Trained Staff Members Research Articles

Optimizing Digital Transition: Addressing Challenges in Modernizing Inventory Systems in Primary Healthcare Facilities

This study investigates the challenges and potential solutions associated with modernizing inventory systems in primary healthcare facilities in the National Capital Region (NCR) of the Philippines, emphasizing operational efficiency, resource management and staff training. A descriptive research design was applied, using both quantitative and qualitative approaches. Data was collected from 67 trained staff members through purposive sam-pling, ensuring diverse perspectives across various organizational roles. The questionnaire was evaluated in relation to users' perceptions of satis-faction, operational efficiency, and the perceived difficulties with digital inventory systems. Reliability is established with the help of Chronbach's Alpha, and ANOVA, used in establishing the relationship between user sat-isfaction and operational effectiveness. From the thematic analysis of the questionnaire, lack of infrastructure, lack of training, and fractured supply chains were pointed out as being the obvious challenges that reduce the smooth digital transition. The study found that while digital transfor-mation has the potential to enhance inventory management and healthcare delivery, significant barriers must be addressed to achieve full adoption. Overall, findings help highlight the need for focussed training with strong digital solutions in optimizing resource management and service delivery in public health settings, providing valuable insights for policymakers and healthcare administrators.

A rural ambulance service in Northern Togo improves access to emergency care for women with obstetric complications.

Maternal mortality remains high in sub-Saharan Africa, with little progress made in the last 20 years. The provision of emergency obstetric care has been shown to have the greatest effect in reducing maternal mortality in countries with high maternal mortality ratios, especially when paired with an emergency transport service. Integrate Health has partnered with the Togolese Ministry of Health to improve maternal and child health via the integration of a free ambulance service into a pre-existing primary care model. In this study, we aim to describe the implementation of this service and assess its effectiveness on access to emergency obstetric care by estimating its coverage of women with obstetric complications. This is a retrospective cross-sectional study using routinely collected data from ambulance logbooks. The study was restricted to pregnant or postpartum woman in four districts of Northern Togo. For each patient transported, the variables collected included date of transport, destination, patient information, kilometres travelled, and reason for transport. Complicated obstetric cases were defined by reason for transport and included maternal haemorrhage, complicated birth, and signs of danger. Estimated coverage of major obstetric complications was calculated using population estimates per fiscal year, the birth rate (3.7%) in Togo, and the assumption that 15% of pregnant women will have a complication. Between July 2020 and June 2023, there were 2926 maternal patients transported by the ambulance service. Of these, 1030 were reported as complicated obstetric cases. Estimated coverage of obstetric complications increased over time and as the programme expanded, from 18% in 2020 to 35.7% in 2021, and 66.5% in 2022. Our findings demonstrate that implementing a rural ambulance service in a region with historically high maternal mortality rates may improve maternal access to emergency obstetric care. The success of our ambulance service was likely due to the fact that it is free, available 24/7, easily accessible, operated by trained staff and community members, and integrated into a pre-existing primary care programme with well-resourced health care centres.

Ultrasound Assessment of Pleural Effusions After Orthotopic Pig‐to‐Baboon Cardiac Xenotransplantation

ABSTRACTBackgroundPleural effusions develop frequently after cardiac surgery in humans. Lung ultrasound is an essential non‐invasive tool in the diagnosis and treatment of these effusions. Pleural effusions also develop regularly after preclinical cardiac xenotransplantation experiments. Unlike in the human setting, modern ultrasound devices lack pre‐installed tools for calculating the volume of pleural effusions in baboons. The aim of this study was to analyze ultrasound examinations of pleural effusions after orthotopic pig‐to‐baboon cardiac xenotransplantation experiments in order to develop a formula for calculating the effusion volume based on ultrasound measurements.MethodsHearts from seven genetically modified (GGTA1‐KO, hCD46/hTBM transgenic) juvenile pigs were orthotopically transplanted into male baboons. Postoperatively, the baboons were tested regularly for the development of pleural effusions using ultrasound. When thoracocentesis was required, the drained effusion volume (EV) was compared to ultrasound‐derived calculations using various formulas. These calculations were based on measuring the distance between lung and diaphragm at the effusions’ maximum height (Hmax). Subsequently, the most promising formula was used to describe the interobserver variability between trained and untrained staff members to predict effusion volumes based on ultrasound measurements.ResultsUltrasound measurement correlated very strongly with the absolute EV (r = 0.9156, p < 0.0001), with EV indexed to total body weight (r = 0.9344, p < 0.0001) and with EV indexed to body surface area (BSA) (r = 0.9394, p < 0.0001). The ratio between Hmax and EV increased with total body weight and BSA and also depended on the baboon species. The sonographic measurements taken by an experienced and an inexperienced observer showed only low interobserver variability. A Bland–Altman plot of both observers’ measurements showed an overall bias of –2.39%.ConclusionUltrasound imaging provides a simple and non‐invasive tool for measuring pleural effusion quantity in baboons. This facilitates simple and efficient monitoring even in the hands of untrained personnel and may guide the decision‐making to perform thoracocentesis.

