Sustainable Healthcare Services Research Articles

Technology Innovation and Healthcare Performance among Healthcare Organizations in Saudi Arabia: A Structural Equation Model Analysis

The number of people in need of healthcare is increasing over time despite the limited resources available in each country; hence, access to healthcare, quality of healthcare, and cost of healthcare remain contemporary global issues. The limitations of travel and access to healthcare during the global pandemic (COVID-19) have triggered the further search for improved and sustainable healthcare services through technology innovation and digital transformation in the healthcare sector. This study examines the impact of technology innovation on healthcare performance among 241 healthcare organizations in Saudi Arabia. The study utilizes the structural equation model (SEM) method to unravel the nature of technology innovation and its influence on healthcare performance. The results of SEM reveal that innovation efforts, in terms of R&D, training, and the acquisition of new software and acquisition of new medical machinery/equipment, have a significant influence on technology innovation and healthcare performance. Furthermore, the results further indicate that technology innovations measured by mobile technology, digitalization of health records, telehealth/telemedicine and artificial intelligence have great likelihood and significant influence on healthcare performance among the healthcare organizations surveyed. This implies that continuous innovative efforts and spending on various technology innovations would further improve the efficiency and quality of healthcare service which give a competitive advantage to healthcare organizations in Saudi Arabia. Hence, innovation which encompasses all stakeholders should be continuously reinforced in Saudi Arabia’s health policy as this would further strengthen healthcare performance.

Interprofessional collaboration in a community virtual ward: A focus group study.

The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.

Translating Planetary Health Principles Into Sustainable Primary Care Services.

Global anthropogenic environmental degradations such as climate change are increasingly recognized as critical public health issues, on which human beings should urgently act in order to preserve sustainable conditions of living on Earth. “Planetary Health” is a breakthrough concept and emerging research field based on the recognition of the interdependent relationships between living organisms—both human and non-human—and their ecosystems. In that regards, there have been numerous calls by healthcare professionals for a greater recognition and adoption of Planetary Health perspective. At the same time, current Western healthcare systems are facing their limits when it comes to providing affordable, equitable and sustainable healthcare services. Furthermore, while hospital-centrism remains the dominant model of Western health systems, primary care and public health continue to be largely undervalued by policy makers. While healthcare services will have to adapt to the sanitary impacts of environmental degradations, they should also ambition to accompany and accelerate the societal transformations required to re-inscribe the functioning of human societies within planetary boundaries. The entire health system requires profound transformations to achieve this, with obviously a key role for public health. But we argue that the first line of care represented by primary care might also have an important role to play, with its holistic, interdisciplinary, and longitudinal approach to patients, strongly grounded in their living environments and communities. This will require however to redefine the roles, activities and organization of primary care actors to better integrate socio-environmental determinants of health, strengthen interprofessional collaborations, including non-medical collaborations and more generally develop new, environmentally-centered models of care. Furthermore, a planetary health perspective translated in primary care will require the strengthening of synergies between institutions and actors in the field of health and sustainability.

The impact of community nursing program on healthcare utilization: A program evaluation

BackgroundThe role of nurses has evolved to meet the dynamic needs of an aging population. Community nursing has been established in Singapore with the aim to anchor population health and provide sustainable healthcare services beyond the hospital to the community. Community nurses provide health services to residents at the Community Nurse Posts (CNP) situated within the heartland residential estates. ObjectiveTo investigate the effect on healthcare utilization six months pre and post first community nurse visit in older adults, and if the effect is modified by the presence of two or more community nurse visits or absence of a polyclinic chronic disease diagnosis. DesignA single-group pretest-posttest study Setting(s)Fifty-one SingHealth CNPs at the southeast and east regions of Singapore ParticipantsCommunity-dwelling older adults aged ≥ 60 years, seen at any of the SingHealth CNPs between 1 April and 30 November 2019. MethodsThe number of emergency department (ED) visits, unplanned inpatient admissions, length of inpatient stay, specialist outpatient clinic (SOC) and polyclinic visits at SingHealth institutions six months from the first community nurse visit were compared to six months prior. Negative binomial generalized estimating equations were used to model healthcare utilization events, adjusting for baseline age, gender, and race. Results1,600 community-dwelling participants were included, of whom 1,561 (median age of 71 years) survived the post-test period. There was a population-average 23% lower rate of ED visits (incidence rate ratio 0.77, 95% confidence interval 0.68 to 0.87, p<0.001) and 15% lower rate of unplanned inpatient admissions (0.85, 0.75 to 0.96, p=0.011). A trend towards a lower rate of inpatient length of stay and a higher rate of SOC and polyclinic visits was also observed. The reduction in acute care utilization may have been greater among adults with two or more community nurse visits. Participants with no recent polyclinic chronic disease diagnosis had a greater increase in SOC visits. ConclusionsCommunity nursing services are associated with reduced acute care utilization, especially for older adults with two or more community nurse visits. The trend of a higher rate of SOC visits could be attributed to the community nurses’ referrals for undiagnosed/ new conditions and/or treatment of suboptimal health issues. There is a potential role for community nursing towards a sustainable healthcare system.

