scholarly journals Perspective of Doctors for COVID-19 Pandemic Readiness in Government Hospitals of Nepal

2020 ◽  
Vol 18 (2) ◽  
pp. 166-171
Author(s):  
Pawan Kumar Hamal ◽  
Nabin Pokhrel ◽  
Dipendra Pandey ◽  
Pragya Malla ◽  
Ritesh Lamsal
Keyword(s):  
Critical Care ◽  
Online Survey ◽  
Local Level ◽  
Health Centers ◽  
World Health ◽  
Local Health ◽  
Medical Doctors ◽  
Care Providers ◽  
Hands On ◽  
Government Hospitals

Background: The study assesses the perspective of doctors working in government hospitals of Nepal regarding hospital preparedness for infection prevention measures, isolation services provisions, critical care service readiness, and training of staff for COVID-19 pandemic management. Methods: This cross-sectional study was done in central, provincial, and local level health centers of the Government of Nepal to assess the perspective of medical doctors regarding COVID-19 pandemic readiness in their facility. Nonprobability sampling was used to collect 56 responses from doctors working in different hospitals of Nepal. An online survey was performed using a questionnaire tool, which was adapted from the guidelines of the World Health Organization and the Centers for Disease Control and Prevention.Results: Most of the participants were medical officers with an MBBS degree (32) followed by anesthesiologists (10). Thirteen participants worked in central hospitals (23.2%), 24 in provincial hospitals (42.8%) and 19 in local health centers (33.92%). The availability of adequate facemask was 84% in central hospitals, which was higher than provincial hospitals (66.7%), and local level health centers (77.8%). There were only 53.8% trained critical care providers in central hospitals and 29.2% in provincial hospitals. Nearly 38.5% (5) of central hospitals had measures for airborne isolation in place, whereas this was only found in 8.3% (2) of provincial hospitals surveyed for critical care facilities. Overall, only 2 hospitals had the provision of a negative pressure room with air exchanges. Only 8 participants working in central hospitals (61.5%) and 14 working in provincial hospitals (58.3%) had performed hands-on training for donning and doffing personal protective equipment. Conclusions: The majority of medical doctors working in government hospitals of Nepal perceive that provision of facemask distribution, airborne isolation rooms, critical care preparedness, and hands-on training to staff were not adequate.Keywords: COVID-19; Government of Nepal; pandemic; readiness.

scholarly journals Consensus on research priorities for Essex & Herts Air Ambulance: a Delphi study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Sarah McLachlan ◽  
Hilary Bungay
Keyword(s):  
Critical Care ◽  
Delphi Study ◽  
Local Level ◽  
Research Priorities ◽  
Clinical Work ◽  
Research Strategy ◽  
Consensus Methods ◽  
Care Providers ◽  
Air Ambulance ◽  
Research Questions

Abstract Background Consensus methods such as the Delphi technique have been used widely for research priority setting in health care. Within pre-hospital emergency medicine, such approaches have helped to establish national and international research priorities. However, in a dynamic field such as pre-hospital critical care, it is necessary to regularly review the continued relevance of findings. Further, considering the variability between pre-hospital critical care providers, it is also important to determine priorities at the local level. Essex & Herts Air Ambulance (EHAAT) sought to develop a five-year research strategy that aligns with their clinical work streams and organisational priorities. Methods All staff and Trustees were invited to participate in an online Delphi study with three Rounds. The Delphi was administered via email and Online Surveys software. The first Round invited participants to submit up to five research questions that they felt were of greatest importance to EHAAT  to advance the care provided to patients. In Round 2, participants were asked to rate the importance of questions from Round 1, while Round 3 required participants to rank questions that were prioritised in Round 2 in order of importance. Results 22 participants submitted a total of 86 research questions in Round 1, which were reduced to 69 questions following deduplication and refinement. 11 participants rated the importance of the questions in Round 2, resulting in 14 questions being taken forward to Round 3. Following the ranking exercise in Round 3, completed by 12 participants, a top five research priorities were identified. The question deemed most important was “How does a pre-hospital doctor-paramedic team affect the outcome of patients with severe head injuries?”. Conclusions The top five research priorities identified through the Delphi process will inform EHAAT’s research strategy. Findings suggest that there is still work to be done in addressing research priorities described in previous literature.

scholarly journals Qualitative Assessment of Factors Influencing Implementation Effectiveness and Sustainability of Strategies for Increasing Tobacco Use Treatment in Vietnam Health Centers

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
Health Centers ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Implementation Effectiveness ◽  
Public Health Systems