Height and breast cancer risk in premenopausal Korean women aged under 40 years of age.

Taller women are at an increased risk of breast cancer; however, evidence regarding this in younger women is limited. This study investigated the association between body height and breast cancer risk in premenopausal Korean women aged <40 years. Premenopausal women aged <40 years enroled in the Kangbuk Samsung Health Study (KSHS) and National Health Insurance Service-National Health Information Database (NHIS-NHID) were included in the analysis. Trained staff members performed anthropometry, including height measurements. Breast cancer incidence was followed up until December 2019. Cox regression model and restricted cubic- spline regression were applied. The mean (standard deviation [SD]) age was 33.3 (3.6) years and 32.9 (4.2) in KSHS and NHIS-NHID cohorts, respectively. After adjusting for age at baseline and other confounders, every 10 cm of height was associated with a 1.44-fold increased risk of developing breast cancer (adjusted hazard ratio [aHR], 1.44; 95% confidence interval [CI], 1.17-1.78) in the KSHS. The restricted cubic spline regression showed an almost linear association between height and breast cancer risk. Compared to women with height <155 cm, aHRs (95% CI) among those with height 160-165 cm, 165-170 cm, and ≥170 cm were 1.67 (1.07-2.60), 1.75 (1.09-2.81), and 2.31 (1.18-3.86), respectively (P = 0.009). Results were similar in the NHIS-NHID cohort (aHR, 1.20 [95% CI, 1.10-1.31] per 10-cm increase in height). In young Korean women, greater body height was associated with increased breast cancer risk.

Evaluation of indoor activities for moderate-to-vigorous physical activity in preschoolers

ABSTRACT The study objectives were 1) to determine the feasibility and acceptability of indoor activities to achieve moderate-to-vigorous physical activity (MVPA) in preschoolers, and 2) compare MVPA estimates between direct observation (DO) and various accelerometry placements. In this cross-sectional study, 35 preschoolers (51% female, 54% 3-year-olds) performed six, 6-minute activities (dancing to video, balloon/bubbles, stationary exergame cycling, circuits, running-in-place, and cleaning up) in sequential order, facilitated by a trained staff member. Triaxial accelerometers (Actigraph Gt3×BT) at the ankle, waist, and wrist measured MVPA using age-specific cut-points. Total activity and MVPA time were quantified via DO of video recordings. Feasibility and acceptability were assessed via parent and child report. Preschoolers contributed 4339, 15-second epochs of accelerometry and DO data (~31.0 minutes/preschooler). Preschoolers achieved MVPA ≥ 50% of the time while engaging in balloon/bubbles, cycling, and circuits; but not while dancing to video (15%), running-in-place (48.5%), or cleaning up (8%). There were no differences in MVPA by age, sex, or between screen and non-screen activities. Parents and preschoolers reported most activities were feasible (≥4.0/5.0). Waist and ankle accelerometry had strong agreement with DO (ICCs range: 0.70–0.84) while wrist had fair to low agreement (ICCs: 0.22–0.58). Multiple indoor activities show promise to increase preschoolers’ MVPA.