The effect of COVID-19 on poor treatment control among ambulatory Hypertensive and/or Diabetic patients in Northwest Ethiopia

Diabetes and hypertension have emerged as important clinical and public health problems in Ethiopia. The need to have long-term sustainable healthcare services for patients with diabetes and hypertension is essential to enhance good treatment control among those patients and subsequently delay or prevent complications. A collective shift towards acute care for COVID-19 patients combined with different measures to contain the pandemic had disrupted ambulatory care. Hence, it is expected to have a significant impact on treatment control of hypertensive and diabetic patients. However, there is limited evidence on the effect of the pandemic on treatment control and its determinants. Therefore, this study aimed to assess the effect of COVID-19 pandemic on treatment control of ambulatory Hypertensive and Diabetic patients and identify the factors for poor treatment control in North West Ethiopia. A retrospective chart review and cross-sectional survey design were conducted between December 2020 and February 2021. Using a stratified systematic random sampling technique, 836 diabetic and/or hypertensive patients were included in the study. Web-based data collection was done using Kobo collect. The changes in the proportion of poor treatment control among ambulatory Hypertensive and/or Diabetic patients during the COVID-19 pandemic period were assessed. A multivariable binary logistic regression mixed model was fitted to identify the determinants of poor treatment control. The odds ratios were reported in both crude and adjusted form, together with their 95% confidence intervals and p-values. Poor treatment control increased significantly from 24.81% (21.95, 27.92) prior to the COVID-19 pandemic to 30.33% (27.01, 33.88), 35.66% (32.26, 39.20), 36.69% (33.40, 40.12), and 34.18% (3102, 37.49) in the first, second, third, and fourth months following the date of the first COVID-19 case detection in Ethiopia, respectively. Marital status (AOR = 0.56, 95%CI; 0.41, 0.74), regimen of medication administration (AOR = 1.30, 95%CI; 1.02, 166), daily (AOR = 0.12, 95%CI; 0.08, 0.20), twice (AOR = 0.42, 95%CI; 0.30. 0.59), and three times (AOR = 0.31, 95%CI; 0.21, 0.47) frequency of medication, number medications taken per day (AOR = 0.79, 95%CI;0.73, 0.87), patients habits like hazardous alcohol use (AOR = 1.29, 95%CI; 1.02, 1.65) and sedentary lifestyle (AOR = 1.72,95%CI;1.46, 2.02), missed appointment during the COVID-19 pandemic (AOR = 2.09, 95%CI; 1.79, 2.45), and presence of disease related complication (AOR = 1.11, 95%CI; 0.93, 1.34) were significantly associated with poor treatment control among Diabetic and/or hypertensive patients during the COVID-19 pandemic. The COVID-19 pandemic had a substantial impact on ambulatory Diabetic and/or Hypertensive patients' treatment control. Being married, as well as the frequency and types of medicines taken per day were all found to be negatively associated with poor treatment control. During the COVID -19 pandemic, patients' habits such as hazardous alcohol use and sedentary lifestyle, longer follow-up time, having disease-related complication (s), patients taking injectable medication, number of medications per day, and missed appointments were positively associated with poor treatment control in ambulatory diabetic and hypertensive patients. Therefore, it is better to consider the risk factors of poor treatment control while designing and implementing policies and strategies for chronic disease control.

