Sustainability Of Healthcare Systems Research Articles

THE EVOLUTION OF NURSING AS A PROFESSION IN HEALTHCARE

Currently, nursing stands as a highly coveted profession drawing significant attention. While its roots can be traced back to ancient times, the formal recognition of nursing as a profession, labeled as such, has only emerged in recent decades. Defined as both a science and an art grounded in evidence, nursing is progressively assuming more significant roles within the healthcare and biomedical realms. The profession’s evolution is intricately linked with advancements in science, technology, and research, which have translated into tangible practices within the healthcare system. Offering both undergraduate and graduate nursing programs elevates the level of responsibility among nurses. However, this advancement lacks proper systematization and acknowledgment of educational standards within the healthcare sector. Future challenges encompass meeting the increasing healthcare demands spurred by longer life expectancies and population growth, alongside facilitating professional mobility within EU nations. Factors such as enhanced financial stability and improved working conditions contribute to the outflow of nurses from the region. Proposed solutions include establishing adaptable mobile teams, prioritizing patient education and preventative measures, integrating LED clinics/facilities, and introducing supportive robotic technologies. Nurses play a pivotal role in delivering care and advocating for health equity, emphasizing the necessity of fostering collaborative partnerships for the future sustainability of healthcare systems.

ENVIRONMENTAL IMPACTS OF COVID-19 HOSPITALS AND ARCHITECTURAL REMEDIES

Pandemics, with their potential for widespread devastation and global impact, have historically been a critical concern for public health and society. the historical impact of pandemics on the environment underscores the interconnectedness of human lives and health, societal systems, and the environment, highlighting the need for holistic approaches to public health and environmental management. The COVID-19 pandemic has brought about significant changes in healthcare facilities worldwide, particularly in hospitals designated for COVID-19 patients to counter and serve the impact on humans which universally led to the rapid establishment of specialized hospitals to manage the surge in patients. However, such hospitals not only posed significant challenges to healthcare systems worldwide but also highlighted the need for sustainable practices in designing and operating healthcare facilities along with their significant environmental impacts. In response to these challenges, architects, designers, and healthcare professionals have explored innovative architectural and other remedies to mitigate the environmental impacts of COVID-19 hospitals. This paper explores these potential environmental impacts and proposes architectural planning strategies that include sustainable practices and green design principles through which, by implementing, COVID-19 hospitals or similar hospitals can minimize their environmental footprint and contribute not only to a more sustainable healthcare system but also create healthier and more sustainable environments for patients, healthcare workers, and the community at large. KEYWORDS: Hospital Environmental Impact, Hospital Environment Relation, COVID-19 Hospital Impact on Environment, COVID-19 Hospital Impact, Environmental Impact of Pandemics, Pandemic Hospital Impact on Environment

Creating pragmatic, rapid‐cycle, evidence‐based innovation: The Kaiser Permanente Northern California Delivery Science and Applied Research (DARE) program

AbstractIntroductionOngoing crises in the quality, affordability, sustainability, value, and equity of U.S. healthcare call for rapid, massive‐scale innovations across multiple specialties. Physician groups and healthcare organizations commit significant monetary and personnel investments for innovation and improvement efforts, but most lack over‐arching systems theory‐supported conceptual frameworks for efficiently coordinating the timely, large‐volume idea generation, refinement, prioritization, evidence development, implementation, and re‐evaluation strategies needed for rapid‐cycle improvements in health care delivery, outcomes, and value.MethodsThis article describes one large‐scale, generalizable model: The Permanente Medical Group's (TPMG) Delivery Science and Applied Research (DARE) program within Kaiser Permanente Northern California. This organization‐level initiative was designed to: (1) elicit clinical innovation and quality concerns across clinical specialties; (2) prioritize these questions for next‐step evaluations; (3) create dedicated analytic, research, and clinical expertise to rapidly study the questions generated; (4) develop communities of clinician‐researchers, embedded within their specialties' clinical operations, who gather ideas for evaluation, generate evidence, and facilitate implementation of research results (a.k.a. evidence‐based innovators); and (5) broadly disseminate findings, to connect results with potential next‐step implementation.ResultsThe DARE program and its components rapidly led to more than 200 recently completed or ongoing projects, informed care changes, influenced national guidelines, developed communities of evidence‐based clinician innovators in 15 specialties, and empowered new paths for career diversity and physician wellness. Key factors in the DARE program's success include explicitly defining high‐impact ideas; engaging researchers with analysts experienced with large clinical data systems; developing several research funding mechanisms scaled to project size; prioritizing rapid and efficient project completion; supporting clinician‐investigators embedded within their specialties; and structured organization‐wide dissemination of findings for informing potential implementation.ConclusionsHigh‐volume, evidence‐based innovation programs can be important, scale‐able, reproducible models for different settings for increasing quality, affordability, sustainability, value, and equity in healthcare and furthering the difficult‐to‐achieve concept of developing sustainable learning healthcare systems.

