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Health Care Management - Science topic

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Dear colleagues,
I'm doing a costing study of palliative care packages in low and middle income countries, and as a first step, we need to estimate the need for palliative care services by country.
Hemorrhagic Fever, such as Ebola, is included in the list of diseases/conditions that generate major needs for palliative care. Others include malignant neoplasm, heart failure, renal failure, COPD, dementia, HIV and etc.  While death numbers for other diseases/conditions are available either through WHO or IHME, I can't find the death number for hemorrhagic fever by country (we are looking at Vietnam and India as two example countries). A lit search was not helpful as well. 
Would anyone know where to find those data?
Thanks! Xiaoxiao
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https://wap.business-standard.com/amp/international,3 days ago,Iraqi health Ministry has said up to 96 cases of VHF has been reported including 18 deaths.
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hello
I am a dental hygienist in Riyadh- Suadi, Arabia, starting my master's research in healthcare administration. Can you help me to choose an easy, practical, and vital topic between these 5 topics?
  • Health Care Management and Technology Adoption Or How Telemedicine Changes Healthcare Administration
  • The Management of Patient’s Problems, who is really responsible?
  • What is the various software that could be used for Hospital management regarding the cost-cutting?
  • How to deal with the financial crisis in the healthcare system being a professional healthcare administrator?
  • How can a good healthcare manager look after human resources data to find out the loops and holes for the improvements?
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Telemdicine and impact on health delivery
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Book recommendation
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1. Introduction to Health Care Management, Book by Nancy H. Shanks and Sharon B. Buchbinder
2. Management of Healthcare Organizations: An Introduction, Book by Peter C. Olden
3. Understanding Health Care Management by Seth B. Goldsmith, ISBN: 9781449632106, Publication Date: 2012-10-02
4.Leadership in Health Services Management, Book by Karien Jooste, Published in 2003
5. Persons Focused Health Care management: A foundation Guide for Health care manager by Donald L. Zimmerman and Danise G. Obson. Harrison
6.Understanding Healthcare Management ( ebook)
Pls pick teh one which more relevant to you. Thanks
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Hi all
I've lost the link to a paper that showed healthcare managers need repeated evidence of improvement program effectiveness, if they are to support the program.
Has anyone seen / read similar literature? I'd be very grateful for the link.
Many thanks
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Not sure this is what you mean but these two items, a report for the UK Health Foundation and a paper might help?
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Latin America and South Asia are now current hot spots for novel Corona virus. Centralized oxygen delivery system and ventilators are required in severe cases. Urban-rural disparity in health care management is not a new issue but during Corona crisis it seemed to be more prominent due to extreme inequity with poor healthcare facilities in rural areas.
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Urban populations are always going to be at greater risk. The fact that the population is physically closer and interacts more creates a breeding ground for the virus. This can tend to make authorities home in on these areas in order to control a fire like spread of the virus. However, this can lead to rural communities once hit with the virus slow to respond because the ability for the recognition its a community problem and not a individual one takes longer to filter through. A bit like lots of little fires spread over a greater distance. The urban spread has multiple fire fighting facilities while the rural has one fire engine running around trying to put them out.
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In program which uses mixed indicator for admission and discharge, to estimate the over all coverage using SQEAC should I use both indicator or WHZ or MUAC?
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Hie
Check this report, STANDARDISED INDICATORS AND CATEGORIES
FOR BETTER CMAM REPORTING. Adapted from MRP User guidelines April 2012
Complies with CMAM Report software April 2015
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In which fields of health care management digital Marketing is applicable?
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What about blockchain technologies here?
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Dear colleagues,
The VAS is a commonly used tool in health outcome studies, when using it to assess importance of certain action or intervention, how we can interpret the results, for example on 1 to 10 line (where 1; the least and the 10; the highest), the average of importance was 4 out of 10, what does that mean? and if we want to identify the level of importance (very important, important, somewhat important, not important), where are the cut off point for each level? to say for example, one third of student view this intervention is very important.
Can we interpret the result as 1-5 is not important and 6 to 10 is important.
Thank you.   
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nice ihformation
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Complications related to viral hepatitis, alcohol-related and non-alcoholic liver disease, are the main reason for seeking gastroenterologists and hepatologists advice. In addition, hepatocellular carcinoma often arise on the ground of hepatitis, representing the fifth most common cancer in men and the ninth in women. In 2015, the World Health Organization estimated that 325 million people were living with chronic hepatitis infections (hepatitis B or C) worldwide and that globally, 1.34 million people died of viral in 2015.
In front of this global health problem, gastroenterologists, hepatologists and hepato-biliary-pancreatic (HBP) surgeons, are daily involved in the clinical routine in taking difficult clinical decisions. As Sir William Osler quoted: “medicine is a science of uncertainty and an art of probability” and no doctor returns home from a busy day at the hospital without the nagging feeling that some of his/her diagnoses may turn out to be wrong, or some treatments may not lead to the expected cure. Probability is a recurring theme in medical practice and the ability of dealing with risk and uncertainty can be elicited through a special kind of intelligence. In 2012, The UK psychologist Dylan Evans defined it as “risk-intelligence” that is "a special kind of intelligence for thinking about risk and uncertainty", at the core of which is the ability to estimate probabilities accurately.  
Consequently, doctors are routinely asked to make predictions, and their predictions would lead to a consistent payoff when regarding a patient’s life. At the basis of “wise” medical decisions, physician’s experience surely plays a vital role. However, doctors can assume that their competency in a given area can be significantly higher than it really is. Such illusory superiority, is described as the Dunning – Kruger effect, a meta-cognitive bias leading to a discrepancy between the way people actually perform and the way they perceive their own performance level. The concept of “risk-intelligence” relies on the confidence that each subject has with their own knowledge, thus returning accurate probability estimates, and a “wise” doctor should be aware that he/she do not known, thus, returning high risk-intelligence.