Designing the temporary dental clinic in the Covid-19 global pandemic

Covid-19 pandemic has directed hospitals to concentrate services for patients who are positive or still in undefined status. Some countries are even forced to build temporary structures or utilize multifunctional buildings such as sports/public halls. On the other hand, hospitals still have to keep performing other routine services and this becomes a challenge for them. When global attention nowadays focuses more on how hospitals serve the Covid-19 cases, this research proposes another side of healthcare service needed by people in the pandemic, which is the dental clinic. The spread of Covid-19 through droplets puts both dental patients and practitioners at risk target of Covid-19 transmission. Therefore, particular standards and protocols are mandatory to be deployed. A prototype design of the temporary dental clinic is the main output from this research. The main objective is to provide service for the community without being afraid of contracting the pandemic as the clinic will be isolated from the regular hospital buildings. To achieve this objective, this research employed three approaches for the methodology. It was started with the desk study to review references on recent technology of temporary building structures. Followed by the online questionnaire using the Google platform distributed to 206 registered dental practitioners in Aceh, in collaboration with the Indonesian Dental Association, Aceh Province, Indonesia. The questionnaire collected the data related to the needs, standards, procedures, and dental service protocols under the Covid-19 pandemic as the main reference for the design process. The last approach was gathering feedback from dentists and international architects who are experts in building science and technology. This was done through a series of pre-design reviews. This research has a high degree of urgency globally, including Saudi Arabia, which is also impacted by the Covid-19 pandemic. It is also in line with Saudi Vision 2030 to enhance the standard quality and sustainability of healthcare services. The prototype design proposed in this research does not only contribute to the Covid-19 pandemic in particular but also post-Covid scenarios or other possible global pandemics in the future.

Sustainable and Robust Home Healthcare Logistics: A Response to the COVID-19 Pandemic

Today, research on healthcare logistics is an important challenge in developing and developed countries, especially when a pandemic such as COVID-19 occurs. The responses required during such a pandemic would benefit from an efficiently designed model for robust and sustainable healthcare logistics. In this study, we focus on home healthcare logistics and services for planning the routing and scheduling of caregivers to visit patients’ homes. Due to the need for social distancing during the COVID-19 pandemic, these services are highly applicable for reducing the growth of the epidemic. In addition to this challenge, home healthcare logistics and services must be redesigned to meet the standards of a triple bottom line approach based on sustainable development goals. A triple bottom line approach finds a balance between economic, environmental, and social criteria for making a sustainable decision. Although, recently, the concept of green home healthcare has been studied based on the total cost and green emissions of home healthcare logistics and services, as far as we know, no research has been conducted on the formulation of a triple bottom line approach for home healthcare logistics and services. To achieve social justice for caregivers, the goal of balancing working time is to find a balance between unemployment time and overtime. Another contribution of this research is to develop a scenario-based robust optimization approach to address the uncertainty of home healthcare logistics and services and to assist with making robust decisions for home healthcare planning. Since our multi-objective optimization model for sustainable and robust home healthcare logistics and services is more complex than other studies, the last novel contribution of this research is to establish an efficient heuristic algorithm based on the Lagrangian relaxation theory. An initial solution is found by defining three heuristic algorithms. Our heuristic algorithms use a symmetric pattern for allocating patients to pharmacies and planning the routing of caregivers. Then, a combination of the epsilon constraint method and the Lagrangian relaxation theory is proposed to generate high-quality Pareto-based solutions in a reasonable time period. Finally, an extensive analysis is done to show that our multi-objective optimization model and proposed heuristic algorithm are efficient and practical, as well as some sensitivities are studied to provide some managerial insights for achieving sustainable and robust home healthcare services in practice.

Role of big data analytics &amp; it in sustainable healthcare services across Europe

The present analysis functions an organized literature review (SLR) to synthesize prior investigation on the applicability of big data analytics (BDA) in healthcare. The SLR examines the results of forty one studies, and provides them in an extensive framework. The results because of this study suggest that uses of BDA in healthcare could be observed from 5 perspectives, namely, wellness awareness of all the common public, interactions amongst stakeholders in the healthcare ecosystem, hospital management practices treatment of certain health conditions, and technology in healthcare service delivery. This particular SLR recommends actionable upcoming research agendas for scholars and helpful implications for practice and theory.