CHALLENGES AND SOLUTIONS IN IMPLEMENTATION OF HEALTH MANAGEMENT SYSTEM FINANCING IN NIGERIA

Health care management system financing plays a vital role in ensuring the availability and accessibility of quality health care services. However, numerous challenges and constraints exist that can hinder the effective financing and sustainability of health care systems. Understanding and addressing these challenges is essential for improving health care financing mechanisms and achieving better health outcomes (124, 125) Healthcare systems in suffer from neglect and underfunding, leading to severe challenges across the six World Health Organization (WHO) pillars of healthcare delivery. We conducted this study to identify the principal challenges in the health sector in and their solutions for evidence-based decisions, policy development and program prioritization Insufficient Funding Allocation: One of the primary challenges in health care management system financing is the inadequate allocation of funds. Limited financial resources can restrict the availability of essential health care services, compromise service quality, and undermine the overall functioning of the health care system. Insufficient funding allocation hampers infrastructure development, workforce capacity building, and the procurement of medical supplies and equipment (126).

The impact of healthcare information technology on reducing medication errors: A review of recent advances

This review explores the impact of HIT on reducing medication errors, encompassing recent advances in electronic health records (EHRs), clinical decision support systems (CDSS), bar-coding technology, telemedicine, and mobile health applications. By synthesizing evidence from scholarly literature, case studies, and real-world implementations, this paper delineates the multifaceted benefits, challenges, and future prospects of integrating HIT into medication management processes. Understanding the evolving role of HIT in error reduction is pivotal for healthcare stakeholders to optimize patient outcomes and enhance the quality and safety of medication administration. In the dynamic realm of modern healthcare, medication errors loom as a formidable challenge, imperiling patient safety, compromising care quality, and inflating healthcare expenditures. However, amidst this backdrop of concern, healthcare information technology (HIT) emerges as a beacon of hope, offering potent remedies to counteract these errors. This review embarks on a journey to unravel the profound impact of HIT on ameliorating medication errors, delving into recent strides across various fronts including electronic health records (EHRs), clinical decision support systems (CDSS), bar-coding technology, telemedicine, and mobile health applications. Drawing upon a rich tapestry of scholarly literature, real-world case studies, and practical implementations, this paper meticulously examines the multifaceted landscape of HIT's influence on medication management. Through a comprehensive synthesis of evidence, we uncover the diverse benefits, confront the inherent challenges, and illuminate the promising vistas that emerge from the integration of HIT into medication-related processes. At the core of this exploration lies an urgent call to comprehend the evolving role of HIT in error reduction, recognizing its pivotal significance for healthcare stakeholders. By assimilating insights from disparate sources, we endeavor to empower stakeholders with the knowledge necessary to optimize patient outcomes, fortify the fabric of care delivery, and foster a culture of safety and excellence in medication administration. In essence, this review serves as a guiding compass amidst the labyrinth of healthcare challenges, illuminating pathways towards safer, more efficient, and more effective medication management practices. As we navigate this terrain, let us remain steadfast in our commitment to harness the transformative power of HIT, thereby ushering in a new era of enhanced patient safety, elevated care quality, and sustainable healthcare systems. In the contemporary healthcare landscape, medication errors represent a significant concern, posing risks to patient safety, quality of care, and overall healthcare costs. However, advancements in healthcare information technology (HIT) offer promising solutions to mitigate these errors.