To date, little is known about risk-intelligence and the Dunning – Kruger effect between doctors, and, especially, among hepatologists, a specialty strongly involved in important clinical decisions. With this aim we conducted a survey to test how risk-intelligence affects medical decision making in this particular clinical setting and whether the Dunning – Kruger bias can effectively affect these physicians.
If you are a gastroenterologist, hepatologist or HBP surgeon please help us in investigate this issue by completing the following survey:
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Thank!
(I hope you will find the correct answers in the appendix section of the manuscript we are writing!)
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Hi, I am looking for a validated tool to measure level of participants' engagement in healthcare high fidelity simulation.
Any guidance is very appreciated.
Thank you,
Val
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I'm on a committee for the NONPF that is looking at that issue. If you find an existing tool I would love to know what it is.
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Increasing unexpected healthcare utilisation in developed countries has led to several questions from the stakeholders, especially the health policy makers. Critics say unexpected healthcare utilisation cannot be prevented, while others say unscheduled utilisation can be avoided if adequate measures are put in place.
I believe, if the root cause of unexpected healthcare utilisation is known, there may be significant reduction to the high influx of patients to the health centres.
Question: In your opinion, what are the factors responsible for sudden utilisation of our health centres?
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Dear Aramide
You raised a question on a complex and complicate aspect of health care, that is utilization. Utilization(actual use of health care services) expressed as rates or proportions or frequency  is a measure of the degree of accommodation between health care systems and population characteristics. Why do people use health care services?. The answer is not straight forward. But we assume that they use the services because they need them and these services are available. The major determinants of services utilization in brief are: Health need, cost and income, distance between residence and location of source of care, degree of awareness, satisfaction and expectation, organizational aspects like referral and waiting lists, sociodemographic characteristics and others. Therefore to understand the pattern of utilization and forces behind the pattern and variation over time and across populations requires careful analysis of available data and perhaps household surveys.
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I have a group of subjects with XX disease enrolled in 2013-2016. After standard assessment, Patient received surgery or conservative treatment in terms of their own willing.
Recently I performed a telephone interview to inquiry their current functional outcome at the same time point. 
My research question is:
1). Which treatment is more effective?
2). Is admission of year a predictor for functional outcome in terms of different treatment? (e.g. For surgery, is functional outcome going better as time goes by whereas for conservative treatment, is functional outcome going worse as time goes?)
3). For those patients who received conservative treatment, what factors may affect their functional outcomes?
Based on these questions, what may be your analytical method to deal with?
Thanks.
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1. difference between conservative and surgery at time x. Compare mean functional score
2. time trend. Compare slopes of regression of functional score on time between conservative and surgical group.
3.other variables in conservative group at time x. Do multiple regression  of functional score on other variables, quantified ,binary or ordinal.
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Organizational reforms and the shrinking of budgets going on in many countries surely have had an impact not only on nurses and clinicians but also on hospital administrators. Despite looking for recent studies on PubMed and google scholar, the only data I got access to (which explicitly states burnout is a thing among hospital admins) dates back to the 90's. Any help appreciated !
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Thank you very much to the three of you for your answers and your recommendations. I'll keep looking !
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What are healthcare professionals' experience on stillbirth in maternity care?
Looking for a qualitative study
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Hello, this is not a qualitative study but a review of studies which i think might point you in the right direction. Hope it helps. http://journals.sagepub.com/doi/pdf/10.1177/1359105317705981
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We (Bournemouth University) are conducting a project for 'Birthrights' on the human rights and dignity aspects of maternity care for disabled women. I should like to include (in the literature search) the paper you have mentioned as being in preparation if it is ready please?
Enabling Maternity Services to provide a normal birth for mothers with a disability: the views of practitioners.
We are hosting a consensus event at Bournemouth University on 26 May to discuss the study and the way forward for maternity services if you know of anyone who would be interested in attending? the link is on Eventbrite:
Thank you, Jilly Ireland
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Hi Jilly
Just saw your question on Research Gate - alas I can't answer your question (!) but I worked for the Irish National Disability Authority (NDA) a number of years back and they conducted a study in this area which might be of interest. Here's the link:
Kind regards
Christine Linehan
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our research objectives is to find if the presence of appropriate healthcare services in schools and  health personnel who provide it 
we have collected our data contacting 40 random schools ( private,governmental) of all levels. asking about presence of healthcare equipments and the provider of care, number of incidence and how they managed it !
we thought of using chi-square test but the sample size is small , is there any other appropriate test we can use ?
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Hawra
Comparing the presence versus absence of any item between private and governmental schools (total 40 schools) means you can arrange the data into 2x2 tables which fits for chi-squared test. if small numbers in some cells then use Fisher Exact Test as an alternative to Chi-squared test.
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hospital personel must follow and evaluate prehospital care and join to prehospital EMS
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Regardless of the care setting we talk about an old but still valid approach to evaluation. These are structure (inputs), process (procedures and activities) and outcome (intermediate or ultimate). In my view these can be applied in the context of the question. Prehospital care must be first defined. Is it related to normal ambulatory care or emergency care?  then each of the above mentioned approaches may be used. Indicators are available for each and can be found in literature.
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I am carrying out a study on Assessing productivity of Nurses in District Hospitals in Ghana.
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Dear you can use some productivity scales used in general HRM research like "Employee performance" "innovation performance" Employee Turnover Intentions"
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Dear Research Scholars,
I need your advice regarding statistical technique.
I have collected data on Knowledge Management Practices such as knowledge perception (8 items) Knowledge gathering (11 items) knowledge creation (12 items) knowledge sharing (18 items) knowledge diffusion (13 items) and Knowledge retention (8 items) (all items are 70) from the Europe, Asia and GCC
(15 Countries have been involved with 200 responds). I would like to show variance between Europe vs Asia vs GCC so, which technique is very best for analysis?
Thank you in advance for your response and advice.
