bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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)&gt;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 &lt; 0.001). Mean raw OR utilization increase from 62% to 66% (p &lt; 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract
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 &lt; 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

Abstract
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

Abstract

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 &lt; 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 &lt; 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

Abstract

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.