STEPS – a patient centric and low-cost solution to ensure standards of TB care to patients reaching private sector in India

Background More than half of the TB patients in India seek care from the private sector. Two decades of attempts by the National TB Program to improve collaboration between the public and private sectors have not worked except in a few innovative pilots. The System for TB Elimination in Private Sector (STEPS) evolved in 2019 as a solution to ensure standards of TB care to every patient reaching the private sector. We formally evaluated the STEPS to judge the success of the model in achieving its outcomes and to inform decisions about scaling up of the model to other parts of the country. Methods An evaluation team was constituted involving all relevant stakeholders. A logic framework for the STEPS model was developed. The evaluation focused on (i) processes - whether the activities are taking place as intended and (ii) proximal outcomes - improvements in quality of care and strengthening of TB surveillance system. We (i) visited 30 randomly selected STEPS centres for assessing infrastructure and process using a checklist, (ii) validated the patient data with management information system of National TB Elimination Program (NTEP) by telephonic interview of 57 TB patients (iii) analysed the quality of patient care indicators over 3 years from the management information system (iv) conducted in-depth interviews (IDI) with 33 beneficiaries and stakeholders to understand their satisfaction and perceived benefits of STEPS and (v) performed cost analysis for the intervention from the perspective of NTEP, private hospital and patients. Results Evaluation revealed that STEPS is an acceptable model to all stakeholders. IDIs revealed that all patients were satisfied about the services received. Data in management information system of NTEP were consistent with the hospital records and with the information provided by the patient. Quality of TB care indicators for patients diagnosed in private hospitals showed improvements over years as proportion of TB patients notified from private sector with a microbiological confirmation of diagnosis improved from 25% in 2018 to 38% in 2020 and the documented treatment success rate increased from 33% (2018 cohort) to 88% (2019 cohort). Total additional programmatic cost (deducting cost for patient entitlements) per additional patient with successful treatment outcome was estimated to be 67 USD. Total additional expense/business loss for implementing STEPS for the hospital diagnosing 100 TB patients in a year was estimated to be 573 USD while additional minimum returns for the hospital was estimated to be 1145 USD. Conclusion Evaluation confirmed that STEPS is a low cost and patient-centric strategy. STEPS successfully addressed the gaps in the quality of care for patients seeking care in the private sector and ensured that services are aligned with the standards of TB care. STEPS could be scaled up to similar settings.

Engineering Financial Performance Evaluation of Wireless Network Based on Intelligent Neural Network Model

Under the global economy, enterprises in the financial industry are facing plenty of opportunities and severe challenges. Aimed at providing a reference enterprise performance evaluation system for related enterprises, the proposed model helps enterprises to learn and sort out their own performance evaluation system according to this structure. A prediction model of BP neural network (BPNN) based on the wireless network is studied as the performance data prediction algorithm. Firstly, the feasibility of this algorithm is analysed through prediction training. Secondly, the proposed neural network algorithm is compared with the traditional algorithm for data prediction. It turns out that this neural network prediction algorithm based on wireless communication is not only universal to the prediction data but also superior to the traditional prediction algorithm in both error gap and relative average error compared with other traditional algorithms. On this basis, the particle swarm optimization (PSO) algorithm is also used to evaluate the performance indicators of three enterprises, and accurate numerical values are obtained to express the corresponding results. Therefore, it is concluded that the subalgorithm can be applied to the enterprise performance evaluation team in the financial industry.

Effect of Monthly Evaluations on Irrational Rates of Antimicrobial Drug Prescription in Outpatient and Emergency Departments

Reduction of the excessive rate of antibiotic prescription is needed to curb antibiotic resistance. This retrospective study was conducted to verify whether monthly evaluations of antibiotic prescriptions could improve clinical antibiotic use in outpatient and emergency departments. Every month, from July 2016 to June 2019, 25% of the antibacterial prescriptions from the outpatient and emergency departments in our hospital were randomly selected. The hospital formed an evaluation team that conducted preliminary evaluations of these prescriptions and an expert team that re-evaluated any problematic prescriptions. We analysed the irrational prescription rate, proportion of antibiotic use, and consistency between the evaluation and expert teams. At the end of the evaluation period, the utilisation rate of single antibiotics in the outpatient and emergency departments increased, the irrational prescription rate decreased, and the proportion of sold antibiotics gradually decreased. In addition, the consistency of prescription evaluation results between the evaluation and expert groups increased over time. In conclusion, monthly evaluation of antibiotic prescriptions is an effective management tool for the rational use of antibiotics in clinical practice and plays an important role in safe clinical drug use.

