bluuebunny/crossref_metadata_2025 huggingface dataset:
Smoking and gut microbiota: a cross sectional study involving students
Authors: Cattaruzza M S , Valeriani F , Sindoni A , Castrechini M , Antinozzi M , Romano Spica V , Liguori G , Galle F
Published: October 2020

Background

Cigarette smoking is associated with oncological and non-oncological diseases. Tobacco smoking causes more than 7 million deaths per year worldwide. Cigarette smoking could impact not only on human tissues and organs, but also on the gut microbiota, i.e. the community of microorganisms in the gastrointestinal tract. The aim of this study is to evaluate the composition of gut microbiota among smoker and non-smoker university students.

Methods

Students from Sapienza University of Rome were asked to fill a questionnaire about smoking attitude and to provide a fecal sample. Students undergoing therapy which could affect gut microbiota were excluded. Differences in microbial composition and variability between smokers and non-smokers were assessed.

Results

A total of 107 students (43.9% males, mean age 21.96±2.52 years, 30,0% smokers) were enrolled so far. As for microbial composition, Firmicutes/Bacteroidetes ratios (F/B ratio) differed between smokers and non-smokers (5.34±16.66 vs 2.47±2.28). As for variability measures, smokers had lower Shannon index (3.43±0.26 vs 3.46±0.29). At Genus level, Prevotella was significantly more abundant in smokers (10.97±15.87 vs 4.86±10.86; p = 0.027) in comparison to non-smokers.

Conclusions

Our preliminary results seem to suggest that smoking habit affects gut microbiota. Smokers had higher Firmicutes/Bacteroidetes ratio and Prevotella Genus, while lower Shannon index. These preliminary data suggest that smoking habit may cause changes in gut microbiota pattern, but further research is needed.

Key messages

Smoking may cause changes in gut microbiota pattern. Smoking seems increases F/B ratio and Prevotella, while reduces gut microbiota variability.
Focus Group: Experience of a Brazilian implementation study on a low resource setting
Authors: Resende R E , Barbabela T , Silva L B , Pinto T L , Oliveira J A Q , Ribeiro A L P , Marcolino M S
Published: October 2020

Background

Developing strategies for health promotion is essential, mainly in remote areas. The Telehealth Network of Minas Gerais, Brazil, developed an implementation study to improve management of patients with hypertension and diabetes - Control of Hypertension and Diabetes in Minas Gerais (CHARMING) Project. Assessing needs and barriers or enablers perceived by local health professionals is of utmost importance to enhance the implementation strategy.

Aim

To evaluate the perception of health professionals about current health strategies for patients with chronic diseases in primary care settings.

Methods

Qualitative study: 3 focal groups were conducted, with 18 healthcare professionals from 8 cities from the CHARMING Project, divided according to professional categories: local coordinators, nurses and doctors. Each group, conducted by 2 mediators and observers, lasted 90 minutes. There was a script to guide discussion concerning continued education, and educational and physical activity patient groups.

Results

Overall, healthcare professionals reported patients have low adherence to health education and physical activity groups. Living in rural and remote areas was perceived as the main barrier. Organizing groups in rural areas and acquiring proper gymnastique items could engage the population. Also, education materials should be adequate for a low-literate population, with interactive tools. Quarrels within the health teams and lack of medications were seen as limitations for properly managing chronic diseases. Concerning professional qualification, nurses reported to prefer short web lectures, physicians preferred studying online books and pre-appraised summaries, while local coordinators preferred presencial lectures.

Conclusions

Local health professionals were participative and willing to share their experiences within focal groups. They pointed out limitations and made suggestions that were not previously noticed and that will improve our health strategy.

Key messages

Listening to local health professionals is essential for developing more effective health strategies, mainly on low resource settings. Focal Groups are an effective qualitative method of research and should be implemented.
Health Literacy in Diabetes management: A priority in health care
Authors: do Ó D , Raposo J , Goes A , Loureiro I
Published: October 2020

Background

Glycemic control and self-management of diabetes are influenced by a range of factors, including health literacy - the ability to access, understand, appraise, and use health information. This study explored associations between domains of health literacy (HL), glycemic control and perceived general health in people with diabetes.

Methodology

Cross-sectional study, with 453 people with diabetes,attending the Portuguese Diabetes Association (APDP). We collected information on HL, demographics, glycemic control and self-perception of health. HL was assessed using the Health Literacy Questionnaire. Descriptive and correlational analysis were performed.

