Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

2013 ◽  
Vol 7 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Ramin Asgary ◽  
Karen Jacobson
Keyword(s):  
Public Health ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Medical Personnel ◽  
Clinical Decision ◽  
Medical Providers ◽  
Medical Practitioners ◽  
Use Of Resources ◽  
Public Health Training ◽  
Site Training

AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

scholarly journals Case-based surveillance of antimicrobial resistance with full susceptibility profiles

2019 ◽  
Vol 1 (3) ◽  
Author(s):  
Sukhyun Ryu ◽  
Benjamin J Cowling ◽  
Peng Wu ◽  
Scott Olesen ◽  
Christophe Fraser ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Clinical Decision Making ◽  
Clinical Importance ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Susceptibility Profiles ◽  
Case Based

Abstract Surveillance of antimicrobial resistance (AMR) is essential for clinical decision-making and for public health authorities to monitor patterns in resistance and evaluate the effectiveness of interventions and control measures. Existing AMR surveillance is typically based on reports from hospital laboratories and public health laboratories, comprising reports of pathogen frequencies and resistance frequencies among each species detected. Here we propose an improved framework for AMR surveillance, in which the unit of surveillance is patients with specific conditions, rather than biological samples of a particular type. In this ‘case-based’ surveillance, denominators as well as numerators will be clearly defined with clinical relevance and more comparable at the local, national and international level. In locations with sufficient resources, individual-based data on patient characteristics and full antibiotic susceptibility profiles would provide high-quality evidence for monitoring resistant pathogens of clinical importance, clinical treatment of infections and public health responses to outbreaks of infections with resistant bacteria.

The Public Health Learning Network: Strengthening the Public Health Workforce of Today to Meet the Challenges of Tomorrow

2017 ◽  
Vol 3 (1_suppl) ◽  
pp. 13S-16S ◽  
Author(s):  
Jennifer McKeever ◽  
Dorothy Evans
Keyword(s):  
Public Health ◽  
Health Workforce ◽  
Health Workers ◽  
Health Resources ◽  
Public Health Workforce ◽  
Years Of Life Lost ◽  
Health Training ◽  
The Public ◽  
Learning Network ◽  
Public Health Training

In 2013, the Health Resources & Services Administration redesigned the long-standing Public Health Training Center program to meet the training needs of the modern public health workforce and to implement parts of the Patient Protection and Affordable Care Act, which sets the training, recruitment, and retention of public health workers as a priority. Understanding that today’s most significant public health threats are socially constructed, resulting in chronic disease and significant years of life lost, the Health Resources & Services Administration laid the groundwork for the creation of a nationally unified network of training centers—the Public Health Learning Network (PHLN). The PHLN is the nation’s most comprehensive system of public health educators, health experts, thought leaders, and practitioners working together to advance public health training and practice. The system comprises 10 regional public health training centers, 40 local performance sites, and a National Coordinating Center for Public Health Training. The PHLN strengthens the workforce in state, local, and tribal health departments, as well as community health centers and primary care settings, to improve the capacity of a broad range of public health personnel to meet the complex public health challenges of today and tomorrow.

scholarly journals Increasing Neonatal Healthcare Productivity using Clinical Reasoning Coaching Tools

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Mossad AbdelHak Shaban Mohamed ◽  
Taher Halawa ◽  
Taufiq Hidayat ◽  
Asrar Abu Bakar ◽  
Azamin Anuar ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Research Question ◽  
Control Policy ◽  
Clinical Decision ◽  
Medical Practitioners ◽  
Continuous Contact ◽  
Diagnostic Skills ◽  
Medical Subspecialty ◽  
Diagnostic Thinking

Introduction: Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.

scholarly journals Strengths and Barriers in Achieving “Green Status” of Breastfeeding; The Story of Frontline Health Care Workers in Sri Lanka

