Es una investigación exploratoria con un diseño de investigación documental, dado que se realizó la revisión de los distintos modelos a través de la historia, haciendo una revisión exhaustiva del modelo de la nueva gestión pública del Centro Latinoamericano de Desarrollo (CLAD). Se concluye que en las instituciones hospitalarias pertenecientes al Estado, este modelo se puede llevar a cabo con éxito, si hay una profesionalización de la alta burocracia como un punto estatal estratégico y, además, si se cuenta con el apoyo y la movilización en el proceso de reforma gerencial del Estado, lo cual permitirá transformar la actual estructura de la administración pública.

An attempt has been made in this article to shed some light on the decisions of patients on their institutional choice in accessing healthcare services within micro empirical framework in the state of West Bengal, India. The determinants of such decisions are also recognized in this article. In conscientious, statistical methods are anticipated to frame the socio-economic and decisional variables, that influence the decision. Principal component analysis and ordered probit analysis have been deployed to scrutinize the same. It is observed that the economic status of the patients, their level of schooling, their income and some other decision variables have a strong influence on their access of healthcare institutions. The study has projected that intra-category and inter-category competition among available alternative service providers needs to be introduced and social entrepreneurship model in state-owned hospitals can be pioneered with due considerations.

Non-urgent unplanned visits are frequently observed in pregnancy. However, there are no studies from Nigeria exploring its burden. A cross-sectional cohort survey of 1,182 women at the only state-owned teaching hospital in Ado - Ekiti was conducted to address this need. One-quarter of the population studied had unplanned antenatal visits during the period of care. Only about one in four of the reasons for the unplanned visits were ‘direct’ pregnancy-related complaints, while the largest proportion of the women, 227 (73.5%), visited on account of infectious morbidities, followed by gastrointestinal disorders, 63 (20.4%). Mothers who were skilled workers were significantly more likely to have unplanned antenatal visits compared with their unemployed counterparts (45.3% versus 20.7%, p = 0.013). Unplanned visits were significantly more in women who had reduced fetal movements (9.4% versus 0.9%, p < 0.0001); significantly more women who had out-of-schedule prenatal visits were admitted for care (37.9% versus 0.2%, p < 0.0001), and had induction of labour (20.1% versus 10.3%, p < 0.0001) when compared with those who had no unplanned visits. Reduced maternal perception of fetal movements (odds ratio: 7.57; 95% C. I. 3.07 - 18.70, p < 0.0001), prenatal admission (odds ratio: 241.81; 95% C. I. 59.02 - 990.75, p < 0.0001), and induction of labour (odds ratio: 1.90; 95% C. I. 1.24 - 2.93, p = 0.003) were found to be independently associated with unplanned antenatal visits.

It has been argued that family issues in individual cultures do not correlate with fulfilment. However, the universality of these findings is unknown as they are based on data from the Western world. To examine the connection between job burnout and recovery and the moderating effects of perceived family cohesion and family size in this relationship. Moderated hierarchical regression analyses were carried out on a sample of medical practitioners working in intensive care units from federal and state-owned hospitals in Southeastern Nigeria. There were 183 participants. Job burnout was negatively related to recovery and perceived family cohesion was positively related to recovery. However, contrary to our assumption, family size was positively related to recovery. Perceived family cohesion was vital in recovery regardless of the doctors' experience of high levels of burnout. In contrast to most previous findings, family size was found to have a moderating effect in the burnout-recovery connection. The findings of this study suggested that family bond is important in collectivistic cultures. This was underscored by the moderating effects family issues had on the relation between burnout and recovery. These findings are different from those in Western societies in which previous studies have been conducted.

Although the impacts of infertility-related stress on mental health have been testified in the literature, the underlying mechanism between them is still not clear. In response to this issue, 286 Chinese women who were pursuing medical treatment for fertility problems in two state-owned hospitals were invited to complete the survey, including the 7-item Dyadic Adjustment Scale (DAS), the Fertility Problem Inventory (FPI), the 5-item Mental Health Inventory (MHI-5), and demographic variables (e.g., age). The multiple linear regression method (SPSS 16) was used to investigate the impact of infertility-related stress and marital satisfaction on infertile women's mental health. Results showed that the total FPI score-and the specific domains of Social Concern, Relationship Concern, and Rejection of Child-Free Lifestyle in particular-had a significant negative relation with infertile women's mental health and marital satisfaction as a moderator between them. Therefore, the core of marital relationship and specific infertility-related stress should be addressed in psychological intervention programs for people facing infertility in mainland China.

The recognition that chronic care delivery is suboptimal has led many health authorities around the world to redesign it. In Norway, the Department of Health and Care Services implemented the Coordination Reform in January 2012. One policy instrument was to build emergency bed capacity (EBC) as an integrated part of primary care service provided by municipalities. The explicit aim was to reduce the rate of avoidable admissions to state-owned hospitals. Using five different sources of register data and a quasi-experimental framework—the “difference-in-differences” regression approach—we estimated the association between changes in EBC on changes in aggregate emergency hospital admissions for eight ambulatory care sensitive conditions (ACSC). The results show that EBC is negatively associated with changes in aggregate ACSC emergency admissions. The associations are largely consistent with alternative model specifications. We also estimated the relationship between changes in EBC on changes in each ACSC condition separately. Our results are mixed. EBC is negatively associated with emergency hospital admissions for asthma, angina and chronic obstructive pulmonary disease but not congestive heart failure and diabetes. The main implication of the study is that EBC within primary care is potentially a sensible way of redesigning chronic care.

BackgroundThere is no generic psychotherapy outcome measure validated for Kenyan populations. The objective of this study was to test the acceptability and factor structure of the Clinical Outcomes in Routine Evaluation – Outcome Measure in patients attending psychiatric clinics at two state-owned hospitals in Nairobi.MethodsThree hundred and forty-five patients filled out the CORE-OM after their initial therapy session. Confirmatory and Exploratory Factor Analysis (CFA/EFA) were used to study the factor structure of the CORE-OM.ResultsThe English version of the CORE-OM seemed acceptable and understandable to psychiatric patients seeking treatment at the state-owned hospitals in Nairobi. Factor analyses showed that a model with a general distress factor, a risk factor, and a method factor for positively framed items fit the data best according to both CFA and EFA analysis. Coefficient Omega Hierarchical showed that the general distress factor was reliably measured even if differential responding to positively framed items was regarded as error variance.ConclusionsThe English language version of the CORE-OM can be used with psychiatric patients attending psychiatric treatment in Nairobi. The factor structure was more or less the same as has been shown in previous studies. The most important limitation is the relatively small sample size.

This paper described the practice of medical cost control in Hubei′s provincial state-owned hospitals. Their measures taken include combinations of overall planning and classification, total volume control and structural adjustment, external governance and internal management, as well as systematical management and difficulties breakthroughs. This paper proposed to further consolidate the outcomes of the abovementioned efforts by improving the fiscal compensation mechanism, furthering medical insurance payment reform, and continuing to monitor and publicize the medical expenses. Key words: Hospital administration; Medical cost; Control; Hubei province