Results

85.4% consider Feeling understood and supported by healthcare providers but only 54.1% have the Ability to actively engage with healthcare providers and 27.8% feel the Ability to find good health information,66.5% consider Having sufficient information to manage my health but only 38.7% are Understanding health information well enough to know what to do and 28.5% refer the Ability to find good health information. Higher HL scores were associated with better glycemic control and more positive perception of general health(GH) across the following domains: Having sufficient information to manage my health, Appraisal of health information, Ability to find good health information, Actively managing my health and social support for health. The domains Ability to actively engage with healthcare providers and Navigating the healthcare system were also associated with more positive perception of GH. Associations achieved either p < 0.001 or p < 0.05. Considering HL levels, a statistically significant negative association was found with the levels of HbA1c and positive association with perceived general health, even for functional HL.

Conclusions

The results emphasize the importance of improving the level of HL of people with diabetes in order to improve glycemic control and the perceive General Health

Key messages

Health literacy is critical for diabetes self-management. People with diabetes need to understand and use health information to promote well-being and diabetes control.
Health needs: a temporary analysis of the social representations of the concept
Authors: Winckler M , Zioni F , Johson G
Published: October 2020

Background

This study aims to analyse the social representations of health needs in a Brazilian municipality, questioning the capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs.

Methods

Qualitative case study in which the data were analysed by: 1) the Health Needs Taxonomy (Matsumoto, 1999), as an instrument for assessing health needs, formatting the interview guide and organizing the empirical data; 2) the Theory of Social Representations (Jovchelovitch, 2000), to capture health needs; 3) Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. The methodological path used was the same in the two moments in which this research is based (2009 and 2016). The entire municipal territory was analyzed and 26 representatives of civil society organizations were interviewed.

Results

Based on the results given, we state that health is a permanent and timeless need, but the mediations for its satisfaction have changed historically. The interface between quantitative indicators and subjectivity in assessing needs reveals the authoritarian architecture of its decision-making process, which has ruined the necessary democracy for prioritising and meeting those needs. The asymmetrical relationships present in the Brazilian society have both undermined the collective character of health needs and promoted the distance between who care and who are cared for. Most of the priorities listed by the interviewees in 2009 remain composing the social context of the municipality in 2016.

Conclusions

The challenges for comprehensive health care remain critical given both the decrease in popular political participation and in institutional spaces, which leads to the annulment of the right to a universal health. Interdisciplinary and participatory diagnostics remain essential to understand the complexity of social changes and the challenges for the consolidation of meeting health needs.

Key messages

The capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs. The challenges for meeting health needs remain critical given both the decrease in political participation and in institutional spaces, which leads to the annulment of the right to a universal health.
From ICD10 to ORPHAcodes: paving the way towards improved identification systems for rare diseases
Authors: Cavero-Carbonell C , Rico J , Echevarría-González de Garibay L J , García-López M , Guardiola-Vilarroig S , Maceda-Roldán L A , Zurriaga O
Published: October 2020

Background

The International Classification of Diseases 10th revision (ICD10) and its clinical modification (ICD10CM) are commonly used for the identification of diseases occurrence worldwide. In Spain, diagnoses are coded with its Spanish version (ICD10ES) since 2016 regardless of the prevalence of diseases. Rare diseases (RDs) are scrambled among common diseases in ICD10 and its derivatives and many RDs dońt have a specific ICD10 code, delaying a proper identification. Orphanet developed a classification system specific for RDs called ORPHAcode. This study aims to characterize whether ICD10ES mapping to ORPHAcodes improves RDs identification and which kind of disorders would benefit the most.

Methods

95% of the disorder level ORPHAcodes indexed at Orphanet was mapped to codes from 20 ICD10ES chapters by comparing the descriptors associated in both classifications. ORPHAcodes were then clustered based on their assigned ICD10ES chapter and the redundancy of each individual ICD10ES code was calculated by counting the ORPHAcodes they mapped to. 3 groups were established: Group 1 (1 ORPHAcode per ICD10ES), Group 2 (between 2-49 ORPHAcodes per ICD10ES) and Group 3 (≥50 ORPHAcodes per ICD10ES).