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 151-151
Author(s):  
Thilini Agampodi ◽  
Neerodha Dharmasoma ◽  
Thushari Dissanayaka ◽  
Iresha Koralagedara ◽  
Janith Warnasekara ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Sri Lanka ◽  
Health Care Workers ◽  
Health Workers ◽  
Medical Practitioners ◽  
Knowledge And Skills ◽  
Funding Sources ◽  
Care Workers ◽  
Grass Root Level

Abstract Objectives The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community. Methods We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints. Results Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement. Conclusions The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF. Funding Sources No funding source.

scholarly journals Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah Brown Amoakoh ◽  
Kerstin Klipstein-Grobusch ◽  
Irene Akua Agyepong ◽  
Mary Amoakoh-Coleman ◽  
Gbenga A. Kayode ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Health Workers ◽  
Clinical Decision ◽  
Health Improvement ◽  
Neonatal Health ◽  
Intervention Period ◽  
Protocol Adherence ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Abstract Background This study assessed health workers’ adherence to neonatal health protocols before and during the implementation of a mobile health (mHealth) clinical decision-making support system (mCDMSS) that sought to bridge access to neonatal health protocol gap in a low-resource setting. Methods We performed a cross-sectional document review within two purposively selected clusters (one poorly-resourced and one well-resourced), from each arm of a cluster-randomized trial at two different time points: before and during the trial. The total trial consisted of 16 clusters randomized into 8 intervention and 8 control clusters to assess the impact of an mCDMSS on neonatal mortality in Ghana. We evaluated health workers’ adherence (expressed as percentages) to birth asphyxia, neonatal jaundice and cord sepsis protocols by reviewing medical records of neonatal in-patients using a checklist. Differences in adherence to neonatal health protocols within and between the study arms were assessed using Wilcoxon rank-sum and permutation tests for each morbidity type. In addition, we tracked concurrent neonatal health improvement activities in the clusters during the 18-month intervention period. Results In the intervention arm, mean adherence was 35.2% (SD = 5.8%) and 43.6% (SD = 27.5%) for asphyxia; 25.0% (SD = 14.8%) and 39.3% (SD = 27.7%) for jaundice; 52.0% (SD = 11.0%) and 75.0% (SD = 21.2%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. In the control arm, mean adherence was 52.9% (SD = 16.4%) and 74.5% (SD = 14.7%) for asphyxia; 45.1% (SD = 12.8%) and 64.6% (SD = 8.2%) for jaundice; 53.8% (SD = 16.0%) and 60.8% (SD = 11.7%) for cord sepsis protocols in the pre-intervention and intervention periods respectively. We observed nonsignificant improvement in protocol adherence in the intervention clusters but significant improvement in protocol adherence in the control clusters. There were 2 concurrent neonatal health improvement activities in the intervention clusters and over 12 in the control clusters during the intervention period. Conclusion Whether mHealth interventions can improve adherence to neonatal health protocols in low-resource settings cannot be ascertained by this study. Neonatal health improvement activities are however likely to improve protocol adherence. Future mHealth evaluations of protocol adherence must account for other concurrent interventions in study contexts.

scholarly journals A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Janet Willars ◽  
David Scott ◽  
Nicola Boydell ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Healthcare Workers ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Comparative Method ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Clinical Decision

Abstract Background The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. Methods The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Results Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Conclusions Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

scholarly journals Data Capture from Medical Device using Augmented Reality

2019 ◽  
Vol 9 (1S) ◽  
pp. 213-217
Keyword(s):  
Augmented Reality ◽  
Medical Device ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Clinical Information ◽  
Clinical Decision ◽  
Imaging Systems ◽  
New Approach ◽  
Video Images ◽  
Biomedical Device

In order to develop medical devices that connect to hand held devices via Bluetooth or USB, a new approach is followed by using Augmented Reality (AR) and machine vision which is utilized to identify digitally a biomedical device and capture reading using Augmented Reality to create 3D imaging of tumors and human organs accurately. By superimposing anatomic structures segmented from tomography images (e.g., CT, MR) on the intraoperative video images. It is integrated with EMR’s, clinical information feeds and medical imaging systems to support clinical decision making through a combined AR view. The output will be in the form of labels; 3D rendered models, or shaded modifications. It uses everyday technology – computers, tablets or smart phones with cameras can be used to connect surgeons in real time, anywhere in the world.AR can be used to capture medical device information on a mobile device and can automate the data collection tasks by health workers in all the developing countries.