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I need your advice regarding statistical technique?
Based on the information provided within the question above - if one of your 6 variables is Dependent Variable (DV) & they are collected as interval / ratio scale data, then you might want to consider 2-way ANOVA.  If they are collected as ordinal scale data, you might want to explore Kruskal-Wallis test.  If it is more than one DV from your 6 variables above, you might want to consider MANOVA.
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It is true that accounting information requires detailed analysis and specialized knowledge to interpret. This usually means a good understanding of the accounting model and accounting practices. However, this is true of most complex systems. For example, the lab reports you receive when visiting the doctor also require specialized knowledge to interpret, but I doubt you would describe them as “deceitful.” Why do the complexities of accounting imply deceit?
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Professions like medicine, economics or pedagogics are based on empirical models or time-tested tools: the interpretative power is insider knowledge. Complexity does not imply anonymity, but every human power structure is based on anonymity. The Sumerian and Babylonian systems of economic accounting mark definitely the begin of human civilization, but they were grounded in a clear-cut ratio of monetary and natural units for counting wealth. The danger of forensic accounting increases when this original relationship is turned into abstract numerical data sets.
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Does your facility have a protocol or guidelines that either limit admissions to inpatient floors during shift change so that oncoming nurses have adequate time to get report for patients they are going to take care of before settling a newly admitted patient? Mainly patients being admitted from the ER.. 
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Prudence
this is a very emotive topic for us working in ED, with 3-4 shift changes per day and break times limiting admission times can adversely affect the KPI for ED flow also, time and motion studies have been done on this with suggested paper based handover (electronic in some sites) to ensure effective information transmission
Mick
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Will they use queuing theory for analysis?
Recently, in our hospital, a local investigator asked us for a study that sought to identify points of congestion in the flow of patients to the intensive care unit, that is, to identify waiting times in each of the intervening instances. Theory of queues proposed by Erlang. The distribution of contracting for the outputs did not behave like an exponential, do you think it is a mistake to use this distribution to hire the expenditures?
Best regards
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     Queueing models usually assume time-independent (input) demand rates. Healthcare facilities generally experience different demand over a day, over a week or over a season. Arrivals consist of acute (unscheduled) and elective (scheduled) patients. In other words, part of the input cannot be controlled and another part can be scheduled. As a consequence, staffing has to be adjusted constantly. The long term
steady-state probability distributions for queue length or delay are usually assumed to be independent of time. In healthcare systems we should rely more on time varying arrival rates and time varying server availability and time-dependent waiting times (Green & Soares (2007), Ingolfsson et al. (2002)). Green (2006) proposes a stationary independent period-by-period (SIPP) approach to determine how to vary staffing to meet changing demand. 
     This  paragraph comes from " ueueing Models in Healthcare" By S. CREEMERS, M. LAMBRECHT and N. VANDAELE.
    In my opinion, you may care the distribution of interval in a certan period(for example ,two hours). Even though the distribution is not exponential, it can be approxmized by other distributions, such as Erlang/hyper-exponential/Phase-type etc. 
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In the UK we have a dedicated public health body that is split into regions.
Has anyone had any experience with setting up or evaluating new models of public health?
Is there any recent research (within the last three years) nationally or internationally looking at merging public health bodies within a larger region, what this looks like, and how effective it is in achieving its objectives?
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Dear Charlotte,
In a Scandinavian perspective I wish to point at articles written by professor Bengt Åhgren. One example is this: Åhgren, B. et al The path to integrated healthcare: Various Scandinavian strategies, Article in International Journal of Care Coordination 17(1-2):52-58 August 2014 DOI: 10.1177/2053435414540606
In Sweden several of the public University Hospitals have merged. You can read about the case of Karolinska University Hospital in Soki Choi´s dissertation 'Competing Logics in Hospital Mergers', Karolinska Institute. You will find a discussion in the dissertation concerning the effects of the merger. 
Best wishes
Lars
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I need to know if in addition to patient surveys there are other types of indicators
on the continuity of care.
Best regards
Andrea
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Thanks for this different point of view
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...
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The following may be relevant:
Review of Total institutions and reinvented identities.
By Bloor, Michael
Qualitative Research, Vol 13(3), Jun 2013, 385-386.
Reviews the book, Total Institutions and Reinvented Identities by Susie Scott (2011). Scott shifts the reader's attention from Total Institutions to Reinventive Institutions, more characteristic of late modernity and defined as 'material, discursive or symbolic structure[s] in which voluntary members actively seek to cultivate a new social identity, role or status. This is interpreted positively as a process of reinvention, self-improvement or transformation'. She carefully picks her way around the traditional (and not wholly deserved) criticisms of Goffman's approach to power, renewed by more recent analyses of Foucauldian governmentality in psy communities, arguing that those who exhibit willing compliance should not be dismissed as cultural dopes or falsely conscious. The scholarship is lightly worn with a minimum of Urry-esque abstractions, and if Palgrave Macmillan would bring out a paperback edition, it could even be a resource book for a third-year undergraduate course. As it is, it will be read with interest by symbolic interactionists and will hopefully inform a new generation of ethnographic studies of institutions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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I am looking at management approaches that improve the quality of care in hospitals in low- and middle-income countries. My particular interest is how to deal with the problem of vertical 'silos' and create decentralised teams that unite the efforts of clinical staff, administrative staff and supply chains in the service of patient care.
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Hi,
I advise you to have à look at this paper:
Internal governance and performance: Evidence from when external discipline is weak
Journal of Corporate finance, April 2017, vol 43, Pages 193-216
Jonathan Kalodimos
Best regards.
 
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There are many computerized Pain Body Maps on the market, but it seems that many are still using paper-based Pain Body Maps - why?