PURPOSE Effective strategies are needed to increase the implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries. Our cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in community health centers (CHCs) in Vietnam. In this paper, we present findings from a postimplementation qualitative assessment of factors that influence implementation effectiveness and program sustainability. METHODS We conducted semistructured qualitative interviews (N = 52) with 13 CHC medical directors (ie, physicians), 25 CHC health care providers, and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. RESULTS Facilitators of implementation effectiveness included training that increased confidence and skill, satisfaction with point-of-service tools, increasing patient demand for TDT, and, for the intervention arm, the value of a VHW referral system that reduced provider burden. The primary challenge to sustainability is the competing priorities driven by the Vietnam Ministry of Health, which may result in fewer resources for TDT compared with other health programs. However, providers and VHWs described several options for adapting the implementation strategies to address challenges and increase the engagement of local government committees and other sectors to sustain gains. CONCLUSION Our findings offer insight into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, these results illustrate the dynamic interplay between barriers to and facilitators of sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems, like that of Vietnam. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, as well as planning for adaptations and subsequent resource allocations, to meet Article 14 goals.

scholarly journals The efficiency of the local health systems: investigating the roles of health administrations and health care providers

2017 ◽  
Vol 13 (1) ◽  
pp. 10-32 ◽  
Author(s):  
Laura Anselmi ◽  
Mylène Lagarde ◽  
Kara Hanson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Systems ◽  
Health Care Providers ◽  
National Health ◽  
Local Level ◽  
Local Health ◽  
Care Providers ◽  
Frontier Analysis ◽  
Decision Making Unit

AbstractThe analysis of efficiency in health care has largely focussed either on individual health care providers, or on sub-national health systems conceived as a unique decision-making unit. However, in hierarchically organized national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and health care providers. Their separate roles and the one of health administrations in particular have not been explicitly considered in efficiency analysis. We applied stochastic frontier analysis to district-level panel data from Mozambique (2008-2011) to assess district efficiency in delivering outpatient care. We first assessed the efficiency of the whole district considered as an individual decision-making unit, and then we assessed separately the efficiency of health administrations and health care providers within the same district. We found that on average only 73% of the outpatient consultations deliverable using available inputs were realized, with large differences in performance across districts. Individual districts performed differently in administrative or health care delivery functions. On average, a reduction of administrative inefficiency by 10 percentage points, for a given expenditure would increase by 0.2% the volume of services delivered per thousand population per year. Identifying and targeting the specific drivers of administrative inefficiencies can contribute to increase service.

scholarly journals Integration of eMental health technologies into traditional community-based interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Turmaine ◽  
C Picot Ngo ◽  
A Le Jeannic ◽  
J L Roelandt ◽  
K Chevreul ◽  
...  
Keyword(s):  
Mental Health ◽  
Digital Technology ◽  
Digital Health ◽  
Local Level ◽  
World Health ◽  
Local Network ◽  
Local Health ◽  
Community Based ◽  
Health Technologies ◽  
Health Programmes

Abstract Background Very little research has been conducted to appraise the merits of including municipalities and their local health providers in the promotion of digital health programmes. While more and more municipalities have locally implemented a health strategic plan and have focused on building local network of professionals, how do the latter react to the implementation of innovative e-mental health community-based programmes? Methods In 2018, 42 French municipalities volunteered to promote StopBlues, a digital health tool aimed at preventing mental distress and suicide. In each municipality, a local delegate was responsible for the promotion of the tool. Using observations, questionnaires and interviews with the delegates, we analysed how the promotion of StopBlues® was conducted in each setting. 2/3 of these municipalities started the promotion directly, and in 2019, a second wave of municipalities launched the promotion with a stronger support from the research team backed by the French World Health Organization Collaborating Centre for Research and Training in Mental Health (WHOCC). Results The use of digital technology in the implementation of a mental health programme received a mixed reception from the local health professionals because of its innovative aspect. 2/3 of the delegates declared that they were struggling to create a stronger network of local partners including private medical practioners. 63% of the respondents stated that their municipalities got involved in the programme for networking purposes. Conclusions Digital technologies have initiated a paradigm shift in the way community-based health programmes are set up but need to strengthen their territorial anchorage in order to be accepted and used at the local level. Key messages Digital technology can be a strong lever against health inequities but its effectiveness has to be studied carefully. Digital technolgy has to be implemented in local settings with the collaboration of local actors in order to be accepted and used.