Virtual Reality as an Adjunct to Traditional Patient Counseling in Patients With Newly Diagnosed Localized Prostate Cancer

ObjectivesTo determine the utility of a virtual reality (VR) model constructed using patient-derived clinical imaging to improve patient understanding of localized prostate cancer (PCa) diagnosis and surgical plan. MethodsPatients undergoing robotic radical prostatectomy were selected and demographic data recorded. Patients completed a questionnaire to assess baseline knowledge of their diagnosis after consultation and shared-decision making with their surgeon. A trained non-clinical staff member then guided the patient through a VR experience to view patient-specific anatomy in a 3-dimensional space. Patients then completed the same questionnaire, followed by an additional post-VR questionnaire evaluating patient satisfaction. Questions 1-7 (patient understanding of prostate cancer and treatment plan) and 11-17 (patient opinion of VR) used a standard Likert scale and Questions 8-10 were multiple choice with 1 correct answer. ResultsIn total, 15 patients were included with an average age of 64.1 years. 6 of 7 questions showed an improvement after VR (p<0.001). The percentage of correct responses on Questions 8-10 were higher after VR but not statistically significant (p>0.13). Mean responses range from 4.3 to 4.8 (Likert scale, 1 through 5) for the post-VR questionnaire, with a mean total of 31.9 out of 35. ConclusionThis small preliminary investigation of a novel technology to improve the patient experience showed potential as an adjunct to traditional patient counseling. However, due the small sample size and study design, further research is needed to determine the value VR adds to prostate cancer surgical counselling.

Accounting for Cognitive Impairment in Concurrent Disorders Treatment: Practical Resources to Meet the Needs of Our Most Complex Clients.

Much has been written about the interplay between mental health and substance use disorders. However, there is a third dimension, which often complicates the provision of care and renders many mainstream approaches less effective. Cognitive impairments, including those that arise from traumatic brain injury, are increasingly being recognized as an important consideration in addictions programming. This article will discuss the findings from a cross-sectorial partnership between the Centre for Addiction and Mental Health (CAMH) and Community Head Injury Resource Services of Toronto (CHIRS). Four recommendations for program administrators are proposed: (1) support screening for brain injury; (2) use free resources to train staff members to recognize, accommodate and address neurocognitive impairment; (3) establish cross-sector partnerships to facilitate collaborative programming and cross training for the most complex clients being served; (4) when developing new programming, include structures and behavioural interventions that have been shown to benefit individuals with cognitive impairment.

Hearing Screening for Congenital CytoMegaloVirus-Exploring Parents' Experiences of Completing Targeted Congenital Cytomegalovirus Screening at the Time of Their Infants' Newborn Hearing Screening.

Background/Objectives: Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disabilities, with prompt detection (<21 days of life) required to enable accurate diagnosis and anti-viral treatment where clinically appropriate. International guidelines recommend cCMV screening for infants who do not pass their Universal Newborn Hearing Screening (UNHS). This study aimed to explore parental experiences of targeted cCMV screening through the UNHS in Victoria, Australia between 2019 and 2020 (HearS-cCMV study). Methods: A qualitative study comprising 18 semi-structured interviews with parents who took saliva swabs from their infants who did not pass their UNHS. A maximum variation sampling strategy was used with data analysed using thematic analysis. Results: Four themes described 18 parents' experiences of cCMV screening: (1) parents' lack of CMV awareness prior to cCMV screening; (2) overall positive experience; (3) varied understanding of CMV post screening; and (4) parents were glad to screen their infant for cCMV. Enablers of targeted cCMV screening included the swab being simple and non-invasive, being easier to complete in the hospital than at home, and the screening being well delivered by the staff. Barriers included a potential increase in anxiety, especially with false positives, and the timing of cCMV screening coinciding with their infant not passing UNHS being difficult for some parents. Conclusions: Parent experiences of targeted cCMV screening were positive. Increasing public knowledge of cCMV and training staff members to complete the CMV swab would reduce the risk of false positives and associated parental anxiety. This would facilitate successful routine targeted cCMV screening.