Results

5588 ORPHAcodes were correlated to 1677 ICD10ES codes. 1051 were group 1, 3261 group 2 (615 ICD10ES) and 1276 group 3 (11 ICD10ES). Most of the Orphacodes correlated to “Q” (>40%), “G” (>14%) and “E” (>12%) chapters of ICD10ES. Regarding specificity, “G” and “Q” were also the only chapters including group 3 ORPHAcodes, while less than 10% of the ORPHAcodes linked to these chapters were in group 1.

Conclusions

New and improved ICD10ES codes are required because just 20% of all ORPHAcodes studied were into group 1. Especial care should be put on the two majoritarian chapters, “Q:Congenital Anomalies” and “G:Nervous System”, that show the lowest specificity for RDs. Complementary use of ORPHAcodes would improve the identification and registry of RDs either.

Funded: Project RD-CODE

Key messages

The lack of a specific chapter for Rare Diseases in the InternationaI Classification of Diseases hinders their identification and therefore their study. Direct mapping between ICD10 and ORPHAcodes or the use of ORPHAcodes for diagnoses codification of Rare Diseases would enable better detection and epidemiological analysis.
Factors affecting readmission and post discharge consult at the Philippine General Hospital
Authors: Malijan G , Cerrado J , Tamondong-Lachica D
Published: October 2020

Background

In a resource limited setting such as the Philippines determining which patients are at high risk for readmission and the factors affecting their ability to adhere to post-hospitalization outpatient consult are key to ensuring efficient and safe healthcare delivery.

Methods

This was a prospective cohort study including patients of the General Medicine service in the Philippine General Hospital. Patient demographics, hospitalization details, and HOSPITAL score were collected prior to discharge. Succeeding patient encounters were classified as readmission, outpatient consult and lost to follow-up; data was collected using a researcher-guided questionnaire. Patients lost to follow up 30 days from discharge were traced. Factors associated with readmission and adherence to post hospitalization consult were extracted; readmission rate, outpatient follow up rate and time to follow up were summarized.

Results

Of the 619 patients included, outpatient follow up rate was 36.3% with a time to follow up of 15.6 +/- 6.8 days. Readmission rate was 16% with time to readmission of 12.4 +/- 7.8 days. Strongest risk factors for readmission were HOSPITAL score of High [RR 2.94 (2.09-4.13)] and prior admission in the last 30 days [RR 2.53 (1.71-3.74)]. Lastly, lost to follow up rate was 47%, and the most frequent reasons preventing outpatient consult were related to health condition (37.3%) and socioeconomic reasons (31.2%).

Conclusions

Patients identified as high risk for readmission and had recent admission had an increased risk of further readmission. Half of patients discharged were eventually lost to follow up, most commonly due to worsening health conditions and socioeconomic limitations, while majority of the patients who were able to follow up were deemed of low to intermediate risk of readmission. These findings highlight the importance of risk stratifying patients prior to discharge and identifying potential factors to improve outcomes at an institutional level.

Key messages

In a resource limited setting stratifying patient’s risk for preventable readmission and targeting identified risk factors are key to reduce negative patient outcomes and unnecessary health spending. The current health condition and socioeconomic factors strongly affect the patient’s ability to adhere to prescribed post-hospitalization outpatient consult.
Assessing patient safety culture and its associated factors in 12 emergencies across Tunisia
Authors: Aouicha W , Tlili M , Dhiab M B e n , Mtiraoui A , Chelbi S , Zedini C , Ajmi T , Said Latiri H , Ben Rejeb M , Mallouli M
Published: October 2020

Background

Although the emergency departments (EDs) are the front line of the public health system, they are considered high-risk environments because of the shocking frequency of adverse events, within. Developing safety culture among EDs professionals, as a strategic focus, remains a priority. The purpose of this study is to measure safety culture in EDs and to determine its associated factors.

Methods

This is a cross-sectional and multicenter study, conducted among professionals from all the EDs of public and private healthcare institutions in central Tunisia. It was conducted from June to September 2017. The instrument tool used was the self-administered Hospital Survey On Patient Safety Culture questionnaire translated and validated by the CCECQA. Data entry and analysis were performed using SPSS 20.0 and Epi info 6. Also, ethical considerations were taken into account.

Results

In total, the study included 442 participants from 12 ED, with a participation rate of 80.35%. All the ten dimensions of safety culture were all to be improved. As for 'teamwork within units', it scored the highest with 46%, however, the lowest scores were attributed to 'the frequency of reported adverse events' (19.6%) followed by 'the non-punitive response to error' (19.8%). Private EDs have shown significantly higher scores regarding nine safety culture dimensions. Also, the size of the hospital was significantly associated with all dimensions of the safety culture.