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It is a good question to which you should be able to hear a variety of answers. I will give a few suggestions here. First let me tell you that I am a teacher at a nursing school in Denmark, but I have recent experience as a bedside nurse from a hematology unit in Denmark. I also have many years experience as a nurse (in various types of positions) from Saudi Arabia in one of the country's leading hospitals. I apologize for talking about me, but I also think it may be valuable for you to know about the settings from where my experience come.
1 The two hospitals, I have worked at, both had computerized medical records. These were built up around a standard format that suited all units in the hospital (some sections more than others). Changes to this system is very difficult to work with. If the desire to get computerized body maps for pain assessment/documentation only comes from one or a few settings, then it is extremely difficult, if not impossible to get such an initiative implemented. 
2) Computerized tools that includes patients' direct involvement requires that they have access to the digital device, which could be an IPad or alike. This requires that hospitals must prioritize buying such devices. Security of hospital property can be an issue, and having IPads or alike pose a property security issue, that of course can be addressed but at the same time contributes to the challenges.
3) It might also be related to the busy clinical practice where patient care has to be prioritized in the middle of an increasingly complex patient population, shrinking resources, and increasing demands, which includes implementation of a variety of projects and new approaches. One could then ask why not the approach to the use of computerized body maps for pain assessment, but it is up against a large number of other projects, 
I have followed your questions since the time you posted it. I had hope to read many more answers. I hope that with Frieda and my answers that your interesting topic will receive some attention and many more would like to share their perspectives and experiences. 
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I will start by mentioning that clinical experience and intuition came before evidence based medicine. This being said I would like to point out to the fact that more and more of our patients are ( and will be )  nonagenarians and they may represent an age group with distinct bio-psycho-social characteristics. Should we define them as a distinct group ? Could you ,  dear colleagues indicate publications devoted to this subject ?
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The Changing Health Patterns of Older Adults Benjamin Shaw of the School of Public Health
Using data from nationwide surveys regarding the elderly in the U.S. and Japan, Benjamin Shaw of the School of Public Health is conducting a four-year National Institutes of Health-funded study on how older adults’ patterns of physical activity, substance use, and health care utilization change with increasing age.
Shaw’s study also looks at how racial, socioeconomic and cultural differences, as well as psychosocial factors of the elderly, impact health behaviors and quality of life.
Although individual health behaviors, including alcohol consumption, smoking, physical activity, and weight management, have been widely studied, Shaw believes we currently know little about how these behaviors change in later life. His study aims to:
  • Describe how individual health behaviors change during old age;
  • Assess the extent to which variations among individuals in late life health patterns of behavior are influenced by key social status indicators and psychosocial factors;
  • Analyze the interrelationships between health outcomes and various health behavior changes during late life; and
  • Compare and contrast the prevalence, determinants, and health impact of various patterns of late-life health behavior change in the U.S. and Japan.
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Hello everyone,
I need help with the scheduling in Anylogic.
I will describe the process
1.       A patient comes in a clinic [newly created agent]
2.       After his visit, he/she is given a future date for a following appointment (appointment 1)
3.       He/she goes home [I created a zone – rectangular node – for this]
4.       Day of the Appointment 1 arrives, he/she needs to go to the clinic [from home]
5.       Point 2, 3, 4 repeat
My difficulty is that for the date and time for appointment 1 needs to be done dynamically (not predetermined). This means that the decision of the future appointment needs to happen at the end of the clinic visit, and it may be different for different patients.
How can I create such a schedule, attach it to each individual patient, and make sure that the patients come back at the clinic on the date of their appointment?
Much appreciated any help received.
Regards,
Alex
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Hello Zakaria,
This was a bit tricky. After the patients get out of the clinic (and go home - i.e. they are not destroyed or exit the system), they go though a bloc that gives them the next appointment. i had to create java classes for this. Anylogic does not directly support this type of schedules. when created, the patients are looking for an available appointment with a doctor [the docs have each their own schedule/timetable]; once the patients gets one, then that patient is always attached to that specific doctor. So, next time that the patient needs an appointment, it will only look at the timetable of his own doc. When it finds an empty slot, it occupies it, calculates how far in time it is, and that is the value of the delay bloc HOME. 
So, it is a fist come first served idea, but, it also checks for availability of the doc. I have some probabilities that also ensure that patients do not need to see the doc every time they come in.
Do not get me wrong, it is not an easy thing to do. And i do not know why no simulation platform incorporated [more complex and complete] schedules.
Hope that helps ;)
Alex 
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I am looking into the required skills and competences of applied theatre practitioners in healthcare environments.
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This could create a psychological help
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My research is to explore a way to decrease hospital social admissions. At the same time facilitating a safe discharge plan for the client. If you can give me different examples of hospital social admissions you've come across and just how each case was addressed.
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We are looking at some ethnographic results which describe some admissions and extended LOS associated with psycho-social issues, but this isn't a pre/post design.  So I can't comment on the trends.  I do think that there's increased attention on patients with 'complex social needs' as hospitals contemplate value-based payment and readmissions.
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We are trying to classify approaches in "humanitarian aid effectiveness" for a masters thesis (humanitarian aids in Afganistan in particular). We are interested in outcome (not output and not efficiency) oriented approaches. However, although humanitarian aids amounts to a huge sum on a global scale, we are having difficulty identifying a monitoring and evaluating system which is designed specific to the nature of humanitarian aids. We would be very happy to hear your recommendations about the literature and discuss issues which may arise.
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Governments are cutting nursing posts and lowering down nursing education, below the European Directive 55. How can we stop this trend. What evidence do we have to convince politicians to invest in the nursing workforce?
Health Ministers, Education Ministers develop new roles in nursing, assistants to nurses, to make it all cheaper.