Availability and readiness of health facilities providing services for other infectious diseases to treat neglected tropical diseases in Ethiopia: implications for service integration in high burden areas

BackgroundThe burden of neglected tropical diseases (NTDs), HIV/AIDS, tuberculosis, and malaria pose significant public health challenges in Ethiopia. This study aimed to the explore service availability and readiness for NTD care among Ethiopian health facilities treating tuberculosis (TB), HIV/AIDS, and/or malaria.MethodsThis study utilized secondary data from the Ethiopian Service Provision Assessment 2021–22 survey. The availability of services was calculated as the percentage of HIV/AIDS, tuberculosis, or malaria facilities providing NTD services. Facilities were considered highly prepared to manage any type of NTD if they scored at least half (> 50%) of the tracer items listed in each of the three domains (staff training and guidelines, equipment, and essential medicines). Descriptive statistics and logistic regression models were employed to present the study findings and analyze factors influencing facility readiness, respectively.ResultsOut of 403 health facilities providing NTD care nationally, 179, 183, and 197 also offer TB, HIV/AIDS, and malaria services, respectively. The majority of TB (90.1%), HIV/AIDS (89.6%), and malaria (90.9%) facilities offer soil-transmitted helminth services, followed by trachoma (range 87–90%). The percentages of the aforementioned facilities with at least one trained staff member for any type of NTD were 87.2%, 88.4%, and 82.1%, respectively. The percentage of facilities with guidelines for any type of NTD was relatively low (range 3.7–4.1%). Mebendazole was the most widely available essential medicine, ranging from 69 to 70%. The overall readiness analysis indicated that none of the included facilities (TB = 11.9%; HIV/AIDS = 11.6%; and malaria = 10.6%) were ready to offer NTD care. Specifically, a higher level of readiness was observed only in the domain of medicines across these facilities. Hospitals had better readiness to offer NTD care than did health centers and clinics. Furthermore, a significant associations were observed between facility readiness and factors such as facility type, region, presence of routine management meetings, types of NTD services provided, and fixed costs for services.ConclusionsEthiopian health facilities treating TB, HIV/AIDS, and malaria had an unsatisfactory overall service availability and a lack of readiness to provide NTD care. Given the existing epidemiological risks and high burden of TB, HIV/AIDS, malaria, and NTDs in Ethiopia, there is an urgent need to consider preparing and implementing a collaborative infectious disease care plan to integrate NTD services in these facilities.

A Prospective Study of Adverse Events in Whole Blood and Apheresis Donors at a Tertiary Care Hospital in Western India

ABSTRACT Background and Objectives: Blood donation is a relatively safe procedure without any discomfort; however, if any unexpected or undesirable effects, i.e., an adverse donor reaction (ADR) does occur, it should be managed promptly and efficiently. The main aim of this study was to analyze the incidence of ADRs among blood donors. Methods: A prospective study was conducted from September 2020 to September 2022 at blood center. All ADRs in whole blood and apheresis donors were managed as per standard operating procedures. An ADR pro forma was filled, and the donor was given postdonation advice as per standard guidelines. The data collected were analyzed to find the incidence, risk factors, and causes of ADRs and to study its effect on repeat donation. Results: Among 83231 blood donations during the study period, ADRs were observed in 250 donors (0.30%). ADRs were most commonly noted in the age group of 18–30 years and were higher in first-time donors (69.6%) as compared to repeat donors (30.4%). The rate of ADR was higher in females (3.11/1000) as compared to males (3.00/1000) The most common type of ADR was vasovagal type (98%) followed by hematomas (2%). Conclusion: Younger, first-time, and female donors were more prone to ADRs in the present study. Better postdonation care and regular training of staff members in counseling, early identification, and management of ADR will aid in decreasing the severity and incidence of adverse reactions which further encourages repeat blood donations.

Understanding the use of CATI and web-based data collection methods during the pandemic among digitally challenged groups at FQHCs: data from the All of Us Research Program.