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements

The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

Assessing Trends in Hospitalizations for Breast Cancer among Women in Korea: A Utilization of the Korea National Hospital Discharge In-depth Injury Survey (2006-2020).

Breast cancer poses a significant health threat globally and particularly in Korea, where mortality rates have risen notably. In this study, we analyzed the characteristics of breast cancer patients discharged in Korea over the past 15 years and explored the association between comorbidities and treatment outcomes to propose effective strategies for managing cancer patients. Understanding these dynamics is vital for informing tailored management strategies and optimizing healthcare system sustainability. This study utilized cross-sectional data from the Korea National Hospital Discharge In-depth Injury Survey from 2006 to 2020. Each year, among patients discharged from hospital with 100 beds or more, those identified with breast cancer patients were based on their primary diagnosis code (C50) according to the ICD-10, as recorded in their medical records. Between 2006 and 2020, an estimated 499,281 breast cancer patients were discharged, with an average annual percent change (AAPC) of 5.2% (95% CI 4.2-6.2, p <.05). A notable increase in AAPC was particularly evident among those aged 60 years and old. Across all age groups, there was a consistent increasing trend in the risk of mortality as the CCI score increased (p <.05). The risk of comorbidity was more pronounced in younger age groups compared to older age groups. The increasing life expectancy is expected to lead to a continued rise in the number of elderly breast cancer patients. Countermeasures are needed to address this trend through appropriate diagnosis and treatment planning. Particularly, considering comorbidities in breast cancer treatment plans is necessary to promote positive treatment outcomes, especially in younger breast cancer patients.

The paradigm shift in allergy consultations through a digital ecosystem.

In Spain, specialist outpatient care traditionally relied on in-person consultations at public hospitals, leading to long wait times and limited clinical analysis in appointment assignments. However, the emergence of Information and Communication Technologies (ICTs) has transformed patient care, creating a seamless healthcare ecosystem. At the Allergy Department, we aimed to share our experience in transitioning form a traditional linear model of patient flow across different healthcare levels to the implementation of a digital ecosystem. By telemedicine, we can prioritize individuals based on clinical relevance, promptly and efficiently addressing potentially life-threatening conditions such as severe uncontrolled asthma or hymenoptera venom anaphylaxis. Furthermore, our adoption of telephone consultations has markedly reduced the need for in-person hospital visits, while issues with unstable patients are swiftly addressed via WhatsApp. This innovative approach not only enhances efficiency but also facilitates the dissemination of personalized medical information through various channels, contributing to public awareness and education, particularly regarding allergies. Concerns related to confidentiality, data privacy, and the necessity for informed consent must thoroughly be addressed. Also, to ensure the success of ICT integration, it is imperative to focus on the quality of educational information, its efficient dissemination, and anticipate potential unforeseen consequences. Sharing experiences across diverse health frameworks and medical specialties becomes crucial in refining these processes, drawing insights from the collective experiences of others. This collaborative effort aims to contribute to the ongoing development of a more effective and sustainable healthcare system.

Working as a Healthcare Professional at Island Primary Care: An Exploratory Qualitative Study on the Cyclades Islands, Greece.

Improving the quality of and access to healthcare services in rural areas is fundamental to developing sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary-care units that lack direct hospital or hospital-health centre access. The research was conducted specifically in the rural islands of the Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors, and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, an unstable working environment, educational and organisational aspects, and an insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

An integrated multiple-criteria decision-making and data envelopment analysis framework for efficiency assessment in sustainable healthcare systems

Efficiency is critical in allocating sustainable healthcare resources to ensure that hospitals can effectively care for patients while maintaining high-quality care delivery. Hence, it is necessary to monitor efficiency carefully. This study aims to assess hospital unit effectiveness through a novel comprehensive approach integrating Multiple-Criteria Decision Making (MCDM) with Data Envelopment Analysis (DEA). The proposed MCDM-DEA framework involves allocating varying weights to distinct data categories. It harnesses the capabilities of the q-rung orthopair fuzzy (q-ROF) methodology to address the inherent uncertainties in healthcare performance assessment. The experimental results provide a comprehensively structured ranking system for specific hospital departments. This ranking system allows decision-makers to identify the strengths and weaknesses of each department, enabling them to make informed decisions regarding resource allocation and improvement strategies. Furthermore, the integration of MCDM-DEA provides a robust and objective assessment tool for monitoring and evaluating the performance of hospital departments over time. These rankings offer invaluable insights to decision-makers, equipping them with the strategic information needed to enhance the overall performance of hospital units.