MANAJEMEN SEKOLAH MODEL PADA JENJANG PENDIDIKAN DASAR

Abstrak: Penelitian ini bertujuan untuk mendeskripsikan tentang Manajemen Sekolah Model pada Jenjang Pendidikan Dasar di SD Negeri 1 Menteng Kota Palangka Raya. Penelitian ini menggunakan pendekatan kualitatif deskriptif. Sumber data dalam peneltian ini yaitu: Kepala Sekolah, Ketua TPMPS dan Guru-guru. Teknik pengumpulan data dilakukan dengan observasi, wawancara, dan dokumentasi. Analisis data dilakukan melalui: Pengumpulan data, Reduksi data, Penyajian Data, dan Penarikan kesimpulan/verifikasi. Pengabsahan data menggunakan Teknik Triangulasi dan Member Check. Hasil penelitian ini menunjukan bahwa: (1) Perencanaan SPMI meliputi: (a) Sosialisasi program SPMI, (b) Pembentukan TPMPS dan Tim Monev, (c) Memetakan mutu, (d) Membuat peta masalah, e) Membuat rencana aksi, (f) Membuat jadwal, dan (g) Menentukan anggaran; (2) Pengorganisasian SPMI: (a) Pengawas: Dinas Pendidikan, TPMPD, Pengawas Sekolah, Penanggung jawab: Kepala Sekolah, Pengelola: TPMPS dan Tim Monev; (3) Pelaksanaan SPMI dilakukan dengan mengikuti jadwal, menentukan Sarpras, mengadakan kegiatan workshop dan TOT; (4) Pengawasan SPMI dilakukan oleh: kepala sekolah, TPMPD, TPMPS, Tim Monev dan Pengawas Sekolah; (5) Evaluasi SPMI dilakukan dengan menentukan jadwal, membuat instrumen/alat ukur, melakukan peninjauan kembali, dan menyusun RTL. Abstract: This study aims to describe the Model of School Management at SD Negeri 1 Menteng, Palangka Raya City. This study uses a descriptive qualitative approach. Sources of data in this research are: Principal, Head of TPMPS and teachers. Data collection techniques were carried out by observation, interviews, and documentation. Data analysis uses: data collection, data reduction, data presentation, and conclusion drawing/verification. Validation of data using Triangulation Techniques and Member Check. The results of this study showed that: (1) SPMI planning includes: (a) Socialization of the SPMI program, (b) Establishment of TPMPS and the Monitoring and Evaluation Team, (c) Mapping quality, (d) Making problem maps, e) Making action plans, (f) ) Make a schedule, and (g) Determine the budget; (2) Organization of SPMI: (a) Supervisor: Education Office, TPMPD, School Supervisor, Person in Charge: Principal, Manager: TPMPS and Monev Team; (3) The implementation of SPMI is carried out by following the schedule, determining the Sarpras, holding workshops and TOT; (4) SPMI supervision is carried out by: school principals, TPMPD, TPMPS, Monev Team and School Supervisors; (5) SPMI evaluation is carried out by determining the schedule, making instruments/measurements, conducting reviews, and making RTL.

STRATEGI PENCEGAHAN DAN PENANGANAN KELUHAN NYERI PUNGGUNG BAWAH BERBASIS LINGKUNGAN PADA KARYAWAN RUMAH SAKIT ERIA BUNDA PEKANBARU Environmental Based Low Back Pain Complaint Management Strategy for Employess in Eria Bunda Hospital

The work environment is closely related to the circumstances surrounding the activities of workers in doing their jobs. The office is a work environment where almost all the workers work mainly in a sitting position. Low back pain is one of the common occupational diseases of the workers. One of the risks of the increasing low back pain cases in workers is taking for granted the right work attitude, the location of the table and the size of the chair that is not ergonomic. RSIA Eria Bunda is one of the most visited RSIA by the public. The results of the initial observations at RSIA Eria Bunda found irregularities in work attitudes and the sitting positions of the employees and their work facilities were also not in accordance with the existing regulations. This is the reason the researcher conducted this research at RSIA Eria Bunda with the aim of knowing what factors can cause low back pain and what strategies can be used in handling complaints of low back pain in employees. The factors used in this study are individual and environmental factors and ergonomics. This research is conducted through quantitative approach with a survey method, cross-sectional data collection, low back pain questionnaire and RULA Worksheet to determine the employee's work attitude. Likewise, interviews and field observations are also conducted. Afterwards, determine the management strategy for complaints of low back pain with a SWOT Analysis. The results of the study are the following: First, there are complaints of low back pain in employees as 20 people (58,82%) and the most influencing factor is the work attitude (p = 0,022). Then, for the results of the RSIA SWOT Analysis, Eria Bunda is in a strong internal position and responds to existing opporto avoid threats. The strategy used by SO is to create a K3 evaluation team, improve the system and work environment and provide education about low back pain as a treatment strategy.

Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT)

Context Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. Objectives This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). Methods In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized. Results The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=−0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836). Conclusions The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.

Improving the function of a high obesity program: Findings from community-engaged Mississippi Delta focus groups

In this policy and practice brief, Mississippi State University Extension Services applies a coalition-driven approach to addressing the prevalence of obesity in communities in the Mississippi Delta through its High Obesity Program, funded by the Centers for Disease Control and Prevention (CDC). Focus groups were conducted with coalition members from six counties to evaluate efforts by this program. The evaluation team used content and thematic analysis to report on coalition activities. Some of the barriers coalition members identified were limited access to healthy foods and the need for more assistance from program staff. Action items were developed and implemented in response to focus group feedback. These items included enhanced communication tools and coalition trainings. This evaluation brief describes some of the common challenges in coalition building and innovative ways to improve them. Our focus group findings are also valuable to public health scientists and practitioners working in rural communities.

Information Technology in the Dissemination of Results of the Primary Health Care Evaluation in Brazil: A Qualitative Study

Background: Considering advancements in information technology for disseminating results of evaluations, it is essential to demonstrate the functionalities and performance of these practices in order to achieve the objectives established by the evaluation proponents. This study aimed to evaluate the use of information technology for disseminating results obtained from the Primary Health Care evaluation in Brazil. Methods: A qualitative single-case study was performed with triangulation of techniques and key informants. Analyses of public documents and field research were conducted. Convenience sample of 54 participants (seven from the Department of Primary Care/Ministry of Health and 47 from teaching and research institutions) was selected from the external evaluation team. Content analysis was performed, and the Atlas ti.8.4.24 software organized, managed, and categorized textual data. Codification was performed by peers (three researchers) while experts validated codes (two researchers). Right after, codes were extracted and categorized.Results: Dissemination of results is complex due to multiple components. Incorporation also favored advances in data observation and implementation of data openness, becoming available for professionals, policymakers, and universities. Challenges regarding delivery time of reports, access restriction, lack of interest, and digital skills influenced reaching expected goals of the proponent.Conclusion: Information technology for disseminating results of evaluations may improve performance of health teams and managers and redefine priorities of work processes to strengthen Primary Health Care. Emphasis in planning, technological infrastructure, digital inclusion, and policy decision making is recommended to disseminate data effectively to the population.

A Potential Failure Mode and Effect Analysis Method of Electromagnet Based on Intuitionistic Fuzzy Number in Manufacturing Systems

Failure mode and effect analysis (FMEA) is a systematic activity in the stage of product design and process design. However, the traditional FMEA has some shortcomings in practical application, such as too many evaluation languages, uncertain weights of influencing factors, and uncertain weights of evaluation members. This paper presents an FMEA evaluation method in manufacturing system based on similarity measure, nonlinear programming model, and intuitionistic fuzzy number (IFN). Firstly, the IFN is used to evaluate failure mode, which overcomes the defect of traditional FMEA evaluation value. Secondly, the weight of failure evaluation team members is solved according to the concept of similarity measure to make up for the blank of evaluation members’ weight aiming at the shortage of unknown weight. Then, the definition of consensus measure is introduced to make the evaluators reach a consensus, and the weights of influencing factors of failure modes (FMs) are calculated. Finally, the weights of evaluators and influencing factors are calculated by IFN algorithm and score function, and the score value of each FM is obtained to rank instead of risk priority number (RPN). The objectivity and practicability of the new method are verified by the example of failure mode for an attractive electromagnet manufacturing system.

Reviewing Health Service and Program Evaluations in Indigenous Contexts: A Systematic Review

This study systematically reviewed evidence regarding health program and service evaluations in Indigenous contexts. Following the PRISMA guidelines and combining terms for ‘Indigenous populations’ and ‘health programs and services’. Eight principles emerged: Principle 1: Adopting Indigenous led or co-led approaches is vital to balance power relationships by prioritizing self-determination, Principle 2: Evaluation team should include local Indigenous community members, Principle 3: Indigenous community knowledge and practice should be foundational, Principle 4: Evaluations must be responsive and flexible to meet the needs of the local community, Principle 5: Evaluations should respect and adhere to local Indigenous protocols, culture, wisdom and language, Principle 6: Evaluations should emphasize reciprocity, shared learnings and capacity building, Principle 7: It is important to build strong relationships and trust between and within researcher teams, evaluators and communities, and Principle 8: The evaluation team must acknowledge community capacity and resources by investing in time and relationships.