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Dear Paul
Before asking how we can stop this trend (a political / campaigning question) we should stop to ask if we should. In this regard I think it is extremely important to note
i) emerging evidence that having both more and more highly educated registered nurses in hospitals improves outcomes / reduces harms... it's not the only evidence and it's not definitive but the obvious source is:
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., . . . Lesaffre, E. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet, 383. doi:10.1016/s0140-6736(13)62631-8
ii) All the evidence associating nurse numbers with patient safety has focussed on registered nurse staffing. There is relatively little evidence on "nurses" or assistants with lower levels of qualification and what there is suggests that they are NOT associated with the improvements in patient outcomes seen with higher nurse staffing levels and indeed there is some evidence of harm
Griffiths, P., Ball, J., Drennan, J., Dall'Ora, C., Jones, J., Maruotti, A., . . . Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies, 63, 213-225. doi:10.1016/j.ijnurstu.2016.03.012
Griffiths, P., Ball, J., Murrells, T., Jones, S., & Rafferty, A. M. (2016). Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ Open, 6(2), e008751. doi:10.1136/bmjopen-2015-008751
Some of the economic modelling studies also suggests that reducing skill mix is the least cost effective solution....
Studies looking at the implementation of assistants as an additional role in Australia do not lend much support...
Twigg, D. E., Myers, H., Duffield, C., Pugh, J. D., Gelder, L., & Roche, M. (2016). The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data. International Journal of Nursing Studies, 63, 189-200. doi:http://dx.doi.org/10.1016/j.ijnurstu.2016.09.008
Peter
 
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I am interested to know the caregivers needs to provide high quality care for patients with cancer. I am not looking for the psychological needs, but the knowledge and skills that we should equip the caregivers with, and the most common demands for the patients with cancer. 
If you are aware about any instrument to measure these needs, this also will be highly appreciated.
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Thank you Aruna,,,good ideas and thoughtful...
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What are the Patient Reported Outcomes worth to be investigated in a medical ward in order to evaluate efficacy of management ? And what is the tool or measure to be used? 
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Dear Vikal, are you a social scientist or a medical scientist. If the former, are you interested in marketing or production these can help better in conceptualizing and tool choice for your research.  For example marketing research for customer satisfaction is benchmarked against customer expectations( itself multifactorially decided in physical, social, technology state and economic terms) of returns on sum total cost monetary and non monetary, physical, social and even mental or psychological cost of seeking care.  In this model it is not difficult to get a low expectant satisfied customer even when medical care is less than desirable.  So define more precisely your interest and the tool will be clearer
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Are there shifts being seen in recent occupational safety and health (OSH) research in comparison to traditional OSH research focuses of past decades? What are some of the causes for such shifts, and what are the emerging trends in the field?
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Worker participation is also considered as a major shift. Worker can assist in the formation and implementation of the OSH management plan, enhance commitment etc.
This is the EU-OSHA guide:
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Evidently, Accountability for reasonableness (A4R) is a widely accepted ethical framework that has been used internationally in previous studies for evaluating legitimacy and fairness in priority setting in hospitals. According to ‘accountability for reasonableness’, a fair priority setting process meets four conditions: relevance, publicity, appeals, and enforcement. Like A4R, is there a widely accepted conceptual framework that has been used in priori studies to evaluate effectiveness in budget management (the whole budgetary process from budget preparation to implementation, and monitoring and evaluation) in case of hospitals? Thank you. 
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Dear Gedion,
I found interesting the publication from the World Bank that I am attaching. It does not fit with the detailed vision that you are asking, but maybe it could give some highlights about a global budget perspective for hospitals.
The author provides a guide for reforming global budgets in the hospital sector. Many countries with publicly funded systems adopted global budgets as a key funding mechanism, which could  combine  administrative simplicity with performance incentives. For countries with poor HIS, global budgets are less complex to implement and required less sophisticated data and reports. However, because that global budgets do not provide strong performance incentives as do some other output based payments systems. Policymakers who are aware of these constraints can use global budgets effectively in combination with other monitoring and evaluation instruments to access a more accurate effectiveness analysis of the budget management processes .
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I am attempting to forecast malaria burden till 2030 for India. 
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Kindly go to this website jane.biosemantics.org and type in forecasting malaria burden in a developing country setting and then go down and click on find articles. You have a lot of articles to choose from.
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Lipsky's book on Street-Level Bureaucracy is more general than the health-care sector, but applies to what I have seen in my field-study locations (public health clinics in South Africa).  Sociology of Health and Illness has articles on nurse-doctor relationships (eg Allen 1997 on Negotiated Order).  Social Science and Medicine has more relevant articles (eg Walker and Gilson 2004 use Lipsky).  But forward-chaining from these turns up very little.    
Academy of Management has articles on high- and low-status work.  Org Sci, Adm Sci Q and Organization have articles that are generally too removed from the domain to be much use.    
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Dear Brendon,
I would recommend you to read articles and books published by professor Marek Korczynski, Nottingham University. I came into contact with him when he was the key-note speaker at a seminar at Lund University in 2010. I think his speech was relevant for your questions. If you read Korcsynski you will find some other authors in this field of service workers connected to health. Examples of texts:
Korczynski, M.; Macdonald, C.(2009), ed Service Work: Critical Perspectives, Routledge, New York: USA.
Korczynski, M.; Evans, C.(2013)., "Customer Abuse to Service Workers An Analysis of Its Social Creation within the Service Economy", Work, Employment and Society, Vol.27 (5), pp. 768-784.
Best wishes
Lars Nordgren
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For a health care company, what are the various sourcing models that it can adopt in order to manage its tail spend? 
Are there any such models? what are the top pharmaceutical companies doing currently to manage their spend?
Any expertise on these?
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Setting up a financial committee and development accountability framework for accountability
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for testing customer experiences in Public and Private hospital care: I am in bit confusion with the validation to use the tool for the research in between the EXQ and other tools HCSQ, PubHosQual, CX, CXQ, PAD Model, PADPoM, EXQUAL, E-S- Qual etc. could you please suggest me how can i clear my understanding?