Experiences in global mental health.

Participating in Global Mental Health program development and education and training efforts is rewarding and exciting work. The author describes several global experiences he has engaged in over the past 30 years, which has focused on teaching and encouraging family therapy and mental health care that support human rights and promote human development as innovated and promoted by the Global Alliance for Behavioral Health, formerly the American Orthopsychiatric Association. The author learned through participation that merely presenting mental health information and treatment approaches through lecture presentation was not adequate to help professionals and advocates in low- and middle-income countries to build sustainable mental health care systems in their home regions. The author engaged in several collaborative program development efforts with local professionals at their invitation. These programs, consisting of multiyear partnerships based on the needs and culture of the home region, will be described in the article. The programs, based on relationships between local professionals and a U.S. team of experts in child mental health care, had long-term positive effects and were highly rewarding. The basis for these programs was an invitation by local professionals, followed by collaboration in setting the agenda for the U.S. professionals' visits, an on-going relationship in which local professionals trusted that the visitors want and need to understand the local cultural environment, and improvements that will be most helpful and sustainable. In this process, the author learned about the cultures he worked in and was a part of extremely meaningful and enlightening relationships and experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

175 A Patient Prioritization Tool for Non-elective Spine Surgeries: Improving Patient Outcomes and Reducing Adverse Events in a Level-1 Trauma Center

INTRODUCTION: The ability to provide comprehensive care at a level 1 trauma center has become challenging, especially considering the impact of COVID on healthcare. These resource-intensive challenges have been exacerbated by provider burnout and a shortage of healthcare providers. In a high-volume tertiary care center, these factors have led to delayed access to care, and potentially an increased incidence of adverse outcomes for non-elective surgical patients. As health systems learn to adapt to these challenges, developing protocols or tools to prioritize patients is paramount for sustainable healthcare systems. METHODS: A database review of all non-elective surgeries at a single level 1 trauma center. RESULTS: A total of 2,088 surgeries were analyzed and 764 (36%) of surgeries were delayed. There was an increase in the prevalence of delays following the start of COVID-19 (33% to 37%), especially amongst the patients who did not require emergent surgery (&lt;12 hours) (51% vs 38%, p &lt; 0.0001). The average time delay to surgery increased from 54.5 hours to 168 hours peaking at 312 hours mid-pandemic. The prevalence of any complication for all patients was 13.3%, including 1.2% mortality rate, 8.1% readmission rate within 90 days, 0.6% infection rate and prolonged LOS (10.2 vs 9.2 days). Amongst the patients with surgical delays, there was a statistically higher mortality rate (3% vs 1%, p-value &lt; 0.05), complication rate (34.7% vs 13.1%, p &lt; 0.0001) and readmission rate (23% vs 8%, p &lt; 0.0001). CONCLUSIONS: An increase in delay for non-elective spine surgery led to increased hospital resource utilization, higher complication and readmission rates, and higher mortality rates in a level-1 trauma center.

Healthcare Information Systems (HIS): Implementation Challenges in Developing Countries

In developing nations, the establishment of sustainable healthcare information systems (HIS) is often hindered by insufficient government policies and outdated technology. Bangladesh is a notable example where many patients lack proper healthcare access due to fragmented and non-digitally recorded data. Research has shown that standardized hospital healthcare systems can streamline patient management, increasing the capacity to serve more patients simultaneously. These systems have the potential to improve healthcare in developing nations significantly. This article offers an overview of the key obstacles that impede HIS implementation in these countries. The study looked at relevant information systems literature using a systematic literature review (SLR). The systematic literature review (SLR) was governed by a review process, and relevant studies were gathered from three databases: IEEE Xplore, EBSCO Databases, and ScienceDirect. A total of 4014 papers were initially found. However, only 11 main studies were included for analysis after a careful selection procedure governed by inclusion and exclusion criteria. This study found 24 obstacles to adopting Healthcare Information Systems (HIS) in developing countries, divided into six groups. These obstacles include a lack of financial assistance, inadequate infrastructure, inadequate education and awareness, cultural and political obstacles, reluctance to change, and poor system quality.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 314-326

Analyzing the 20-year declining trend of hospital length-of-stay in European countries with different healthcare systems and reimbursement models.