scholarly journals Mixed Methods Lot Quality Assurance Sampling: A novel, rapid methodology to inform equity focused maternal health programming in rural Rajasthan, India

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250154
Author(s):  
Aneel Singh Brar ◽  
Bethany L. Hedt-Gauthier ◽  
Lisa R. Hirschhorn
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Mixed Methods ◽  
Maternal Health ◽  
Local Level ◽  
Local Health ◽  
Care Providers ◽  
Study Results ◽  
Lot Quality Assurance Sampling ◽  
Health Programming

India has experienced a significant increase in facility-based delivery (FBD) coverage and reduction in maternal mortality. Nevertheless, India continues to have high levels of maternal health inequity. Improving equity requires data collection methods that can produce a better contextual understanding of how vulnerable populations access and interact with the health care system at a local level. While large population-level surveys are valuable, they are resource intensive and often lack the contextual specificity and timeliness to be useful for local health programming. Qualitative methods can be resource intensive and may lack generalizability. We describe an innovative mixed-methods application of Large Country-Lot Quality Assurance Sampling (LC-LQAS) that provides local coverage data and qualitative insights for both FBD and antenatal care (ANC) in a low-cost and timely manner that is useful for health care providers working in specific contexts. LC-LQAS is a version of LQAS that combines LQAS for local level classification with multistage cluster sampling to obtain precise regional or national coverage estimates. We integrated qualitative questions to uncover mothers’ experiences accessing maternal health care in the rural district of Sri Ganganagar, Rajasthan, India. We interviewed 313 recently delivered, low-income women in 18 subdistricts. All respondents participated in both qualitative and quantitative components. All subdistricts were classified as having high FBD coverage with the upper threshold set at 85%, suggesting that improved coverage has extended to vulnerable women. However, only two subdistricts were classified as high ANC coverage with the upper threshold set at 40%. Qualitative data revealed a severe lack of agency among respondents and that household norms of care seeking influenced uptake of ANC and FBD. We additionally report on implementation outcomes (acceptability, feasibility, appropriateness, effectiveness, fidelity, and cost) and how study results informed the programs of a local health non-profit.

Use of neurosurgical decision-making and damage-control neurosurgery courses in the Iraq and Afghanistan conflicts: a surgeon's experience

2010 ◽  
Vol 28 (5) ◽  
pp. E9 ◽  
Author(s):  
Richard J. Teff
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Clinical Pathway ◽  
State Of The Art ◽  
Damage Control ◽  
Care Providers ◽  
Hands On ◽  
Hands On Learning ◽  
To Receive

A shortage of Coalition neurological surgeons in the Iraq conflict prompted a creative approach to standardized neurosurgical care in 2007. After formulation of theater-wide clinical pathway guidelines, a need for standardized triage and neurological resuscitation was identified. The object was to establish a simple, reproducible course for medics, forward surgical and emergency room personnel, and other critical care providers to quickly standardize the ability of all deployed health care personnel to provide state-of-the-art neurosurgical triage and damage-control interventions. The methods applied were Microsoft PowerPoint presentations and hands-on learning. The year-long project resulted in more than 100 individuals being trained in neurosurgical decision making and in more than 15 surgeons being trained in damage-control neurosurgery. At the year's conclusion, hundreds of individuals received exceptional neurosurgical care from nonneurosurgical providers and a legacy course was left for future deployed providers to receive ongoing education at their own pace.

scholarly journals Investigating Predictors of Prenatal Breastfeeding Self-Efficacy

2019 ◽  
pp. 084456211988836
Author(s):  
Kathryn Corby ◽  
Debbie Kane ◽  
Deborah Dayus
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Self Efficacy ◽  
Online Survey ◽  
World Health ◽  
Prenatal Period ◽  
Care Providers ◽  
Optimal Method ◽  
Breastfeeding Knowledge ◽  
Multiparous Women