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Customer experience is a new and exciting concept marketing which are being practised in the present business environment and gaining importance in academic field. my this paper may be useful to you 
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Are anyone aware of studies assessing patient satisfaction and quality of treatment in people with diabetes, comparing a standard structured out patient structure with pre-planned visits to an on-demand structure, where the patient demands all services?
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Hello Claus
   I am not aware of any such studies but I work at a retail pharmacy in a medical building and we have a diabetes center in the building staffed by nurses and dietitians that are certified diabetes educators. Both pharmacists on staff are certified in diabetes management.. Patients can only be seen at the diabetes center with an appointment but we can see them at the pharmacy whenever is convenient for them by appointment or as walk-ins. We have not done any studies comparing participant satisfaction levels between on demand services and standard appointment based services.
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We are developing a MOOC around this challenge to service delivery and want to hear from anyone who has evidence, service models, service user stories etc that could contribute to the MOOC material. we want to be as globally inclusive as possible so would welcome your input, especially if you want to contribute videos, presentations, podcasts and your research. please get in touch with us. 
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 Harshvardhan and Rebecca
thank you very much for these. they will be very useful
Lucy
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Abstract
Menstrual health and hygiene has strong inferences on the health and wellbeing of a woman in general and of the overall society, in particular. The study of United Nations, 2013 revealed that globally menstrual women make up half (49.58%) of the population. Therefore, it is important to not overlook a phenomenon that a large percentage of the population experiences this on regular basis. The challenge of addressing the socio-cultural taboos, beliefs, and misconceptions about menstruation, is further compounded by the low knowledge levels, understanding and awareness of menstruation health. In 2010, Government of India has launched ‘MHS’ for the promotion of menstrual health and hygiene among adolescent girls in rural areas. Therefore, there is a great demand and need for accurate and relevant communication strategy which have been credited with advocacy, behaviour changes and social mobilizations to approach in combating this issue. In the words of Cohen (1963), the media “may not be successful in telling their readers what to think, but are stunningly successful in telling their readers what to think about”. Thus, this study is an attempt to examine the communication strategy and its efficacy to encompass good menstrual information, knowledge which influences individual or community decisions that enhancing, motivating and mobilizing them towards the use of good health practices and responds to care interferences.
The main objective of the study is to target and tailor menstrual health and hygiene messages to the rural women to find out the best communication strategy. The research will be based on the empirical study, where the researcher will examine the efficacy of the selected medium to be used for the diffusion of health related programme. The study will adopt quasi-experimental method wherein villages of Gaya district of Bihar will be selected through multistage sampling. The sample from the study subject will be selected by probability sampling. The data collection technique will be an interview schedule and focus group discussions of the study subjects. Communication strategies evaluations were reviewed to determine their impact on awareness, information seeking, knowledge, attitude and behaviour change towards the use of good health practices and responds to care interferences. Further the study will be helpful for government and non-government organizations for disseminating health awareness related information and practices.
Key Words: Menstrual Health, Communication Strategy, Gaya District, Empirical Study, Bihar
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Thanks Guys for putting all this valuable information together.
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Particularly with reference to the NHS of UK, it can be said that the general physicians are required to be actively involved in patient care, especially in the case of hospital discharge and rehabilitation after trauma. But to what extent the pharmacist can be involved too? What powers, authorities, and skills can the pharmacist apply to relieve an ailing patient?
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Pharmacists have long had an important,yet often unrecognized  role in primary and secondary health care. There has been studies showing that pharmacists as part of the primary health care team has led to improved glycaemic control in primary care patients. Many pharmacists,unlike doctors,  have not published studies which underly their roles in patient care and hopefully this can be changed.
Pharmacists also provide information to patients about drug use, major adverse reactions, drug interactions. However there role in compliance with medications especially in patients with polypharmacy cannot be over emphasized.
How do we get pharmacists involved? We simply ask them to be involved in quality projects and at the meeting of the heads of various departments requesting what involvement needs to be done.
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I am looking a variation in Medical test requesting practices by Primary care physicians. The tests I am looking at have clear guidelines, the data is normalised by demographics etc. Other variables like experience, special interests, QOF framework, patient pathways, resource allocation, easy of access etc have been factored in.
After all this one would still see 15 to 30 fold variation. 
how does one go about defining " acceptable variation" in such a system where in a human being ( Doctor) is interacting with a patient. 2 sets of human factors influencing each other. 
For example, I am a secondary care physician- and I am aware , in the last 10 patients I saw for a suspected condition - the number of tests I did vary from person to person. 
Thoughts and comments please
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I agree with above.......The correlation coefficient of ïntrapractise"" tests on a single case (predefined) or coefficient of variation  between practices in a single clinic are good suggestions to undertans the äcceptability in the variation!!!
However, the analysis should inform the system of the benefit of such an excercise...the secular trends in variablity of practise is already known and defined.
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I am in the process of conducting a meta-analysis and I am unsure about how to approach studies that have a high, or unclear risk of bias.
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First of all, I tend to lump unclear bias with low bias. Why penalize a study for what often is a reporting shortcoming and not a shortcoming of how the study was conducted. For example, the Cochrane risk of bias assessment tool wants to know how the randomization procedure was done. No one reports that now a days.
I see two approaches to dealing with studies with high risks. One, you could calculate the overall ES with and without those studies, and then discuss the difference if any. Two and my preferred way, you could run a subgroup analysis comparing the subgroup ESs for the studies with and without a high risk of bias. If there is no statistical difference between the two subgroups in ES, then you can say that the studies with a high risk of bias are not skewing your analysis.
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 Nursing errors commonly include failure to:
* collaborate with other healthcare team members
* clarify interdisciplinary orders
* ask for and offer assistance
* utilize evidence-based performance guidelines or bundles
* communicate information to patients and families
* limit overtime
* adequately staff patient care units with enough nurses to allow them to safely provide care.
 Please describe what you can do to minimize these types of errors?
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I wanted to add that when an effective verbal tool was used I witnessed dramatic improvement in not just pt. safety but morale and mutual respect.