The study aims to investigate the last 20-year (2000-2019) of hospital length of stay (LOS) trends and their association with different healthcare systems (HS) among 25 European countries. A panel dataset was created using secondary data from Eurostat and Global Burden of Disease study databases, with dependent and control variables aggregated at the national level over a period of 20years. A time trend analysis was conducted using a weighted least squares model for panel data to investigate the association between LOS, HS models [National Health Service (NHS), National Health Insurance, Social Health Insurance (SHI), and Etatist Social Health Insurance], healthcare reimbursement schemes [Prospective Global Budget (PGB), Diagnosis Related Groups (DRG), and Procedure Service Payment (PSP)], and control variables. The study showed a reduction of average LOS from 9.20days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to NHS (b = - 0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS compared to PGB. Our results confirmed the downward trend of LOS in the last 20years, its multifactorial nature, and the influence of the SHI model of HS. This could be due to the financial incentives present in fee-for-service payment models and the role of competition in creating a market for healthcare services. These results offer insight into the factors influencing healthcare utilization and can inform the design of more effective, efficient, and sustainable HS.

The content of the human right to health protection

This article reveals the content of the human right to health care. The difference between the concepts of the right to health and the right to health care is studied and the definition of these concepts is provided. The article analyzes the international legal acts that enshrine the right to health and examines the system of national legislation in the field of protection of the right to health care.&#x0D; The legislation of Poland, Portugal, Hungary, Italy, the Czech Republic and Estonia is analyzed and the differences in their legal regulation of this issue are determined.&#x0D; The three key obligations of the state regarding the right to health care are defined and divided into three categories, namely the obligation to respect, protect and fulfill the duties assigned to it.&#x0D; It was emphasized the need to adopt the developed draft strategy for the development of the health care system until 2030, which has already been published for public discussion and is being prepared for adoption, in order to develop the state's medical system, promote the health and well-being of citizens by ensuring fair access to quality medical services , building sustainable health care systems.&#x0D; It was concluded that the content of the right to health care is that the state provides various favorable conditions and available high-quality goods and services necessary for the highest attainable level of health. The priority directions of the development of the domestic health care system have been determined.&#x0D; It has been established that the content of the right to health care consists in the provision by the state of a variety of favorable conditions, available and high-quality goods and services necessary for the highest attainable level of health, through ensuring access to health care facilities, high-quality goods and services on a non-discriminatory basis basis, a safe environment, as well as establishing responsibility for violations of human rights in the field of health care.

Discussing the Subjective Well-Being of Hospital Volunteers from a Mental Health Perspective with Health Care System Sustainability during the COVID-19 Pandemic

This study explored the subjective well-being of hospital volunteers during the COVID-19 pandemic from a mental health perspective using a health care system sustainability perspective, and adopted the purposive sampling method to conduct a questionnaire survey. A total of 520 questionnaires were distributed, and 500 questionnaires were recovered, with a recovery rate of 96.1%. Of the recovered questionnaires, 43 invalid questionnaires were eliminated, and 457 valid questionnaires were collected, for a valid recovery rate of 91.4%. The data analysis method explored the variable path analysis through descriptive analysis and structural equation modeling. In addition, new data analysis methods have been added to explore the variable path analysis, such as descriptive analysis, discriminant validity, mediation effects, and structural equation modeling. The results show that: (1) the work resources of the hospital volunteers exerted a significant impact on their subjective well-being; (2) the work resources of the hospital volunteers exerted no significant impact on their flow experience; (3) the work resources of the hospital volunteers exerted a significant impact on their leisure involvement; (4) the leisure involvement of the hospital volunteers exerted no significant impact on their subjective well-being; (5) the leisure involvement of the hospital volunteers exerted a significant impact on their flow experience; (6) the flow experience of the hospital volunteers exerted no significant impact on their subjective well-being; and (7) the leisure involvement of the hospital volunteers exerted a mediating effect between work resources and flow experience.