Conclusions

This study has shown that the level of safety culture needs to be improved in public and private EDs and also underlines the importance of developing the safety culture and the implementation of safety and quality management systems.

Key messages

Patient safety culture is to be improved in Tunisian emergencies, although it is significantly more developed in private settings. A punitive culture still reigns in Tunisian healthcare context.
Barriers and facilitators to implement oral health policies on Brazil, Colombia, and Chile
Authors: Lopes Galante M , Lugo D , Castro G , Ovalle M , Pischel N , Giraldes A , Carrer F
Published: October 2020

Background

Public health policies are important for the general population's well-being. Among the policies, oral health is included in the context of integral health, so those responsible for creating oral health policies and programs are key elements for the programs focusing on improving the health of a country's population. Oral health is considered a right to the citizen in the countries of this study (Brazil, Colombia and Chile), although their health systems are different. The aim of this study was to understand which barriers and facilitator occurs during the implementation of oral health programs/policies.

Methods

A qualitative study was conducted within personal interviews with decision-makers, at the political, technical and academic levels. Data were transcribed and analyzed using Maxqda®.

Results

It was observed that, at the moment of the insertion of oral health into the Health System, the formation of dentists with an emphasis in the public service proved to be a critical knot in these countries, also populatiońs lack of knowledge about their rights was mentioned. In Chile and Colombia one of the main facilitators was the previous existence of oral health programs. As barriers, we identified the lack of systematization of epidemiological data. In Brazil, the main facilitators were a large number of dentists already available in the job market and the political will of politicians to include oral health as public, mainly by the president of the country. Managers unprepared to work in public service was one of the main barriers.

Conclusions

During the development and implementation of public policies several factors are encountered, and although oral health is offered in different ways by health systems, it can be concluded that human resources are fundamental elements for functioning of public services and consequently success, besides the interest of the managers and politicians for the inclusion of this theme in the political agenda of the country.

Key messages

Oral health policies are influenced by several factors at the moment of its implementation, among them, the most prominent one is the formation of the dentist. Stakeholders should keep in mind that oral health is a fundamental part of the comprehensive health of the population and should include and advocate for this theme.
Patient's perspective on an integrated knowledge translation tool in homecare occupational therapy
Authors: Ruest M , Léonard G , Drolet M J , Guay M
Published: October 2020

Background

Patient engagement and integrated knowledge translation (IKT) approaches involving end-users of knowledge are increasingly documented for their social benefits in the subsequent application of health innovations. Algo is an IKT-based algorithm conceived with occupational therapists (OTs; supervisors) and non-OTs (users) in Quebec's (Canada) public homecare services (HCS) to support skill mix for bathing equipment selection. However, the unknown patient experience related to Algo's utilization in HCS hinders the deployment of adjusted facilitation strategies for the beneficiaries.

Methods

A multiple case study (case: a HCS minimally including an OT, a non-OT and a manager) was performed with semi-structured interviews and focus groups, based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) model. For intra-case analysis, extracts related to patient's experience were analyzed thematically according to the i-PARIHS components (Innovation, Recipients and Context) by a patient collaborator who shares its recommendations.

Results

Seventy-four (74) extracts from 5 cases referring to different trajectories of Algo's IKT process were analyzed by the patient collaborator and discussed through 5 interviews over 14 months. The following themes were identified: the promotion of Algo's relative advantage (Innovation) adjusted to the recipients' mandates, the consolidation of interprofessional collaboration between OTs, non-OTs, and managers (Recipients) and the development of their leadership abilities through the HCS instances (Context).

Conclusions

Patient's recommendations on Algo's IKT process in public HCS will orientate next facilitation orientations for supporting its utilization with patients living occupational difficulties during hygiene care at home. The integration of these findings expands the epistemic perspectives considered for developing public health policies to positively impact on quality of patient care.

Key messages

Patient’s perspective should be involved in integrated knowledge translation studies in order to expand end-users’ consideration in the development and application of knowledge. Patient’s feedback on the knowledge translation process (i.e., knowledge, recipients and context characteristics) offers a holistic perspective of analysis for improving facilitation orientations.
Operating Rooms efficiency: leveraging data to improve management of elective surgery
Authors: Quercioli C , Carta G A , Cevenini G , Messina G , Nante N , Becattini G , Sancasciani S
Published: October 2020

Background

Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime.