IoT Drone Technology Integration in Medical Logistics Delivery

Drone technology has linked up several opportunities to enable direct connection with the medical consumable donors to receive request through mobile phone communication and deliver medical consumables via Drone device. The recent development in autonomous air navigation and implementation of Drones into mainstream geographical ecosystem have been recognized for adoption in healthcare emergency responses. At the center of the innovation is the Internet of Things (IoT) technology which had necessitated advanced mission specification for Drones to operate beyond visually line of sight (BVLOS) in responding to classified healthcare assignments. The use of Drones in the healthcare management, welfare support, emergency responses and health risk management was investigated in the selected country of the Central East Africa (Rwanda). The research discovered a system of dynamic connection between the tiers of governments in active partnership with the private sector initiative to exploit Drone technology innovation to improve healthcare service delivery up to the grass root level with an outstanding productivity. The article evaluated Africa’s involvement in the society healthcare extreme automation using Drone technology capabilities and deliberated on the possibilities and benefits for implementation and adoption into the national healthcare sector in Nigeria. The paper concluded that future implementation of the research will accomplish the digital health demands of Nigeria government, public and private sector health maintenance to guarantee sustainable healthcare investment and effective healthcare service delivery.

The blind spot: value‐based health care in obstetrics and gynaecology

Key content Continuing financial constraints on the UK’s National Health Service means the need for clinicians to provide high‐quality care in a cost‐effective way has never been greater. While the medical education system equips doctors with skills to provide safe clinical care, it should also provide an understanding of healthcare costs and cost‐effectiveness analysis. Value‐based care is becoming a key paradigm in women’s health services, where clinicians must employ strategies for delivering value, rationalising costs and capitalising on the use of emerging technologies. The calculation of value of an intervention for providers and service users may differ; care must be taken to ensure this concept is adapted for, and not imposed on healthcare systems. Engaging trainees in systems transformation and embedding the concepts of ‘do no financial harm’ are essential to ensure sustainable healthcare services. Learning Objectives To understand the principles of value‐based health care. To highlight the importance of adopting ‘cost‐conscious’ care within daily clinical practice. To learn the differences between ‘cost’, ‘charge’, ‘price’ and ‘reimbursement. To encourage developing value‐based competencies for future medical workforce through utilising out of programme placements and digital resources. Ethical Issues The ethical obligation of clinicians to consider cost may encompass justice and equity. However, the impact of practicing value‐based health care is yet to be evaluated.

The Healthcare Organization in COVID-19 Age: An Evaluation Framework for the Performance of a Telemonitoring Model

Telemedicine services (TS) are not only supportive for healthcare professionals, but managers also see them as essential for the provision of an efficient, effective, and sustainable healthcare service. Several systems make TS available in different ways and contexts. However, no commonly accepted framework meets the need to draw conclusions about which TS can efficiently be measured. For this purpose, a framework is proposed in order to define a dynamic method of performance evaluation that can be used to improve the sustainable management of a telemonitoring model for COVID-19 patients. A case study analysis based on the experience of three telemedicine networks in different locations providing telemonitoring services (northern, central, and southern Italy) was performed. A total of four phases (1. Identification of the target population; 2. Identification of health needs; 3. Definition of the operational plan; and 4. Monitoring of the service by indicators), and seven indicators have been identified. Despite the differences raised in the Italian contexts, applying a performance evaluation framework could help the managerial sector to understand if the service is working as intended and what effects the service is producing on the healthcare organization. Considering the long-term field experience, this framework is an easy-to-use tool that will allow healthcare organizations to evaluate the performance of their telemonitoring model, and improve it according to new needs. Providing a healthcare service in an efficient context is fundamental for the sustainability of the health system as a whole.

Risk of hospital insolvency and its relationship with income and borrowings from banks: a case\u2013control study with large-scale financial data in Japan

Considering the variety of stakeholders surrounding hospitals, hospital financial distress should be understood as a social issue, rather than just a matter involving the hospital owners. The present study aimed to assess Japanese hospital insolvency and related factors based on a nationwide financial dataset, and to identify indicators of the risk of insolvency. The legal financial reports used included a balance sheet and a profit-and-loss statement of hospitals owned by healthcare corporations, representing about 70% of all Japanese hospitals. This case–control study with descriptive analyses was conducted to clarify the financial status of healthcare corporations and to assess associations between specific factors and insolvency. Insolvency was found in 5.9% of healthcare corporations in 2016. Insolvency was significantly associated with operational income per sales (odds ratio, 0.16), and both short- and long-term borrowings per sales (odds ratios: 1.46 and 1.22 in this order). The present study found that 5.9% of Japanese healthcare corporations were insolvent, and hospital profitability and borrowing (both short- and long-term) could be key factors related to preventing hospital insolvency in Japan. To maintain sustainable healthcare services by hospitals, decision makers should consider the risk of insolvency, and balance the amount of borrowings against sales.