Background While breastfeeding is considered the optimal method of infant feeding, Canadian breastfeeding rates remain below the World Health Organization recommendations. Breastfeeding self-efficacy is known to positively influence breastfeeding outcomes. While previous research has identified predictors of breastfeeding self-efficacy in the immediate postpartum, this study identified predictors of breastfeeding self-efficacy in the prenatal period. Research aim: The aim of this study was to identify predictors of breastfeeding self-efficacy in the prenatal period among both primiparous and multiparous women. Methods A sample of 401 Canadian pregnant women in their third trimester completed an online survey. Stepwise multiple linear regression identified predictors of breastfeeding self-efficacy. Results The following variables explained 41.2% of the variance in breastfeeding self-efficacy among the entire sample: feeling prepared for labor and birth, number of children, breastfeeding knowledge, anxiety, length of plan to exclusively breastfeed, income, plan to exclusively breastfeed, and type of health-care provider. Among primiparous women, the following variables explained 31.6% of the variance in breastfeeding self-efficacy: feeling prepared for labor and birth, income, anxiety, length of plan to exclusively breastfeed, education, and marital status. Among the multiparous women, the following variables explained 33.6% of the variance in breastfeeding self-efficacy: anxiety, length of prior exclusive breastfeeding experience, breastfeeding knowledge, and plan to exclusively breastfeed. Conclusion Through the identification of predictors of breastfeeding self-efficacy in the prenatal period, health-care providers can strategically target women at risk of low breastfeeding self-efficacy and intervene early to promote breastfeeding.

scholarly journals Knowledge, Attitude, and Practices Regarding Childhood Tuberculosis Detection and Management Among Health Care Providers in Cambodia: A Cross-Sectional Study

2021 ◽  
Author(s):  
Yom An ◽  
Alvin Kuo Jing Teo ◽  
Chan Yuda Huot ◽  
Sivanna Tieng ◽  
Kim Eam Khun ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Health Centers ◽  
World Health ◽  
Case Detection ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Childhood Tb

Abstract Background The World Health Organization (WHO) estimated that 29% of global tuberculosis (TB) and almost 47% of childhood TB cases were not reported to national TB programs in 2019. In Cambodia, most childhood TB cases were reported from health facilities supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2019. This study aimed to compare the healthcare providers' KAP on childhood TB case detection in ODs with high and low childhood TB case detection in Cambodia. Methods We conducted a cross-sectional study between November and December 2020 among healthcare providers in 10 purposively selected operational districts (ODs) with high childhood TB case detection and 10 ODs with low childhood TB case detection. A total of 110 healthcare providers from referral hospitals and 220 from health centers were interviewed. We collected information on socio-demographic characteristics, training, and KAP on childhood TB. Pearson's Chi-square or Fisher's exact and Student's t-tests were performed to explore the differences in KAP of healthcare providers from ODs with low vs. high childhood TB detection. Results Of the 330 respondents, 193 were from ODs with high childhood TB case detection, and 66.67% were from health centers. A significantly higher proportion (46.11%) of respondents from ODs with high childhood TB case detection received training on childhood TB within the past two years than those from low childhood TB case detection ODs (34.31%) (p=0.03). Key knowledge on childhood TB was not significantly different among respondents from ODs with high and low childhood TB case detection. A significantly higher proportion of respondents from ODs with high childhood TB case detection had a good attitude (98.96% v.s. 97.08%, p=0.002) and performed good practices (58.55% v.s. 45.26%, p=0.02) on contact investigation in the community than those from low childhood TB case detection ODs. Conclusions Healthcare providers from ODs with high childhood TB detection had better attitudes and practices towards childhood TB. The attitudes and practices need to be improved among healthcare providers in ODs with low case detection. Further investment in training and experience sharing on childhood TB case detection among healthcare providers is needed to improve childhood TB case detection.

scholarly journals A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
World Health ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Public Health Systems ◽  
Factors Influencing

Abstract Background Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. Methods We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. Results Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. Conclusion Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users. Trial registration NCT02564653, registered September 2015

Critical Care Nursing in Papua New Guinea

2020 ◽  
Vol 14 (1) ◽  
pp. 35-44
Author(s):  
Ged Williams ◽  
Rose Jaspers ◽  
Veronica Wohuinangu ◽  
Svatka Micik ◽  
Adrian De Luca
Keyword(s):  
Critical Care ◽  
Papua New Guinea ◽  
Health Care Providers ◽  
New Guinea ◽  
Local Health ◽  
Critical Care Nursing ◽  
Care Providers ◽  
Local Health Care ◽  
Fact Finding ◽  
Care Nursing

ObjectiveTo explore and understand the current context of critical care nursing in Papua New Guinea (PNG).MethodA three day fact finding mission and consulation process with leaders of critical care and health services in PNG.ResultsAlthough challenged by limited resources and healthcare infrastructure there is a determination among local health care providers to growth and improve the provision of critical care services from the major hospitals of PNG. The PNG Critical Care Nurses Society (PNG CCNS) was officially formed in March 2020, providing hope and optimism for a renewed emphasis on this important speciality in PNG.ConclusionThe authors and the PNG CCNS recommend the establishment of active and supportive partnerships with other critical care leaders of the world to help guide future developments in PNG.

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