Methods

We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)>200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization.

Results

The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p < 0.001). Mean raw OR utilization increase from 62% to 66% (p < 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p < 0.001).

Conclusions

This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs.

Key messages

An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.
Assessing patient safety culture and its associated factors in Tunisian primary healthcare centers
Authors: Tlili M A , Aouicha W , Sahli J , Sid N , Ben Dhiab M , Mtiraoui A , Ajmi T , Zedini C , Mallouli M
Published: October 2020

Background

Primary healthcare centers provide the first contact for patients and it goes without saying that quality and patient safety in these facilities are vital goals and challenges. In fact, it has been identified that a significant proportion of safety incidents caught in hospitals had originated in the earlier levels of care, and some studies have found that errors in primary care can result in severe consequences. Hence why, a developed Patient Safety Culture is a component key to improve patient safety and healthcare quality in these settings. Thus, this study aimed to assess patient safety culture in Tunisian primary healthcare centers and to explore its associated factors.

Methods

It is a cross-sectional descriptive multicenter study, conducted from January to April 2016 in all the 30 primary healthcare settings of the Tunisian center, partners of the Faculty of Medicine of Sousse. The measurement instrument used was the validated French version of the Hospital Survey on Patient Safety Culture Questionnaire. The data analysis was conducted using the Statistical Package for Social Sciences (SPSS 20.0) and Epi info 6.04d for windows.

Results

A total of 214 professionals participated in the study, corresponding to a response rate of 85%. The “Teamwork within units” dimension had the highest score (71.5%). The lowest scores were for the dimensions related to “Frequency of events reported” and the “Non-punitive response to errors” (31.4% and 35.4% respectively). Additionally, the “Frequency of reported events” dimension was significantly higher among professionals involved in risk management committees (p = 0.01).

Conclusions

This study demonstrates that the level of patient safety culture needs to be improved in primary healthcare centers in Tunisia. Strategies to nurture patient safety culture should focus upon building leadership capacity that supports open communication, blame-free environment, teamwork and continuous organizational learning.

Key messages

Patient safety culture in primary healthcare settings is not as strong to ensure the provision of safe care. A well-designed patient safety initiatives, with organizational policies, must be integrated in order to enhance patient safety and quality of care.
Description of healthcare professionals’ attitudes on patient safety in the Tunisian operating rooms
Authors: Tlili M A , Sayeh H , Aouicha W , Souki M , Taghouti E , Lamine H , Chelbi S , Ajmi T , Ben Rejeb M , Mallouli M
Published: October 2020

Background

Currently, ensuring surgical safety remain a worldwide challenge. The description of operating room professionals' attitudes toward patient safety in their work units helps to identify strengths and weaknesses in term of patient safety, allowing a clearer vision of the safety aspects that require special attention. This study aimed to describe healthcare professionals' attitudes on patient safety in the Tunisian operating rooms.

Methods

This is a cross-sectional descriptive study spread over a 6-month period (October-April 2018). It was conducted among healthcare professionals working in the operating rooms of the two teaching hospitals of Sousse (Tunisia). The measuring instrument used is the Operating Room Management Attitudes Questionnaire (ORMAQ), which consists of 60 items spread over 8 dimensions. The latter has been subjected to a transcultural validation process inspired from the Vallerand method. Data entry and analysis was done by the Statistical Package for Social Sciences (SPSS.20) software.

Results

A total of 303 professionals participated in the study (participation rate= 76.13%). The most developed dimension was teamwork and the least developed was “Procedural errors/ compliance”. Items' results show that 94.8% of professionals confirmed that seniors should encourage medical and paramedical staff to ask questions, 53.5% of professionals stated that personal problems can adversely affect their performance and 87.5% agreed that operating rooms' team members share responsibilities for prioritizing activities in high workload situations. In addition, 50.9% of participants reported that the managers don't listen to staff or care about their concerns.

Conclusions

Operating rooms professionals' attitudes toward patient safety in their work units reflect an alarming situation regarding the quality of healthcare provided to patients. These results should be taken into consideration to guide future intervention on quality management improvement.