Estimated direct costs of renal cancer by stage and care phase: a whole disease modeljuj

Abstract Background Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which include costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines. Methods Considering the clinical pathway for RCC adopted in the Veneto region (north-east Italy) and the latest guidelines, we developed a very detailed “whole-disease” model that covers the probabilities of all potentially necessary diagnostic and therapeutic action involved in the management of RCC. Based on the cost of each procedure according to the Veneto Regional Authority's official reimbursement tariffs, we estimated the total and average per-patient costs by stage of disease (early or advanced) and phase of its management. Results In the first year after diagnosis, the mean expected cost of a patient with RCC is €12,991 if it is localized or locally-advanced, and reaches €40,586 if it is advanced. For early disease, the main cost is incurred by surgery, whereas medical therapy (first and second line) and supportive care become increasingly important for metastatic disease. Conclusions It is crucially important to examine the direct costs of care for RCC, and to predict the burden on healthcare services of new oncological therapies and treatments, as the findings could be useful for policy-makers planning the allocation of resources. Key messages An estimation of the direct costs of renal cell carcinoma, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services. Our model could represent a useful tool for policy-makers in the optimization of resources allocation, especially in a time of budget constraints.

A Two-Echelon Responsive Health Analytic Model for Triggering Care Plan Revision in Geriatric Care Management

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults’ needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the Internet of Medical Things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities.

Wholesome Coin: A pHealth Solution to Reduce High Obesity Rates in Gulf Cooperation Council Countries Using Cryptocurrency

Obesity is considered one of the leading causes of chronic and noncommunicable diseases; these include diabetes, cardiovascular disease, and cancer. The obesity prevalence is threefold higher in the Arab Gulf Cooperation Council (GCC) population than the rest of the world and leaves healthcare providers within the region with no alternative than to offer continuous and sustainable healthcare services. Obesity prevention would be more economical for governments than providing treatment. Preventing obesity is challenging because it requires motivating individuals to live a healthy lifestyle. Personal health (pHealth) has recently been actively involved in finding solutions to encourage healthy living. However, pHealth does not address the high percentage of people lacking the desire to maintain healthy living plans, which could have a negative effect on attempts aimed at reducing obesity prevalence. This study sheds light on the challenges faced by the GCC governments in reducing high obesity rates using pHealth; we propose a solution, Wholesome Coin, which incorporates advanced technologies to help governments reduce high obesity rates. Wholesome Coin has two components: one uses wearable IoT (WIoT) to help patients manage their behavior by tracking their physical activities and diet, and the other utilizes blockchain technology to help healthcare payers to incentify patients to maintain a healthy living plan by awarding digital coins that can be redeemed for real goods and services. GCC governments’ adoption of Wholesome Coin could improve the quality of life of obese patients in a seamless, secure, and self-motivated manner, resulting in a healthier tomorrow, especially amid challenging times featuring global social distance campaigns.

Framing Sustainable Healthcare Services.

This paper develops an analytical framework using process thinking to achieve sustainable healthcare services. Healthcare is characterised by low economic efficiency. At the same time, it is embedded in ethical concerns related to society and nature. Healthcare is thus conceptualised as functionality in an ecosystem. The patient is woven into both nature and society. Given the complex nature of healthcare services, we seek an alternative way to understand healthcare services, focusing on the exchange aspect of the economy. We offer a conceptual model that helps build an analytical framework focusing on how practitioners and leaders in healthcare frame their activities. This framing provides guidance in healthcare practice. Furthermore, framing is associated with both healthcare service providers as well as patients and next of kin—the recipients. This framework aims to guide practical research and development activities in healthcare.

The cost of one unit blood transfusion components and cost-effectiveness analysis results of transfusion improvement program.