The All of Us Research Program (Program) is an ongoing epidemiologic cohort study focused on collecting lifestyle, health, socioeconomic, environmental, and biological data from 1 million US-based participants. The Program has a focus on enrolling populations that are underrepresented in biomedical research (UBR). Federally Qualified Health Centers (FQHCs) are a key recruitment stream of UBR participants. The Program is digital by design where participants complete surveys via web-based platform. As many FQHC participants are not digitally ready, recruitment and retention is a challenge, requiring high-touch methods. However, high-touch methods ceased as an option in March 2020 when the Program paused in-person activities because of the pandemic. In January 2021, the Program introduced Computer Assisted Telephone Interviewing (CATI) to help participants complete surveys remotely. This paper aims to understand the association between digital readiness and mode of survey completion (CATI vs. web-based platform) by participants at FQHCs. This study included 2,089 participants who completed one or more surveys via CATI and/or web-based platform between January 28, 2021 (when CATI was introduced) and January 27, 2022 (1 year since CATI introduction). Results show that among the 700 not-digitally ready participants, 51% used CATI; and of the 1,053 digitally ready participants, 30% used CATI for completing retention surveys. The remaining 336 participants had "Unknown/Missing" digital readiness of which, 34% used CATI. CATI allowed survey completion over the phone with a trained staff member who entered responses on the participant's behalf. Regardless of participants' digital readiness, median time to complete retention surveys was longer with CATI compared to web. CATI resulted in fewer skipped responses than the web-based platform highlighting better data completeness. These findings demonstrate the effectiveness of using CATI for improving response rates in online surveys, especially among populations that are digitally challenged. Analyses provide insights for NIH, healthcare providers, and researchers on the adoption of virtual tools for data collection, telehealth, telemedicine, or patient portals by digitally challenged groups even when in-person assistance continues to remain as an option. It also provides insights on the investment of staff time and support required for virtual administration of tools for health data collection.

Detection of contraband drugs in forensic-correctional mental health services using TeknoScan-a gas chromatography tool

Substance misuse is a major problem among individuals involved in forensic-correctional mental health services. Urine drug screening detects substance use and deters the entry of contraband into forensic-correctional units, albeit with limitations. For example, a point-of-care urine sample may not be possible and patients can alter or substitute samples to avoid detection, highlighting the role of ancillary tools to detect contraband substances. This study describes the pattern and types of substances detected from environmental samples using a gas chromatographic analyzer (TeknoScan TSI3000) in forensic-correctional populations to model the benefits of similar tools in similar settings. Samples collected over 18 months (January 2020 to June 2021) by trained staff members using the machine were reviewed. During this period, 217 environmental samples were recorded, and 66 (30%) samples were positive for contraband substances, including tetrahydrocannabinol (25%), methamphetamines (19%), and cocaine (16%). Other substances detected include methylene-dioxymethamphetamine, heroin, morphine, lysergic acid diethylamide, tramadol, and methyl-benzoate. Fewer positive samples were detected, especially during the time corresponding with the COVID-19 restriction on the forensic units. TeknoScan was beneficial as an ancillary tool to detect and deter contraband substances. It also provided evidence for risk management. Adequate training is needed for the successful implementation of the tool.

An evaluation of training components necessary to teach staff members to conduct an intensive pediatric feeding intervention

AbstractIn applied behavior analysis, parents or other caregivers are often trained to implement an intervention after the intervention has been demonstrated effective when implemented by professionals. However, training novice staff members to conduct specific behavioral interventions has received less attention. This is particularly true in the context of training staff to implement interventions to treat food refusal. In the current study, we implemented three levels of training to evaluate the level of intensity required to train staff members (i.e., behavior technicians, Registered Behavior Technicians®, and Board‐Certified Behavior Analysts®) to implement a feeding protocol with a role play partner. Only one participant met the mastery criteria following the first training phase, which included written instructions and video modeling. Following 72 h of exposure to the instructional materials, we provided participants an opportunity to ask clarifying questions about the procedure (second training phase). Only one participant met mastery in this phase. Three other participants required in vivo feedback and modeling (third training phase) to master the protocol. We discuss clinical implications and future research directions.

An Empirical Study on Laboratory Sample Rejections

Clinical laboratory plays a crucial role in the diagnosis and management of the patients. The increased focus on the patient safety and awareness that the information provided by these laboratories has direct impact on diagnosis and treatment requires that laboratories prioritize reduction in error rates. For patients safety the laboratory has the right to refuse samples that are incompletely, incorrectly labelled because of wrong methods of collection, storage and transportation. Despite the remarkable advances and the modern innovations which have transformed laboratory diagnostics from manual and labour- intensive service to fully automated process, the clinical laboratory still shows a number of pre-analytical errors that might lead to erroneous patient diagnosis and treatment that follows. The present study is to analyse the reason for rejections of the tests and lab related incidents. Every sample that reaches the laboratory is considered for the calculation to improve the laboratory practices by using quality indicators. The major findings of the study are that most rejections are happening at pre-analytical phase. The study suggests several changes in the sample collection and transportation process. Rejections of the samples are high because of human error which can be minimised by training technicians and staff members. Policies and procedures specific to specimen collection, transportation and preparation should be strictly followed.