Key messages

Considering human factors is essential to improve safety in operating rooms and has an important role in reducing the occurrence of adverse events in these settings. It is important to study the underlying attitudes that determine the human factors for a better understanding and resolution of patient safety problems.
A novel tool to predict in-hospital mortality after hip-fracture: the PRIMOF score
Authors: Di Martino G , Di Giovanni P , Cedrone F , D'Addezio M , Masciarelli M , Meo F , Scampoli P , Staniscia T
Published: October 2020

Background

Increased life expectancy has led to an increased incidence of hip fractures in aged people. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stays, significant complications, and higher mortality rates. Being aware of the factors associated with in-hospital death or adverse events can help patients and healthcare providers make informed planning and management. The aims of this study were the development and validation of a score predicting in-hospital mortality among hip fractured patients.

Methods

Patients were selected from the hospital discharge record referring to the period 2006-15 and including data on the population aged 40 years or over in Abruzzo, a region of Southern Italy. The whole population was divided into 2 random samples in order to control the accuracy of predictions and to increase the reliability of all the statistical analyses. A multivariate logistic regression model was performed to identify the predictors of in-hospital mortality. All the diagnoses significantly associated with in-hospital mortality were included in the final model.

Results

The score ranged between 0 and 27 and was divided into four groups to facilitate the tool interpretation. An increase in odds ratio values was documented alongside the increase in PRIMOF score both in training and in validation groups. The score showed a good calibration and a good accuracy in predicting in-hospital mortality.

Conclusions

This study has shown that a simple score, based on the clinical history of the patient, allows to stratify the risk of hip fractured population in terms of in-hospital mortality. The identification of individuals at high risk of short-term death can be of great significance to health providers and public and private health services.

Key messages

Patients reporting hip fractures often show relevant comorbidities leading to higher in-hospital mortality rates. A simple score, based on the clinical history of the patient, allows to stratify the risk of hip fractured population in terms of in-hospital mortality.
Community pharmacists’ involvement in ensuring patient safety
Authors: Kazaryan I , Sevikyan A , Amirkhanyan A , Vardanyan L , Melikyan M
Published: October 2020

Burden of injuries to patients from adverse events is one of the top 10 causes of death and disability in the world; medication errors are a leading cause of injury. Most adverse events can be avoided. The objective of this work was to study involvement of community pharmacy professionals in ensuring patient safety in Armenia.

Community pharmacists and technicians from all the regions of Armenia were asked to complete previously designed questionnaire. 353 professionals completed self-administered questionnaire. Data were analysed with SPSS statistical software, version 22.0.

87.8% of respondents reported that they observe prescribing errors when evaluating prescription at pharmacy. 69.4% of them indicate that the main error is wrong dose; 32.3% pointed medicines interactions; 32.0% - contraindications. Number of professionals from Yerevan, who indicated wrong dose, is higher than number of those from other regions (p < 0.001). Only 5.1% of participants register errors at pharmacy. 83.0% of pharmacy staff reported they always or often evaluate therapeutic aspects of prescriptions. 42.2% of respondents noted that, when patient is pressing, they never dispense a medicine without being sure that it is safe for patient; 27.5% do it very rarely. 76.8% of responders are sure their services ensure safe use of medicines by patients. 26.1% of pharmacy staff reported having SOPs at their pharmacy; 80.3% are interesting in introducing this strategy.

Various prescription errors are observed by community pharmacists; however they are mainly not registered (there is no such requirement). In some cases prescriptions are not evaluated at community pharmacies. Approval of new standards for pharmacy practice seems to be beneficial. Recommendations are drafted for submitting to Ministry of Health.

Key messages

Involvement of pharmacy professionals in ensuring patient safety have to be increased. There is need for changes in pharmacy practice regulation leading to safer use of medicines by patients.
Health regulation in Brazilian municipalities
Authors: Bastos L , Bastos D , Barbosa M
Published: October 2020