We started using the SBAR format when we had to contact another nurse or, especially, a doctor.
Situation, Background, Assessment & Recommendation --
- many nurses struggle to communicate the reason they called in about 30-45 seconds -- losing the attention of the clinician AND (very importantly) annoying the clinician, triggering the nurse to feel shaken, upset and creating distraction from the task at hand. It was wonderful and effective to communicate well AND to be expected to make a recommendation to which the clinician could then agree or not. 
Communication. 
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see above
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I have found these to be minimally helpful as a clinician.  There is a large degree of information overload, which leads to an ignore it and click through it which unfortunately leads to missing an important warning and a clearly contraindicated drug gets prescribed.  Remember that the shepherd who cried wolf became an annoyance rather than a guardian.
The high risk warning alerts are helpful (eg. allergy warnings, major drug-drug interaction warnings). However, many high risk alerts are incorrect.  As an example, azithromycin is prescribed, the record notes that the patient is allergic to erythromycin with the reaction being nausea; my clinical experience tells me that people who experience nausea with erythromycin will likely not experience this with azithromycin.  Hence, one more irritating warning box that has to be dealt with.
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The health care industry seeks to protect, restore, and enhance health.it is important to adopt an approach to design, construction, and operations and maintenance that supports a healthy environment, both in their facilities and in their communities
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You may find the following WHO publication useful : HEALTHY HOSPITALS,
HEALTHY PLANET, HEALTHY PEOPLE - Addressing climate change
in health care settings.
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A major trend for medical advice, given the growing trend of sick patients living longer, is to look for advice on the web from sources such as HEALTHPAD, etc, I am now intrigued by the comparative effectiveness of those sources of MEDICAL help.
I am wondering on serious research that would compare,let us say, 100 patients with a serious flu or stomach infection, and put them in a situation to consult an actual physician face to face and 3 or 5 web medical advice places and then compare the results of the advice . 
My last book was on orgnizational culture in clinics and hospitals. Now I am asking what if the local culture is taken away (can it be done?) and we look for medical advice  outside the brick and mortar locations.
Any advice of reserach on this topics is WELCOME.
I am fully aware that the results might be contradictory in many cases or fully wrong methodologies in others.  But this is a topic of huge implications for every and all countries health systems.
Please advice with your views but more important with serious research citations on this techno-social topic. Probably one with major social implications.
MUCHAS GRACIAS AMIGOS
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Looks like Cochrane has been investigating that for awhile http://www.cochrane.org/search/site/internet
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I have found some standards for quality as the Joint Commission standards, and also I have seen the standards on health of the ISO, I want to know if there is more and better, and if there is guidelines or standards for quality and planification in health.
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Most US facilities use the standards established by the Joint Commission,
Also UK standards
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A colleague of mine has requested assistance in attaining international evidence demonstrating how up-skilling paramedics improves quality/patient care and the economic value of doing so, to continue to strengthen the case for change at a strategic level.
I am "putting it out there" to call on the international pool of knowledge and information, that may not have been published, but undoubtedly exists. Even small individual case studies are as important as large scale projects to bring about and support change.
Thanks so much for your consideration and look forward to hearing all you have to offer. 
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Yes, up-skilling would mean to teach or learn additional paramedic skills, based on current paramedicine curriculum.
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Demand of transparency of health care systems has evolved over the last years. Some of the domains expected to conduct transparenly are pricing and quality of care . Likewise this concept is different for health care consumers, physicians and health care organizations administrative staff. My question refers to what should be the expectations of  elderly people, elderly patients and their care givers in terms of transparency?
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The meaning of " health care system transparency " to geriatric patients and their care givers and vice versa:
a.Expectations of  elderly people: Elderly are generally neglected in my country ie India. What would elderly expect from health system is to 'LISTEN' to them, to 'UNDERSTAND' what is really wrong with them and to 'EMPATHIZE' with them'.
The question is whether the 'health care system' does Listen, Understand, and Empathize?!  
b. elderly patients: In a state where elderly already feel lonely and neglected sickness adds to their plight. They are not able to ask for appropriate services: due to inability to reach hospitals due to loco-motor problems, or may be due to financial constraints or due to dementia setting in.
When the geriatric population of the  nations is on the rise we need to set up systems where 'something' could be done for elderly patients.
c. their care givers: Care givers of elderly patients are usually turning old themselves ie my mother is 87 plus and my eldest brother who is 65 years old is taking care of her. He himself will require a care taker within a few years time. What happens to my oldest old mother!
I think we have to bring back the notion of empathy amongst the newer generations to see what we are seeing. By the way I am also 60.
The new generation health care system providers need to learn about geriatric Care from technical and from humane point of view.
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I am bachelor in nurse and I follow the orientation of management of care. Now, I do a master thesis, and need some recommendations for definition of the study object. My interest is research the issue of the quality of nurse care in populations with dementia in México City.
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Hi Andres  This is avery important question . I suggest you to address the organisation of nurses called " Admiral Nurses " which operates in the UK. they have vast experience in coping with dementia patients .
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I am using the cochrane handbook for assessmen of risk of bias in RCTs
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Great question and answers. Another simple but important distinction is how the 3 specific steps of an RCT are designed to control the "big three" biases. So:
Randomization prevents confounding (makes the baseline prognostic factors equal across groups).
Allocation concealment prevents section bias (prevents manipulation of the randomization scheme so the similarity across groups provided by randomization is preserved)
Blinding prevents measurement bias (a.k.a.  performance bias) - this occurs post randomization and as well described is not always possible. 
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Beyond stratifying for health literacy, we are interested in controlling for an individual's total exposure to/encounters/interaction with healthcare delivery.  This could be thought of as duration of exposure as well as intensity for unit time.