How Costing and Funding Systems Create Institutional Tensions Between Management and Medical Personnel in The Public Health Care Sector

2021 ◽  
Author(s):  
◽  
Caroline Thirsk
Keyword(s):  
Public Health ◽  
Institutional Theory ◽  
Medical Staff ◽  
Medical Personnel ◽  
Structured Interview ◽  
Public Health Care ◽  
Internal Conflict ◽  
Future Research ◽  
Use Of Resources ◽  
Starting Point

<p>This research examines the conflicting relationship between management and medical personnel in the New Zealand Public Health Sector with regard to costing and funding systems. Due to the lack of research into small DHBs, this research focuses on small hospitals as they face unique circumstances not experienced by larger hospitals, to discover potential areas where costing and funding systems cause conflict, the reasons for this conflict and to provide possible solutions to prevent or mitigate this conflict. The method employed is a qualitative exploratory case study of one DHB utilizing a two phased semi-structured interview approach. A total of 10 interviews were conducted and analysed.  Three main areas from which conflict arises were identified: the costing system within the case hospital, the Population-based funding system and Inter-district flows. Each area is investigated from the perspectives of management and medical staff, using Institutional Theory and the concept of legitimacy. The institutional theory lens is used to identify and separate the interviewees into three groups based on their competing institutions. Each group’s answers were then compared to find reasons as to why there was conflict.  Three core reasons for the conflict were identified: ineffective communication, lack of trust in management and the costing and funding systems themselves. Much of the tension is because of misconceptions, limited knowledge and poor communication leading medical personnel to feel that management does not respect their opinions and management to believe that medical personnel are unwilling to cooperate with them. This research also determined that the institution of management that focuses on costs and economic use of resources and the institution of medical personnel which is patient focused, are necessary to the operation of a public hospital. Though it can be a difficult to balance, the ideal situation would be for these institutions to work in harmony and perhaps eventually merge. Suggestions are given for reducing internal conflict between management and medical personnel and it is hoped this research offers a starting point for future research into improving both the costing and funding systems and the internal relationships between management and medical staff.</p>

Practice-Based Teaching and Public Health Training: Bringing Real-World Projects to the Classroom to Teach Intervention Planning and Communication Strategies

2018 ◽  
Vol 5 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Jacey A. Greece ◽  
William DeJong ◽  
Jonina Gorenstein Schonfeld ◽  
Ming Sun ◽  
Donna McGrath
Keyword(s):  
Public Health ◽  
Real World ◽  
Health Workers ◽  
Communication Strategies ◽  
Public Health Problem ◽  
Health Training ◽  
Public Health Agencies ◽  
Public Health Training ◽  
Health Agencies ◽  
Intervention Planning

Master of Public Health (MPH) courses can strengthen competency-based education by having students work on real-world problems in collaboration with public health agencies. This article describes practice-based teaching (PBT) and illustrates its importance for coursework in intervention planning and health communications. With a PBT course, community agencies benefit by receiving high-quality deliverables at no cost, such as intervention plans, policy proposals, and communication strategies. For faculty, PBT results in potentially richer practice and scholarship opportunities, plus a deeper understanding of local public health issues and exposure to new topics. Importantly, PBT allows students to expand their professional networks, explore potential careers, obtain teamwork experience, and develop a broader set of professional skills. PBT in public health training is a pedagogy that has immense benefit to students, public health agencies, communities, and faculty, particularly in the areas of intervention planning and communication, which often require innovative solutions and thorough understanding of various modes of technology and social media to effectively address a public health problem. The example presented in this article demonstrates the immense utility of the pedagogy in public health. With the growing demand for skilled public health workers, PBT warrants more extensive application in schools of public health and specifically in courses focused on basic skills for developing and implementing programs and policies to address public health problems.

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