The regulatory structures can become determinants in the organizational process of health management, as it has the possibility of giving more effective responses to the user who seeks the Brazilian health system. The objective of the study is to analyze the regulation of health services in Brazilian municipalities, considering the regulation centers, recommended by the legislation of the Unified Health System (SUS). This is a descriptive exploratory study with a qualitative focus, developed in municipal regulatory centers in Brazilian states, through semi-structured interviews. The sample consisted of eighteen managers and seventy regulation professionals, from September / 2017 to January 2018. As limiting factors in regulation, the following stand out: great demand for people; unavailability of beds; systemic difficulties in relation to the agreed services; procedures that are difficult to schedule and execute; problems in information flows between primary care and regulation. The main potentialities are: increased financial resources for health; reorganization of internal regulatory procedures; meeting users' needs; health training for regulatory professionals; and strengthening primary health care. The study showed that it is difficult to concentrate higher education professionals to perform the tasks of regulators of medium and high complexity procedures; there are obstacles to operationalize the regulatory process, since the regulatory structures created coexist with insufficient resources, agreements that are inconsistent with the country's reality; there is recognition of the need for a strong regulatory component in guaranteeing qualified access to health, and one of the greatest challenges is to understand the multiplicity of scenarios, subjects and interests, and to implement user-centered strategies.

Key messages

Health regulation in Brazilian municipalities.
Differences between surgical team members in terms of teamwork, workload and stress
Authors: Aouicha W , Tlili M A , Sahli J , Limam M , Dhiab M B e n , Chelbi S , Said Latiri H , Ajmi T , Ben Rejeb M , Mallouli M
Published: October 2020

Background

Within Operating Rooms (OR), teams consisting of professionals with different training and backgrounds are expected to function optimally in a high-risk environment that is scattered with stressors, that often appear simultaneously and are usually related to the ever-present time pressure which is often paired with ineffective teamwork and an ever-increasing workload and stress. This study aimed to investigate whether there are significant differences in teamwork; workload; and stress levels between surgeons, anesthesiologists, and scrub nurses.

Methods

This was an observational cross-sectional study, conducted over 3 months in 2018, in Sahloul University Hospital; in 4 ORs with different specialties. We used a validated observation sheet to asses teamwork (Observational teamwork assessment for surgery tool) during the intraoperative phase. At the end of each operation, stress and workload of the surgical team members were measured. All ethical considerations were taken into account.

Results

Overall, 160 participants from the concerned ORs participated in the study and 50 operations were observed. Most of the participants were nurses (45.6%). Concerning teamwork, in fact, surgeons received significantly higher scores on all of the dimensions. The mean global teamwork score for surgeons was 4.87 (SD = 0.75, p < 0.01) on a scale of 0 to 6. Moreover, ANOVA test showed that surgeons experienced higher workload with a mean of 66.88 (SD = 25.98, p < 0.01). However, nurses were significantly more stressed than both anesthesiologists and surgeons.

Conclusions

This study offered a practical method to evaluate, simultaneously, teamwork, workload and stress in the OR and revealed differences across team members as surgery unfolds. Given the importance of care delivery in the ORs, the findings of this study can be used to lead targeted interventions to enhance the surgical team performance.

Key messages

There were significant differences between surgical team members in terms of teamwork, workload and stress. Surgeons had higher teamwork and workload; however, nurses had the highest stress.
Field Hospitals
Authors: Karakoç M , Erdoğan Ö
Published: October 2020

Background

The need for field hospitals arise when existing health services fall behind in case of a disaster or an emergency. This study is intended to generate a standard level for the capacity of field hospitals with different levels.

Methods

In the descriptive study, standard levels (SS) were generated for field hospitals upon assessment of specifications of the field hospital models designed or applied onsite in the literature through content analysis.

Results

The field hospitals were standardized in four categories in the research: SS I, SS II, SS III and SS IV. SS is divided into two parts as health units and support services, and their use among the SS's depends on the need. Health units consist of Triage+Reception, Operating Room, 4 Bed ICU, Surgical Preparation, Laboratory/ Blood Bank, Radiology, CT, Resuscitation Room, Emergency Service, Ambulatory Care, Pharmacy, Dentistry, Dermatology, Psychiatry, Birth Consultation, Pediatric Department, Patient Admission, Doctors' Room, Sterilization, Morgue, Contagious Diseases, and Ophthalmology, while support services consist of Management, Office, Workshop (Medical Gas), Staff Dorm, Storage / Transportation, WC / Bathroom, Generator, Fresh / Waste Water, Dining Hall, Kitchen, Cold Storage Room, Laundry Room, Solid Waste, Staff Rest Room, and Reception. SS I provides emergency services and transfer to an upper level, and contains specific health units only. SS II allows for short term ambulatory treatment for the patients and contains specific health and support units. Since SS III has fundamental ambulatory care services and SS IV has wide range of ambulatory care services, they contain various health and support units.

Conclusions

Specifications of the field hospital SS's were defined in line with the need for health service that might arise during the disaster preparation planning.

Key messages

Health and support units forming the field hospital SS’s were determined. SS’s enables sustainability of the public health services following a disaster.
Patients and doctors: what kind of changes in outpatient clinic services can be made in concert?
Authors: Arshukova I , Dugina T , Dobretsova E
Published: October 2020

Background

Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients.

Methods

The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p < 0.05): descriptive statistics, U test, χ2-test.

Results

Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required.

Conclusions

Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%).

Key messages

The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.
Novel health system strategies for tuberculin skin test-guided Isoniazid preventive therapy
Authors: Van Ginderdeuren E , Bassett J , Hanrahan C F , Mutunga L , Van Rie A
Published: October 2020

Background

Global TB elimination demands a scale-up of Isoniazid preventive therapy (IPT) but tuberculin skin test (TST)-guided IPT poses great logistical and human resource challenges.

Objectives

Performance of TST self-reading by patients and fast-track TST reading by trained low cadre health care workers (task-shifting) was compared to formal TST reading by high cadre staff in a cohort of 278 South African adults living with HIV. Health economic impact of these novel strategies was assessed from a provider and societal perspective and simulations were performed for 5 other countries (USA, Germany, Brazil, India, Russia) to evaluate generalizability. In addition, accuracy of TST at antiretroviral treatment (ART) initiation was assessed by a repeat TST 6 and 12 month later.

Results

TST self-reading was highly accurate, with 89% sensitivity (95% CI 80, 95) and 100% specificity (95% CI 97,100) for detecting presence/absence of any induration. Agreement in TST reading between low and high cadre health care workers was very high (kappa 0.97). Compared to standard of care, a combined fast-track, task-shifting and self-reading strategy reduced TST reading costs in South Africa from a patient perspective by 81% and from a provider perspective by 92%. In all 5 countries simulated, TST reading cost was reduced by ≥ 78 % from a provider perspective. Repeat testing at 6 and 12 months showed high (31%, 95% CI 23, 40) TST conversion during the first 12 months of ART.

Conclusions

Empiric IPT for all people living with HIV followed by TST assessment after 6 or 12 months to identify those in need for lifelong IPT could increase the effectiveness of IPT programs. TST self-reading to reduce the number of patients that need to return for TST reading (to only those patients with self-determined presence of any induration) together with fast-tracking and task-shifting of TST reading could increase cost-effectiveness and reduce patient costs associated with IPT programs.

Key messages

Novel strategies are essential to control TB. Task-shifting, fast-tracking and patient TST self-reading empower patients and HCWs; optimal TST timing can increase cost-effectiveness of IPT programs.
Peri-operative elective path optimization through algorithms in the Local Health Authority of Bologna
Authors: Leonessi M , Tubertini P , Longanesi A , Malaguti E , Guicciardi S , Fabbri C
Published: October 2020

Background

High costs of healthcare and population ageing force the health system to constantly improve its efficiency in order to provide patients the best possible care with the available resources. In this perspective, the Local Health Authority and the University of Bologna started an experimentation to re-organize, manage and control the peri-operative elective path of general surgery, a discipline that works in a multiplatform environment according to a Hub & Spoke logic.

Methods

The experimentation is built on two mathematical programming models. The first one defines patient preparation appointments (i.e. diagnostic and anesthesiologic visits), harmonizing patient preparation with available resources, and planning migration from Hub to Spoke platforms, in order to optimize waiting time and facilities utilization. The second model defines weekly optimal admission plans. Both models consider the availability of resources in terms of surgical teams, operating room slots and number of beds for each operating unit. The proposed approach works on a four-week time horizon following a rolling horizon framework (weekly update) in order to effectively manage high priority patients.

Results

Both models have been tested on real-world instances over a six-month observation period. Overall, it was possible to increase the efficiency of surgical programming by reducing the waiting times for surgical interventions in over 20% of cases of high priority patiets in four local departments.

Conclusions

The proposed model represents one of the few cases in Italy of surgical programming developed through mathematical models. It will be necessary to evaluate the evolution of its effectiveness to optimize the system's ability to respond to the growing health needs of the population.

Key messages

Mathematical models are needed to optimize surgical planning. Efficiency of surgical planning may reduce waiting times for high priority procedures.