Isolation of Rift Valley Fever Virus from Field Specimens Using Cell Culture Approaches.

Several techniques have been developed to diagnose Rift Valley fever infection. Viral isolation is one of the most difficult techniques to apply but offers great opportunities for further research. It is useful, for example, for the development of an accurate diagnostic test suitable for screening for Rift Valley fever virus infection, specific treatments by testing known antiviral molecules that act on the replication cycle to assess their therapeutic or even prophylactic potential, therapeutic applications, and vaccine candidates. Understanding how the virus replicates and interacts with the host cell and organism and identifying biomarkers of infection or new targets for the development of treatments are made possible through field virus isolates. Biosafety level 3 conditions are a pre-requisite for viral isolation by a trained staff member. Here, we describe the procedure to isolate Rift Valley fever virus from field samples by cell culture.

INFLUENCE OF PERCEIVED QUALITY ON THE OVERALL SATISFACTION EXPERIENCE OF HOTEL GUESTS

The hotel industry has seen many changes in the last few years, some of which can be attributed to the quickening pace of technological advancement, shifting traveler preferences due to health concerns, and turbulent political and economic events that forced hotel management to place a premium on product and service quality. To thrive in a progressively cutthroat market, lodging establishments need to be prepared to adjust and tweak their operational procedures. Aware of the fact that users very quickly leave hotel accommodations whose services do not meet their expectations, needs, and desires and go to the competition. Therefore, prominent hotel chains, on the one hand, take into account the needs and wishes of their guests, and on the other hand, the quality of service in the hotel, but also the final destination, i.e. the very appearance and impression of the destination. In the hotel industry, achieving acceptable quality is a difficult process that calls for specific knowledge and abilities in every department as well as essential communication with hotel employees. Only consistently trained staff members who are committed to guest satisfaction can effectively manage quality in a hotel, which eventually boosts earnings, reduces expenses, and adds value to the establishment. This study looked into how a guest’s overall perception of the hotel and its services was affected by the expected caliber of that service. Hypothesis One: Perceived quality of service in a hotel is positively influenced by the hotel’s physical environment, attractiveness and construction of the destination, interaction with employees, and accompanying services and amenities in the hotel. Hypothesis Two: The pronounced heterogeneity of hotel service users, their motives for choosing a hotel, and the necessity of interactions with hotel staff are positively correlated with the perception of the level of service quality in the hotel. The paper will test hypotheses regarding the relationship between the physical hotel environment, its attractiveness, the destination’s construction, interactions with staff, and the hotel’s amenities and ancillary services and perceived quality of service. Simultaneously, an attempt will be made to ascertain the relationship between the reason for selecting the hotel and the perceived quality of services offered, as well as the importance of interacting and fostering a good rapport with service providers.

Applying an Analytical Hierarchy Process for Decision Making Business Strategy in CV. Optik President

Vision is one of the vital organs of the human body which has a very fundamental role for life. With good eyesight, this can help people improve their quality of life. The eyeglass market is anticipated to develop over the next several years as a result of a variety of factors, including expanding populations, a demographic shift toward older age groups, and changing lifestyles characterized by a higher reliance on digital gadgets. Of course, the COVID-19 pandemic is also one of the factors that increases eye disease because most people use gadgets in their lives, causing symptoms of digital eye strain. In this way, this is a supporting factor in the development of the optical market. The market is expanding the fastest in the Asia Pacific region, with a growth rate of 13.5%. Offline optical retail stores provide significant promise and value. These physical businesses provide customers with an immersive and tangible shopping experience that is unmatched by internet shopping. To guarantee that customers receive accurate prescriptions and distinctive eyewear options, optometrists and store staff offer customized services like frame fittings, professional eye exams, and expert lens consultations. In actual storefronts, customers may physically try on frames to assess fit, comfort, and style. Trained staff members are available to provide timely assistance. Furthermore, a wide range of eyewear options, including designer brands and niche goods, are usually available in these stores, giving customers the opportunity to peruse and select from a diverse inventory. Furthermore, optical retail stores foster confidence and trust, particularly among those who appreciate in-person interactions or have certain vision needs that necessitate expert guidance. By looking at this market development, the company wants to expand, targeting West Karawang, East Karawang and Cikarang as targets for opening their branches. using the Analytical Hierarchy Process (AHP) method will be able to improve the quality of decision making that will be produced by the company starting from developing criteria and sub-criteria which can ultimately determine the best alternative. The results of this research provide recommendations for new criteria and sub-criteria for the company and also determine which location of the three alternatives the company will provide.

Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews.

Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4.

Defining research engagement with African American participants in Alzheimer’s disease research studies: A qualitative study

AbstractBackgroundDiverse recruitment of racial and ethnic groups affected by Alzheimer’s disease (AD) into research is an important public health priority. Black/African American older adults are more likely to develop AD compared to White older adults; however, representation of Black/African American individuals in AD research studies is estimated to be as low as 2.5 percent. Improved engagement with underrepresented communities is essential to increasing representation. Here, we define a theory of research engagement from a grounded theory approach in collaboration with Black/African American participants enrolled in two ongoing Alzheimer’s disease cohort studies at Vanderbilt University Medical Center.MethodVanderbilt Memory and Aging Project and Tennessee Alzheimer’s Project participants (n = 18, 68±10 years) who self‐identify as Black or African American were invited to participate in focus groups on research engagement. Focus groups were hosted in a community location. Pre‐discussion, participants completed the Measuring Trust in Medical Researchers scale. Each session lasting 90 minutes was moderated by a trained staff member, audio‐recorded, and subsequently transcribed. Data were analyzed following methodology described by Strauss and Corbin (1990, 1998) and modified by Charmaz (2006). Open coding to identify themes was independently conducted by 3 team members, and codes were refined using an iterative process.ResultThe overall mean score of trust in medical research was 43.9±7.4 (range = 36‐59) suggesting a moderate amount of trust. Participants expressed inclusion in the process and experiencing benefits from research as motivators for research engagement. Participants voiced a desire to better understand inclusion and exclusion criteria and an interest in hearing about the cohort and previously used methods of recruitment. Some members communicated the importance of a welcoming and passionate environment as a driver for engagement.ConclusionOur initial work defining research engagement identified key concepts important to our local community. Working together with the community to define research engagement helps immerse participants in the research process. These concepts are well established in the literature, and lessons learned from our focus groups will help define a theory of engagement with local context that can be used to evaluate our future activities.

Participative decision making: implications on organisational citizenship behaviour in a public higher education institution

Due to the authoritarian administrative style, used by educational institutions, where those in charge make decisions and middle and lower-level employees simply carry out orders without providing any input, participatory decision-making has gained popularity in the educational setting. Nevertheless, higher education institutions are at a crossroads since they are unsure how to handle the problems, posed by a highly dynamic environment, and the rapid changes that are occurring. Thus, academic staff has been required to take on extracurricular duties to enhance institutions to those that are formally outlined in their job descriptions. In this context, developing OCB and ensuring its sustainability has become increasingly crucial for boosting universities' effectiveness. Based on the social exchange theory, this study aims to assess how participative decision-making can constitute a key idea in modern management that impacts employees’ organisational citizenship behaviours in two campuses of a public higher education institution in South Africa. Data was collected from a post-positivist perspective, a quantitative research method, and a convenience sampling technique to select a sample of 253 academics, through a structured questionnaire. Based on the results of the descriptive analysis, employees reported a medium level of participative decision-making and agreed to display the five organisational citizenship behaviours. Using Pearson correlation and multiple linear regression models, the study found a positive relationship between participative decision-making and the five dimensions of organisational citizenship behaviour. Therefore, the study recommends that employees should be more involved in the decision-making for them to display organisational citizenship behaviour. However, public higher education institutions should establish a strong data-driven culture and train staff members to be proficient in code and quantitative concepts; and senior management has to develop rules with open access to the most important metrics.