Paving the Path for Sustainable and Responsible Off-Label Use of Pharmaceutical Products in Europe.

Off-label use of pharmaceuticals involves a wide array of aspects ranging from legal and regulatory ones to clinical to safety considerations. Access to off-label therapies is particularly relevant question for patients in areas of unmet medical need. Simultaneously, off-label use also triggers wider considerations relating to social and economic sustainability of health care systems and access to health. National authorities have adapted different regulatory approaches to off-label use of pharmaceuticals, ranging from (1) "regulatory silence"; to (2) allowing off-label use at the discretion of the treating physician; and to (3) a more stringent approach in which off-label use is subject to third party approval. This article provides a brief overview of these different regulatory approaches from a helicopter perspective, and it discusses benefits and shortcomings these approaches. Finally, it presents ideas for preconditions for sustainable and responsible off-label use of pharmaceutical products to ensure patient safety whilst ensuring their timely access to health.

Do adjustment costs constrain public healthcare providers' technical efficiency? Evidence from the New Zealand Public Healthcare System.

Efficiency analysis is crucial in healthcare to optimise resource allocation and enhance patient outcomes. However, the prompt adaptation of inputs can be hindered by adjustment costs, which impact Long-Run Technical Efficiency (LRTE). To bridge this gap in healthcare literature, this research employs a Bayesian Dynamic Stochastic Frontier Model to estimate parameters and explore healthcare efficiency dynamics over time. The study reveals the LRTE for New Zealand District Health Boards (DHBs) as 0.76, indicating around 32% more input utilisation due to adjustment costs. Most DHBs exhibit consistent short-run operational efficiency, with the national Short-Run Technical Efficiency (SRTE) very close to the LRTE. Among the tertiary providers, Auckland and Capital & Coast DHBs operate below the LRTE level, setting them apart from other tertiary providers. Similarly, Tairawhiti and West Coast DHBs also fall below the LRTE level, as indicated by their SRTE scores, potentially influenced by their unique healthcare settings and resource challenges. This research brings a new perspective to policy discussions by incorporating the temporal dynamics of decision-making and considering adjustment costs. It underscores the need to balance short-term and long-term technical efficiency, underlining their collective significance in fostering a sustainable and efficient healthcare system in New Zealand.

An Analytic Hierarchy Process Contingency Analysis of Factors Affecting the Emigration Decision of Medical Doctors in Turkey.

While the importance of explicitly identifying and considering contingent factors such as decision content and context is widely accepted as a way to ensure the validity of the decision analysis for the specific task at hand, few studies include this. This research uses a contingency theoretical approach to study factors affecting the emigration decision of medical doctors (MDs) for the specific case of Turkey. The motivation for conducting this study arises from the observation that the growing trend in emigration among MDs from Turkey is having a significant impact on the country's healthcare system. Dealing with the emigration of MDs is crucial for ensuring an effective and sustainable healthcare system, especially in terms of the availability of services, satisfaction, and employment of the healthcare staff. Contextual factors were explicitly identified through consultation with experts, while the generic factors were retrieved from the specialized medical migration literature. The Analytic Hierarchy Process method was utilized to prioritize the factors. Seventy-three participants were surveyed about their intention to either study or work abroad. The findings reveal that low remuneration and anxiety about their future due to the political situation in the country constitute the two most important factors driving the decision to emigrate.

Cost-effectiveness of treating advanced melanoma with tumor-infiltrating lymphocytes based on an international randomized phase 3 clinical trial

IntroductionIn a multicenter, open-label randomized phase 3 clinical trial conducted in the Netherlands and Denmark, treatment with ex vivo-expanded tumor-infiltrating lymphocytes (TIL-NKI/CCIT) from autologous melanoma tumor compared with ipilimumab improved...