Background This study aims to analyze the cost of the entire transfusion process in Turkey including evaluation of the cost of transfusion from the perspective of hospital management and determination of savings achieved with the transfusion improvement program. Methods Invoices, labor, material costs were calculated with micro-costing method, while general production expenses were calculated with gross costing method between January 2018 and December 2019. Unit costs for each blood product were calculated separately by collecting unit acquisition costs, material costs, labor costs, and general production expenses and, then, distributed into six different blood products as follows: erythrocyte suspension, fresh frozen plasma, pooled platelet, apheresis platelet, cryoprecipitate, fresh whole blood. The total costs for 2018 and 2019 were calculated and the savings achieved were estimated. The Turkish Lira was converted into the United States Dollar ($) currency using the purchasing power parity. Results In 2018/2019, the blood component transfusion cost was $240.90/251.18 for erythrocyte suspension, $120.00/128.67 for fresh frozen plasma, $313.50/322.19 for pooled platelet, $314.24/325.73 for apheresis platelet, $104.95/113.99 for cryoprecipitate, and $189.91/209.09 for fresh whole blood. The total transfusion cost was $6,224,208.33 in 2108 and $5,308,148.43 in 2019. As a result of the transfusion improvement program launched in 2019, the amount of blood components decreased by 23.24%, compared to the previous year, and a saving of $916,059.9 was achieved. Conclusion The transfusion is a burden for both the hospital management systems and the country's economy. To accurately calculate and manage this economic burden is important for sustainable healthcare services.

Enhancing the use of computed tomography and cardiac catheterization angiography in Zambia: A project report on a global extension of medical technology in Japan.

Cardiovascular disease (CVD) is one of the leading causes of death in adults in Zambia among the non-communicable diseases. The Government of the Republic of Zambia through the Ministry of Health procured Japanese radiological systems, computed tomography, and angiography for the University Teaching Hospitals (UTHs) - Adult in 2015. However, the operation of these diagnostic systems has not been optimal due to lack of a proper maintenance service plan, lack of competent health professionals, and erratic supply of medical consumables. In this study, we report our experiences of providing intensive training to multidisciplinary healthcare teams of the radiology department at UTHs - Adult from 2017 to 2019 to strengthen the quality management system of the radiological equipment so as to provide effective healthcare services. However, the COVID-19 pandemic has had enormous negative impact on essential healthcare. Long-term support through continuous hands-on training must be provided to establish sustainable healthcare services.

A charitable access program for patients with lysosomal storage disorders in underserved communities worldwide

BackgroundLysosomal storage disorders (LSDs) are rare genetic disorders, with heterogeneous clinical manifestations and severity. Treatment options, such as enzyme replacement therapy (ERT), substrate replacement therapy, and pharmacological chaperone therapy, are available for several LSDs, including Gaucher disease (GD), Fabry disease (FD), and Hunter syndrome (mucopolysaccharidosis type II [MPS II]). However, patients in some countries face challenges accessing treatments owing to limited availability of locally licensed, approved drugs.MethodsThe Takeda LSD Charitable access program aims to meet the needs of individuals with GD, FD or MPS II with the greatest overall likelihood of benefit, in selected countries, through donation of ERT to nonprofit organizations, and support for medical capacity-building as well as family support via independent grants. Long-term aims of the program are to establish sustainable healthcare services delivered by local healthcare providers for patients with rare metabolic diseases. Patients receiving treatment through the program are monitored regularly, and their clinical data and progress are reviewed annually by an independent medical expert committee (MEC). The MEC also selects patients for enrollment completely independent from the sponsoring company.ResultsAs of 31 August, 2019, 199 patients from 13 countries were enrolled in the program; 142 with GD, 41 with MPS II, and 16 with FD. Physicians reported improvements in clinical condition for 147 (95%) of 155 patients with follow-up data at 1 year.ConclusionsThe response rate for follow-up data at 1 year was high, with data collected for > 90% of patients who received ERT through the program showing clinical improvements in the majority of patients. These findings suggest that the program can benefit selected patients previously unable to access disease-specific treatments. Further innovative solutions and efforts are needed to address the challenges and unmet needs of patients with LSDs and other rare diseases around the world.

Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox.

BackgroundThe integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges.ObjectiveThe aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology.MethodsWe have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office.ResultsWe verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019.ConclusionsWe show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials.