bluuebunny/crossref_metadata_2025 huggingface dataset:
Fighting childhood obesity in Brazil: a grassroots perspective
Authors: Nasser G
Published: October 2020

Issue

Brazil is facing one the main growing public health concerns of this century, with obesity and overweight affecting approximately 20% of children. Alongside this epidemic, there is a an increase in concomitant non-communicable diseases such as diabetes and cardiovascular disease. Interventions that promote health and integrate the civil society with the public and private sectors are essential to tackle changes in the long term.

Description of the Problem

The nutrition education project presented here was developed by a Brazilian non-profit from 2016 to 2018. With a focus on health and nutrition, the project included interventions such as BMI monitoring, assessment of iron-deficiency anemia among children, school gardens and education. This strategy has been developed in several areas of the country, with success in all scenarios, demonstrating that a bottom-up approach, with the involvement of the community is needed to promote change.

Results

The program has been successful in integrating the major activities into the daily curriculum of the schools, with the adoption of healthier lunches for children. 76% of parents attested that a school garden made their children eat more fruits and vegetables and 33% of the children affirmed changing their eating habits after the program. Buy in from the local governments and communities demonstrate the effectiveness of interventions.

Lessons

Investments from the private sector on social programs needs to ensure a more sustainable approach, so that behaviour change, which is key to reduce the risk factors associated with NCDs can be fostered. This needs to be done with an integral approach, with the support from local, as well as national and international stakeholders.

Key messages

Long-term change is possible with a grassroots approach that engages communities towards a healthier lifestyle. A school or a home garden can bring about better nutritional choices.
Difficulties in implementation of the National Health Map in Bulgaria
Authors: Georgieva S , Kamburova M , Tsanova D
Published: October 2020

Background

National Health Map (NHM) of Bulgaria determines the required minimum of healthcare facilities, hospital beds and specialists at different levels of Health System to meet population's needs of healthcare. Its main objective is to adapt structure of the healthcare network to the population health needs ensuring for every Bulgarian citizen an equal access to health services. Through it healthcare resources have been planned on a territorial basis and the national health policy has been implemented. The aim of this report is to analyze the actual availability of healthcare facilities and staff, and compare with the minimum necessary according to the NHM.

Methods

Content and critical analysis of statistical data of the Bulgarian Ministry of Health.

Results

Bulgaria is among countries with relatively low number of general practitioners (GPs) among countries of EU where the range is between 42 and 253 per 100 000 inhabitants. According to the NHM, taking into account administrative division, infrastructure and morbidity, optimum GPs/population ratio is about 67/100 000 while an actual availability is 55.9/100 000. The most serious deficiency is in remote areas where the ratio is between 26 and 32 per 100 000. Quality of primary health care is affected by the fact that 23.89% of GPs are without acquired specialty. Number of practicing nurses in Bulgarian health system is 30% lower than the recommended minimum. Nurses/population ratio is unsatisfactory. Physicians/nurses ratio is not consistent with European standards. Hospital beds are 6.3/1000 which range Bulgaria among five European countries with the highest availability of hospital beds but they are unevenly distributed both on a territorial basis and on specialties.

Conclusions

There is a lack of human resources in Bulgarian Health System and unequal availability and accessibility of health facilities in different regions of the country. Distribution of hospital beds on specialties also must be optimized.

Key messages

National Health Map of Bulgaria determines population needs of accessible outpatient and hospital care, distributes health institutions on territorial bases and implements National Health Policy. Difficulties in implementation of National Health Map are insufficient number general practitioners (GPs), a large proportion of GPs without acquired specialty, inadequate ratio physicians/nurses etc.
The role of leadership in driving change in cancer survival outcomes in seven high income countries
Authors: Morris M , Seguin M , McKee M , Nolte E
Published: October 2020

Background

There is well-established variation in cancer survival across high-income countries with seemingly-similar health systems. There is much research on reasons for these differences, but the role of leadership has been under-researched despite being one of the WHO 'building blocks' that underpin a functioning health system. Leadership is variously defined as including governance, stewardship, responsibility and accountability. As part of the International Cancer Benchmarking Partnership, this study looked at these diverse aspects of leadership to identify drivers of change and improvement across a range of high-income countries.

Methods

Cancer strategy documents were analysed from 22 jurisdictions: Australia (3 states), Canada (10 provinces), Denmark, Ireland, New Zealand, Norway, and UK (4 countries). Key informants in 15 of these jurisdictions, representing a range of stakeholders, were recruited through a combination of purposive and 'snowball' strategies, and invited to participate in semi-structured interviews. Documents and interview transcripts were analysed using a thematic approach.

Results

Different facets of leadership emerged: diffused vs centralised (including the central role of a cancer agency in some places); national, regional and local leadership structures; links between primary and secondary care. This study, however, demonstrated a central role for sustained leadership and political commitment, crucial for initiating and maintaining progress, as was a coherent vision that supported the implementation of national policies locally. Clinical leadership emerged as vital for translating policy into action.

Conclusions

Improving cancer outcomes is challenging and complex but is unlikely to be achieved without effective leadership and sustained political commitment that can create effective co-ordination of care.

Key messages

Different facets of leadership of the cancer care system emerged as important when exploring the reasons for variations in cancer outcomes in high-income countries. The persistence of these variations is unacceptable. Change will require political commitment and effective leadership, especially by clinicians.
Increasing efficiency for reducing elective surgery waiting times: a multi-interventions approach
Authors: Quercioli C , Carta G A , Cevenini G , Messina G , Nante N , Becattini G , Sancasciani S
Published: October 2020

Background

Elective surgery long waiting times are a common problem in publicly funded health systems. They have been tackled allocating additional resources or using existing resources more efficiently but results are patchy. We studied the effectiveness of a multi-interventions project based on the reorganization of existing capacity.

Methods

In a district general hospital (Siena's Province, Italy) with 150 beds, 4 elective surgery operating rooms (ORs) opened 6 hours/day 5 days/week (surgery specialties: general surgery, orthopedics, gynecology and urology) in October 2018 a project for reducing surgery waiting times was implemented based on 3 key points: i) separation of the Day Surgery (DS) flow from that of the ordinary activity; ii) increase of available operating time through reorganization of personnel: 30 additional hours/week were made available; iii) allocation of operating sessions flexibly in proportion to the waiting list: the made-available hours were redistributed through an algorithm able to estimate the optimal allocation of surgical time blocks to minimize the length of waiting lists, taking account of the interventions priority class. The waiting time of the out from 1/10/2019 to 31/12/2019 (N = 635) was compared with that of the interventions carried out from 1/10/2018 to 31/12/2018 (N = 634) using t-test.

Results

Waiting times for non-urgent cases (that can be operated beyond 30 days) were significantly reduced for all specialties (p < 0.01) except urology. For general surgery, orthopedics and gynecology, DS interventions' mean waiting time decreases from 198 to 100 days (-50%) that one of ordinary interventions from 213 to 134 days (-37%). Waiting time for urgent cases (to be operated within 30 days) was also reduced.

Conclusions

A multi-interventions project based on using existing capacity (personnel and structures) more efficiently and improving planning methodologies resulted to be strongly effective in reducing waiting times for elective surgery.

Key messages

To effectively reduce surgical waiting times, a strategy is needed that involve the entire process: from surgical planning, to staff and structures organization. The flexible OR time allocation on the base of the waiting list is a key point to improve surgery planning and reduce waiting list.
Adaptive work in the health care response to domestic violence in Palestine
Authors: Bacchus L , Alkaiyat A , Shaheen A , Alkhayyat A , Od H , Halaseh R , Feder G , Sandouka R , Colombini M
Published: October 2020

Background

A health system response to domestic violence against women is a global priority. However, little is known about whether or how they work in LMICs where there are greater structural barriers. HERA (HEalthcare Responding to violence and Abuse) aimed to strengthen the primary healthcare response to domestic violence in the West Bank of Palestine.

Methods

The sample for the qualitative study was 18 participants at two primary health care clinics and included five women, nine primary health care providers, two gender-based violence focal points and two domestic violence trainers. Data were analysed using thematic analysis drawing an Extended Normalisation Process Theory (ENPT) and feminist scholarship. We collected data on identification and referral of domestic violence cases.

Results

HERA interacted with political, sociocultural and economic aspects of the context, creating a degree of unpredictability and uncertainty in working of the intervention. The political occupation restricted women's movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants' choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable within a context of constraints. Participant narratives highlight the use of subterfuge, hidden forms of agency and governing behaviours (of self and others) to ensure the safety of all involved during implementation.

Conclusions

The findings have implications for how HERA can be sustained in the long-term, particularly with regards to the provision of support for women. Support at all levels within the health system is needed to enable change and strengthen the response to violence against women.

Key messages

Health care providers and women worked with and around contextual constraints. The transformation of the clinic case manager role is an emergent feature of HERA. Extended Normalisation Process Theory helped to articulate nuances about intervention-context interactions.
Pediatric ambulatory care sensitive admission and deprivation index, ten years retrospective analysis
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Masciarelli M , Meo F , Scampoli P , Staniscia T
Published: October 2020

Background

Ambulatory Care Sensitive Conditions (ACSCs) are conditions where effective community care and case management can help prevent the need for hospital admission. Even if the ACSC episode itself is managed well, an emergency admission for an ACSC is often symptom of overall poor quality of primary and community care. Lower socioeconomic status individuals show higher rates of hospitalization due to ACSCs. The purposes of this study is to examine the association between socioeconomic status and the risk of hospitalization due to an ACSC in pediatric population through a retrospective analysis of administrative data of the Abruzzo region.

Methods

We identified hospital discharge records from 2008 to 2018 of subjects under 18 years of age to take into consideration for the study. Hospitalizations due to ACSCs were selected by ICD9-CM coding developed by Billings et al. and implemented by Lu et al. For establishing the socioeconomic status, we used the Italian Deprivation Index (IDI) developed by Caranci et al. as a categorical variable expressed in quintiles. A multilevel logistic regression model was implemented using ACSC vs non ACSC hospitalization as dependent variables.

Results

In the study period, a total of 317,586 hospital discharge records were selected, 18059 (5.69%) of which related to ambulatory care sensitive hospitalization. After correcting for age, gender, and citizenship, ACSCs hospitalization was associated with lower IDI (aOR1.21;CI95%1.09-1.34) and a slight gradient as the deprivation increased. Moreover, it was also associated with emergency department admission (aOR6.53;CI95%6.19-6.89).

Conclusions

Avoidable hospitalization in pediatric settings is associated with lower socioeconomic status computed by IDI. This study confirms inequity in primary care or community care after adjusting for age, gender and citizenship. Italian deprivation index represents a useful tool to identify population and areas where improving prevention is necessary.

Key messages

The Italian deprivation index could be used to implement primary and community care strategies in pediatric settings. Socio-economic factors are associated with the performance of the health services.
Assessment of immunization service delivery in Pakistan: A cross-sectional survey of health facilities
Authors: Abdullah S , Taighoon M T , Siddiqi D A , Dharma V K , Khamisani T , Khan A J , Chandir S
Published: October 2020

Background

Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to the poor quality of service delivery. This study aims to summarize the quality of immunization centers throughout the Sindh province, Pakistan, by assessing all Government vaccination facilities and their associated health workers.

Methods

A health facility and worker assessment survey adapted from tools developed by BASICS and EPI-Sindh was used to record facility infrastructure, processes, and human resources. Using expert panel ranking, we developed critical criteria to indicate items immunization centers need to be operational (vaccinator, a cold box or refrigerator, and vaccine supplies) as well as high, low, and moderate function requirements and their respective scores.

Results

Out of 1396 centers assessed, 1236 (88.5%) were operational, while 1209 (86.6%) offered immunization services. Only 793 (66.0%) of the functional immunization facilities met the critical criteria. The average scores for high, moderate, and low function requirements were significantly lower for centers that did not meet the critical criteria. Of 2,153 healthcare workers interviewed, 1874 (87.1%) were vaccinators. 1805 (96.3%), 1655 (88.3%), and 1387 (74.0%) were trained in vaccination, cold chain, and inventory, respectively.

Discussion

One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. Health workers have adequate training and experience, suggesting that sub-optimal vaccination center quality is due to inadequate infrastructure and inefficient processes. Our study presents innovative and critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within an LMIC setting.

Key messages

Every 2 out of 5 facilities in Sindh Province lacked essential equipment for immunizations such as vaccines, vaccinator and cold box for vaccination. In all health facilities, the health workers appear sufficiently trained, indicating that poor quality may be due to missing infrastructure and inefficient processes in resource-constrained settings.
Brazilian especialized care: challenges and proposals to provide integrality on health assistance
Authors: de Moura Ferraz E , Marques da Silva J F , Hisatugo F , de Freitas Mendonça F , Carvalho B G , de Almeida Polo E P , Lopes Santini S M
Published: October 2020

The Brazilian health system has as principles the integrality of assistance and the regional health planning of services, organized through attention networks. In the constitution of this network, specialized care fraction, even though it concentrates a significant importance in citizens right of health guarantee, has represented a problem of great relevance, constituting a challenge for the organization of health care, whether in the field of management or assistance, in Brazil, as well as in other countries. In this perspective, this study aims to identify the challenges and propose strategies to effectuate the provision of specialized care fraction in the Brazilian health system. This is a qualitative and exploratory study, developed in the northern macro-region of the State of Paraná in Brazil. The data collection took place through semi-structured interviews, with the participation of public and private managers and other subjects that compose the assistance and management network of this region, between 2016 and 2017. The data were organized through discourse analysis, supported by policy analysis referential. The results show an expressive demand for this fraction of assistance in the analyzed territory, mostly offered by private institutions. The high demand is linked to the low resoluteness of primary health care and an ineffective communication system between different points of care. Other challenges highlighted in this phenomenon are: the lack of solidarity and the sharing of responsibilities between federal entities; the weakness of the counties; asymmetries of power between public and private managers; the fragile integrated and regionalized planning; the underfunding of the system; the fledgling regulatory system; the conflicts between governance actors; and political interferences.

Key messages

In order to overcome challenges to provise the specialized care fraction, is necessary to strength the cooperation between entities, making viable health policies coherent to collective needles. With the objective of organize the provision of integrality of health, one of the essential requirements would be qualify the assistance on the different points of care that compose the health network.
Drug interactions in the elderly of the Unified Health System (SUS) in Brazil
Authors: Silveira V F , Teodoro J A , Acúrcio F A , Júnior A A G , Nascimento R C R M
Published: October 2020

Background

Elderly people with chronic non-communicable diseases generally use a large amount of medicines, increasing the risk of adverse events that can compromise the quality of pharmacotherapy.

Objective

To analyze the prevalence of drug interactions in the elderly assisted by primary care of the Unified Health System (SUS), who use polypharmacy.

Methods

This is a cross-sectional study, part of the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) - Services, 2015, which used a representative sample of the Brazilian population. Elderly were considered people with 65 years or older and polypharmacy was defined as the concomitant use of five or more medicines. Drug interactions were classified using Micromedex®. The variables were presented as absolute and relative frequences, mean and standard deviation, using the software Stata® 13.

Results

Of the 1,157 elderly people interviewed, 19.01% (n = 220) were in polypharmacy. The average of chronic diseases was 3.84 ± 1.73 per elderly person, being hypertension (91.82%, n = 202) and arthritis (55.91%, n = 123) he most frequent. There were found 1,076 interactions, ranging from 0 to 23 per person, with an average of 3.87 ± 3.41. In the polypharmacy group, the prevalence of drug interaction was 88.99% (n = 194). Among the interactions, 66.83% (n = 679) were classified as moderate, 31.10% (n = 316) major and 2.07% (n = 21) minor; 84.83% (n = 861) were pharmacodynamic and 15.17% (n = 154) pharmacokinetic. The most prevalent interactions were: Hydrochlorothiazide and Acetylsalicylic Acid (5.31%, n = 54); Captopril and Hydrochlorothiazide (5.31%, n = 54) and Losartan and Acetylsalicylic Acid (3.74%, n = 38).

Conclusions

The most prevalent interactions have synergistic or antagonistic effects, which need monitoring to ensure the safety and effectiveness of treatment, especially due to the physiological changes resulting from aging.

Key messages

Analyze the prevalence of drug interactions in elderly people using polypharmacy. Cross-sectional, evaluative study.
Hand hygiene and standard hygiene precautions in healthcare settings Monastir Tunisia 2019
Authors: Dhouib W , zemni I , Kacem M , bennasrallah C , ben fredj M , abroug H , Bannour R , Sriha Belguith A
Published: October 2020

To ensure adherence to standard hygiene precautions in healthcare settings, the World Health Organization (WHO) recommends that compliance with these precautions be assessed in any care setting through periodic audits to improve the quality and safety of care procedures

This was a cross-sectional descriptive study that was conducted in the University Hospital of Monastir during the month of July 2019.It was a self-administered questionnaire that explored the knowledge and attitudes in terms of standard precautions in hospital hygiene and administred to the various occupational categories involved in each department. The data was entered and analyzed by the SPSS 20 software.

A total of 440 health professionals responded to the questionnaire with a Sex-ratio of 0.55.The median age was 30 years with an IQR [26,36]. The median length of professional service was 5 years IQR[2,9]. In terms of training on standard precautions, 69.3% were trained, of which 64.5% had training of less than 5 years.

More than half, 54.6% of professionals knew where to find a procedure or sign “what to do if exposed to blood”. Concerning the attitudes of professionals, the majority applied the standard precautions of the various topics and more specifically hand hygiene.

Our results showed acceptable adherence to standard precautions (glove hygiene, etc.) except for accidents during blood exposure which encourage us to follow an action plan with corrective actions.

Key messages

Acceptable adherence to standard precautions. Accident at exposure to blood need to be controlled.
Cost minimization of 3 methods of acquiring dental radiographic image
Authors: Coscarelli C , Leoni L , Força F , Feris F , Nacao N , Fonseca F , Machado M , Raimundo R , Cavalcante C , Pereira P
Published: October 2020

The objective of this study is to develop a complete economic evaluation of 3 diagnostic techniques for interproximal radiographic, comparing the conventional radiographic technique, direct (CMOS) and indirect (PSP) digital techniques in the diagnosis of dental caries, from the perspective of SESC/Brazil (Social Trade Service). A complete cost-minimization economic assessment was performed. Initially, a systematic review was performed and it was verified that the accuracy for the diagnosis is similar between the techniques. The direct medical costs (related to the technique) were estimated by the bottom-up technique, taking into account the value of the clinical hours of the professionals, equipments and materials used. The time horizon was 10 years. The values were discounted at 3% per year, and a sensitivity analysis was prepared into two scenarios (one more pessimistic with costs 20% higher than estimated and one more optimistic with costs 20% lower). Direct digital radiography proved to be the option with the lowest cost (US$ 1.16), followed by semi-direct (US$ 1.35) and conventional (US$ 1.47). Conventional radiography presented the highest cost for the period (US$ 74,943.65), and the use of digital radiographs could promote savings of US$ 6,000.59 and US$ 15,448.35, if used by the semi-direct and direct method. respectively. Regarding the sensitivity analysis, in the most optimistic scenario of the time horizon there would be savings of US$ 4,800.47 (semi-direct digital) to US$ 12,446.09 (direct digital) compared to the traditional technique (films). In the most pessimistic scenario, these values vary in savings over the time horizon from US$ 7,200.71 (semi-direct) to US$ 18,538.02 (direct). It is concluded that the direct radiographic technique was the most cost effective and its incorporation in the SESC units is suggested.

Key messages

Digital dental radiography. Cost minimization analysis. Health technology assessment.
Cost-utility analysis of remote monitoring of users with pacemakers five years after implantation
Authors: Lopez-Villegas A , Bautista-Mesa R , Peiro S , Catalan-Matamoros D , Robles-Musso E , Lopez-Liria R , Leal-Costa C
Published: October 2020

Introduction

Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of patients with pacemakers, 5 years after implant.

Methods

Under a controlled, not randomized nor masked clinical trial, 82 patients with pacemaker were initially selected (CM = 52; RM = 30). Patients were monitored during 5 years, after what a total 34 for CM in hospital and 21 for RM finalised the study. A cost-utility analysis was conducted to assess cost-utility of RM in terms of costs per gained quality-adjusted life years (QALYs). Costs from National Health Service (NHS) and patient perspectives were considered.

Results

After 60-months of follow-up, total costs per patient were 23.02% lower in the RM than in the CM group, corresponding to a €82.10 cost saving per patient (p = 0.033). However, the reduction of in-hospital visits derived from RM does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144). Patients in the CM group showed a slightly better QALY at the end of the study (3.579) than RM group (3.306). Costs/QALYs obtained by the RM group were higher than the CM group (p = 0.773). The incremental cost-effectiveness ratio of CM in comparison to RM becomes positive (€301.16).

Conclusions

This study confirms RM of patients with pacemakers appears still as a cost-effective alternative to conventional monitoring in hospital after 5 years.

Key messages

Total costs per patient were 23.02% lower in the Remote Monitoring than in the Conventional Monitoring group (p = 0.033). The reduction of in-hospital visits derived from Remote Monitoring does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144).
Assessing communication during remote follow-up of users with pacemakers
Authors: Lopez-Villegas A , Catalan-Matamoros D , Lappegard K T , Peiro S , Lopez-Liria R
Published: October 2020

Introduction

With the unstoppable implementation of digital contributions to meet many of the needs of current patients, it is expected that telehealth will progressively be adopted. Remote services are increasingly used in healthcare organizations across the globe. Cardiovascular diseases are the main cause of mortality in Europe while pacemakers are a common implantable medical device. The progressive implementation of pacemakers with remote monitoring is reducing traditional visits to hospital. Considering that effective communication is a key ingredient for the provision of quality healthcare services, this study aims to explore the communication experiences in older adults with pacemaker in remote monitoring. The study is based on a non-masked randomised observational design.

Methods

The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection.

Results

Findings revealed overall positive communication experiences by pacemaker users in remote monitoring without significant differences between users in hospital monitoring. The remote option is perceived as safe and convenient, and talking with the clinicians from home is considered as comfortable and confidential.

Conclusions

The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts are discussed.

Key messages

Findings revealed overall positive communication experiences by pacemaker users in remote monitoring without significant differences between users in hospital monitoring. The remote option is perceived as safe and convenient, and talking with the clinicians from home is considered as comfortable and confidential.
Quality of life in patients with pacemakers 12 months after implant in the Arctic Circle
Authors: Lopez-Villegas A , Catalan-Matamoros D , Peiro S , Lappegard K T , Lopez-Liria R
Published: October 2020

Introduction

The purpose of this study was to analyse the health-related quality of life (HRQoL) of patients followed up using a remote device-monitoring system (RM) compared to patients followed up through conventional monitoring (CM), 12 months after the implantation of a pacemaker.

Methods

This is a trial design that used the EuroQol-5D and the Minnesota Living with Heart Failure Questionnaire (MLHF) questionnaires. The HRQoL of a cohort of 50 consecutive patients randomly allocated to one of the two follow-up modalities was measure database line and then during follow-up, 12 months after the pacemaker implantation. Eventually, 23 patients were followed-up through standard outpatient visits, while 23 used a remote monitoring system.

Results

The baseline clinical characteristics and health-related quality of life of the patients from both groups were observed to be statistically similar. Twelve months after the pacemaker implantation, both groups showed statistically signiﬁcant improvements in the baseline parameters based on the MLHF.

Conclusions

The patients followed up through hospital visits showed a greater increase in MLHF- HRQoL after 12 months, although the increase was not signiﬁcantly greater than that of the TM group. Furthermore, the frequencies of emergency visits and re-hospitalisations did not differ between the groups.

Key messages

Patients included in conventional monitoring group showed an increase in HRQoL after 12-months since pacemaker implant, although it was not signiﬁcantly major than remote group. Frequencies of emergency visits and re-hospitalisations did not differ between the remote and conventional monitoring groups.
Long-term Quality of Life and Safety in Remote Monitoring of Patients with Pacemakers
Authors: Lopez-Villegas A , Lopez-Liria R , Leal-Costa C , Peiro S , Robles-Musso E , Bautista-Mesa R , Rocamora-Perez P , Lappegard K T , Catalan-Matamoros D
Published: October 2020

Introduction

Health-related quality of life (HRQoL) and functional capacity values immediately after pacemaker implantation have been well established; however, not much has been known about its long-term effects. The present study compared the long-term effectiveness and safety of remote monitoring (RM) plus a clinic visit versus clinic visits alone during follow-up of adults implanted with PMs.

Methods

This study was a single-centre, controlled, non-randomised, non-blinded clinical trial. Data were collected pre-implantation and after 60 months. The patients in the PONIENTE study were assigned to two different groups: RM and conventional monitoring (CM). The EuroQol-5D (EQ-5D) questionnaire was used to assess HRQoL and Duke Activity Status Index was used for the functional capacity.

Results

After five years, 55 patients completed the study (RM = 21; CM = 34). EuroQol-5D and functional capacity values were improved; however, significant differences were observed only in the EQ5D visual analogue scale (p < 0.001).

Conclusions

Remote monitoring was equally feasible, reliable, safe, and clinically useful as CM. The frequencies of rehospitalisations and emergency visits did not differ between the groups. RM was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Improved HRQoL was described not only immediately after PM implantation but also extended over a long time.

Key messages

Remote monitoring of patients with pacemakers was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Patients included in both groups of follow-up were equally feasible, reliable, safe, and clinically useful.
Patients, users, caregivers and citizens’ involvement in local HTA unit in Quebec: a survey
Authors: Touré M , Poder T G , Safianyk C , Fournier M , Ganache I , Pomey M P , Gagnon M P
Published: October 2020

Increasing emphasis is given on involving patients in health technology assessment (HTA). While this is mainly done at the level of regional and national HTA agencies, this tendency is also emerging in local HTA units. In this study we provide the results of a survey conducted in local HTA units in the province of Quebec, Canada. The aim of the survey was to provide a panorama of local HTA units practices to involve patients in their process, their interest in doing so, and their information needs for this. The survey was conducted in 2017 with a response rate of 11 units over a possibility of 12. Results indicate that only 3 units over 11 never involved patients or members of the public in their process and that all will involve them in the next few years. The three most important needs identified in the HTA units were: recruiting and selecting patients; integrating experiential knowledge; and knowing and implementing the winning conditions for partnership. To conclude, patient involvement in local HTA units is quickly evolving; that is why the latter urgently need tools to involve more effectively patients and members of the public in their process.

Key messages

There is a need to develop tools to involve patients in HTA process. Patient involvement in local HTA units is quickly evolving.
Health guidance for prevention of lifestyle-related diseases using health-related mobile applications
Authors: Tamura S , Haruyama S , Ogami A , Yokoyama A , Okuno T , Kubono Y , Takakura K , Esumi S
Published: October 2020

Issue

Lifestyle modifications are essential for the prevention of lifestyle-related diseases such as hypertension, hyperlipidaemia, and type 2 diabetes. Healthcare providers in Japan are required to use information and communications technologies (ICT), such as health-related mobile applications (mHealth apps), in health guidance.

Description of the Problem

To understand the results of and issues in health guidance, two searches were conducted to identify the domains of health guidance provided using ICT. We searched the PubMed and Japan Medical Abstracts Society databases to identify articles published from 2000-2018. The first search identified frameworks of health guidance provided using ICT. The second search identified primary studies about using mHealth apps published between 2000 and 2018. The sample comprised 22 unique programs from 38 primary studies. The following research questions were explored: 1) What is the purpose of using the mHealth app?

2) Is there a significant difference in the effect of using the mHealth app instead of face-to-face communication?

Results

The mHealth app was used to enhance convenience and to improve or modify lifestyle. The latter included self-monitoring, typing health information, providing knowledge, sharing information, providing encouragement and praise, and correction of action plans. Some positive effects were observed, including compensating for insufficient information, enhancing self-management, and improving degrees of satisfaction of users. Only two programs did not report a significant difference in the effect of using the mHealth app as compared to face-to-face communication.

Lessons

This review showed that the frequency of typing information about diet and exercise appeared to be related to the prevention of primary lifestyle-related diseases and the improvement of self-management behaviour.

Key messages

Use of the mHealth app for providing health guidance might enhance continuous support for self-monitoring and self-management behaviour. Use the mHealth app for providing encouragement and praise might promote a smooth conversation, which in turn would facilitate appropriate self-management behaviour.
Multidisciplinary Day Surgery Unit: a Health Technology Assessment
Authors: Pietrantonio M , Caracciolo A , Barbarino A , Triassi M
Published: October 2020

Issue

The aim of this study was to improve effectiveness, efficiency and quality of healthcare provided in Day Surgery (DS) setting at “Villa Malta” Hospital in Sarno (Italy). Health Technology Assessment (HTA) was used to compare two organisational models: the first one, in force at the beginning of the study, was characterized by a decentralisation of care activities at the individual Surgery Units; the other one provided for a centralisation of care activities in one unit, named the Multidisciplinary Day Surgery Unit (MDSU).

Description of the Problem

We evaluated economical (cost-minimisation analysis), performance (effectiveness, efficiency, appropriateness, quality and safety) and ethical-social aspects. The cost-minimisation analysis took into account costs incurred and revenues received (DRG-based reimbursement). The perceived quality and the ethical and social impacts were assessed by reference to the voluntary interruption of pregnancy (VIP) and the increasing offer of the Otorhinolaryngology services.

Results

MDSU has resulted in a net gain of €1,261,097 per year. This is a result of the increase in hospitalisation production of €1,235,869 and the savings on staff costs of €30,476. The new model also shown an improvement in efficiency through standardisation of the number of DS admissions and in perceived quality concerning VIP, ensuring greater privacy and humanisation for the patients. Finally, the introduction of the Otorhinolaryngology services in DS has increased the quality of healthcare on offer, without the need to transfer the surgical candidates to other hospitals.

Lessons

The centralised model has shown definite advantages over the decentralised one. MDSU was adopted to provide DS services at “Villa Malta” Hospital and this organisational model could be chosen by other hospitals to improve quality of healthcare.

Key messages

MDSU has advantages especially in economic, ethical and social terms. MDSU increases hospitalisation production, improves humanisation of patients and increases quality of healthcare on offer.
Nursing care in early extubation of cardiosurgical patient: a literature review
Authors: Soave G , Monaco E , Monte G , Gregori D , Martinato M
Published: October 2020

Introduction

Recent studies show that mechanical ventilation (MV) is necessary in only 5-10% of cardiosurgical patients. Thus, this finding denies the theory arguing that a prolonged period of MV (24 hours to 7 days) reduces the risk of complications. Based on these considerations, strategies have developed, i.e. the Fast Track (FT), with the aim of encouraging early extubation (1 to 8 hours after surgery). The objectives of this review are: to verify the effectiveness of FT in terms of reducing post-operative complications, mortality and costs, to analyse the operating procedures and inclusion criteria of each protocol and to outline nursing care in the whole process.

Methods

Literature search was performed in Cochrane, PubMed, and CINAHL databases. No limits have been applied on study design and publication timespan. Population included adult patients who underwent cardiac surgery with admission to an intensive care unit and were mechanically ventilated.

Results

16 articles (including 8 RCT) have been selected. The protocols require that nurses, based on specific parameters, assess the possibility of weaning from sedation and early extubation according to standardised practices. Early extubation decreases the risk of MV-related complications by decreasing hospitalization lenght and thus total costs by at least 3%. No significant differences have been found between FT and standard of care regarding postoperative complications and mortality.

Conclusions

Taking into account both the proven applicability, safety and efficacy of FT protocols and their high heterogeneity in published studies, that prevent their comparison, further research is needed to identify a reliable algorithm for early extubation based on pre-operative, intraoperative and postoperative data.

Key messages

Early extubation decreases the risk of MV-related complications by decreasing hospitalization lenght and thus total costs by at least 3%. Recent studies show that mechanical ventilation (MV) is necessary in only 5-10% of cardiosurgical patients.
Review of Philippine Health Laws and its Implication to HTA Institutionalization
Authors: Uezono D , Fajardo M , Zuniga Y M , Briones J , Genuino A J , Guerrero A M , Castro B
Published: October 2020

Objective

To identify the implications of health legislations on the direction of health technology assessment (HTA) institutionalization in the Philippines.

Methods

We reviewed 15 health laws and extracted information using a preset data extraction tool. The collected data was then subjected to the KJ (Kawakita Jiro) method to group similar provisions, taking into account their respective implications to the HTA direction. Once grouped, a core concept was identified that captured the underlying provisions within the group. After which, the core concepts were tabulated and matched with the core components of HTA institutionalization to identify specific policy implication to HTA.

Results

Three major paradigms emerged that are considered important in the institutionalization of HTA. First, common among the health laws are the need for the provision or expansion of benefit packages through the Philippine Health Insurance Corporation. Aside from the benefit packages, the reviewed laws also require delivery of new health services that entail the use of specific health technologies. Lastly, as a consequence of the need for new health services, equity concerns became evident in relation to the identified health services specifically in terms of socioeconomic divide, geographical location and disease status.

Discussion and Conclusions

The three paradigms identified from the review of health laws indicate synergism and antagonism to the HTA-related policy content of the Philippines' UHC Law. Some identify the need for HTA before being funded by the government while others do not explicitly state this. Despite the health laws requiring expansion or creation of benefit packages and delivery of new health services, there is still a need to undergo HTA in order to ensure efficient use of resources. The presence of these laws should not be tantamount to exception of undergoing HTA process but rather should be taken as a guide for priority-setting of topics for assessment.

Key messages

In the process of institutionalizing HTA, existing legislations on health can help map out areas of priority for assessment. Many health policies preceded the signing of the Universal Health Care Law, thus it is important to review them to determine provisions that are synergistic or antagonistic to the content of UHC Law.
Stress perception and associated factors among healthcare students
Authors: Dardouri M , Mallouli M , Chelbi S , Ben Rejeb M
Published: October 2020

Introduction

Stress and its deleterious effects are currently a major topic in public health. Health care studies can be very stressful as they pose a challenge for students around the world. The aim of this study was to assess stress perception among healthcare students and to identify its associated factors.

Methods

A descriptive cross-sectional study was carried out over a five-month period (January-May 2017) among healthcare students at the Higher School of Health Sciences, University of Sousse (Tunisia), during the 2016/2017 academic year. The socio-demographic and health status data have been collected using a pre-established data collection sheet. Stress perception was assessed by the French version of the Perceived Stress Scale with 10 items (PSS-10). Factors associated with stress were examined using ANOVA and T-student tests.

Results

A total of 237 students participated in the study with a response rate of 64.40%. The average age was 20.57±1.05 with a female predominance of 90.7%. The mean of the PSS-10 total score was 31.37±4.406. A rate of 89% of cases had a perceived high-stress score. Factors associated with stress were social status (p = 0.005), housing (p = 0.01), hometown (p = 0.03), presence of a diagnosed health condition (p = 0.02), presence of eating disorder (p = 0.04), presence of sleeping disorder (p = 0.004).

Conclusions

This study reported that healthcare students had a high level of stress associated with endogenous and exogenous factors. Stress management strategies must be included in the educational curriculum in healthcare schools.

Key messages

Health care studies pose a challenge for students around the world. Healthcare students had a high level of stress associated with endogenous and exogenous factors.