Is anyone aware of a validated method of measuring this?
thanks
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Hello.  I cannot specifically answer the appropriate validity method of measuring this.  However, you may want to approach validity incrementally.  That is, first think of the entire healthcare delivery process from a "linear" perspective; hence, the time a patient enters the healthcare system of delivery to their complete exit.  During each phase you may consider validity measures and developing a composite index with respect to the full linear process.  Obviously dynamic interactions across the clinical spectrum will impact and intervene with respect to a "dose" response; the fact still remains that it is a linear process -- walk in the door and leave through the door.  What happens in the "Black Box" is your "holy grail."  Good luck.
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I am searching for research literature and scholars working on Indic perspectives on end of life care. Can anyone who has been working or published in this area may kindly share their experience and published work? Thank you.
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Developing an innovative model of palliative care in the community in brazil
Santiago Rodríguez Corrêa, Mauro Almeida 
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We at our institution have developed a protocol to deal with terror attacks . Now how can i confirm scientifically that my protocol has actually improved the outcome of the incident in term of mortality and morbidity owing to better patient disaster management plan ?
International studies just describe an event and then discuss the outcomes - no set protocols yet!!
need guidance
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Dear Ahmad
I think it would be wrong to expect to truly prove superior results with your new protocol.
The most important outcomes for the patients would be survival and then things like long-term quality of life within multiple domains (cognition, return-to-work etc). Further down the line it would be secondary outcomes like length-of-stay (ICU/hospital), days on respirator etc but these would mean less to the patient and more to everyone around him/her (including whoever pays for it all).
Testing new protocols scientifically mostly ends up with measuring outcomes like compliance to the protocol, times between events etc, which means little to the patient if it can't be converted into those outcomes I mentioned (and possibly others of course). For exemple, see what's written on the WHO checklist for surgery in NEJM, and you'll see that it's not as simple as we would all like to think to prove superiority.
Just my 2 cents...
Very best
Johan
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In most of the societies, small reforms are done to improve the health status of the people, but sometimes results are not up to the mark. Can you suggest some measures to achieve set goals for health?
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Small changes to the system will result in small results,  The changes need to be sustained over a very long period, even after change is detected.  In order to measure change you need to set long-term goals of at least 10 years in order to detect real change.  These changes will not be large but if the system changes are sustained will continue to be maintained and increased over time.
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it has to do with the filed of "logistics" and the gaps in customers' expectations when it comes to health management 
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Hi, looks at the studies (Pedro Pita Barros) Nova School Business and Economics.
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I would like to measure patient perception of service quality (or patient experience) in Emergency Department of hospitals.
Is there a valid questionnaire in this regard?
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please find the following very useful comprehensive guide document 
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Dear friends, We are conducting a research on cost effective analysis of sexual and reproductive health service provision. We focus only on medical services in both static clinic and outreach. We would like to focus on indicators like "Cost per client", "Cost per service", "Number of clients per service provider per day", "Cost recovery ratio", etc.  Could you please share your experiences?
Thank you in advance.
M. Suchira Suranga
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Dear Suchira,
I am doing a study which is similar of your kind but the setting is different.. May be following articles will help you:
Lagu T, Rothberg MB, Nathanson BH, Pekow PS, Steingrub JS, Lindenauer PK. The relationship between hospital spending and mortality in patients with sepsis. Arch Intern Med. 2011; 171: 292–299.
Yasaitis L, Fisher ES, Skinner JS, Chandra A. Hospital quality and intensity of spending: is there an association? Health Affair. 2009;28: 566–572.
Narang A, Kiran PS, Kumar P. Cost of neonatal intensive care in a tertiary care center. Indian Pediatr. 2005; 42: 989–997.
Kahn JM. Understanding economic outcomes in critical care. Curr Opin Crit Care. 2006; 12(5):399–404.
 Roberts RR, Frutos PW, Ciavarella GG, et al. Distribution of variable vs fixed costs of hospital care. JAMA. 1999; 281(7):644–649.
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I am working on a project to show how social media can be used to improve patient outcomes, specifically in community health centers.
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There are some links to this topic. But be careful! The causal link between changes in organization of care and patient outcomes as hard endpoints is weak. Its easier to take patient satisfaction or other soft outcomes. Be also aware that this can only be investigated with observational methods. And there you always have all sorts of bias. Also there is a tendency only to look at improvements and forgetting that each intervention also produces risk and adverse events.
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Often training in health care is assessed through evaluation of learning and evaluation index. what other ways and means can be used to evaluate impact and effectiveness of the training buildings?
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Increasingly, education and training of physicians is migrating from being mostly an assessment of knowledge to assessment of a broader set of competencies.  For physicians in the U.S., the Association of American Medical Colleges has now specified a set of 13 "entrustable professional activities" (EPAs).  An initial survey of graduating medical students and faculty responsible for residency programs (the next step in training) indicated that only about 1/2 of the graduates have attained the desired level of competence in those 13.  It is now about 15 years since the ACGME (Accreditation Council on Graduate Medical Education) in the U.S. began to promote a set of six competencies that all residents should attain.  More recently, the ACGME has begun to put more rigor in the process.  Work has been proceeding in defining "milestones" or intermediate steps in the attainment of the competencies.  Knowledge is still an important competence, as are skills, as is ability to behave professionally, communicate effectively with patients and in teams, etc.  
On the whole, this seems to be a very positive trend; and as you can infer from the above there is still an enormous amount of work to be done both on specifying the outcomes and in ensuring that the learning objectives of each stage of education and training are aligned with them.
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I am working on my master's thesis and will be testing models that have facets of health as the outcome. Specifically, I am looking at:
  • physical health (i.e., health problems, such as hypertension, pain, vision problems),
  • functional health (i.e., how health problems impair or limit daily functioning, such as working, sleeping, seeing),
I'm thinking that these facets of health are formed by their indicators, rather than the indicators being reflective of the facet of health. But can an argument be made in favor of reflective?
Related, if I do treat these are formative, what are the implications for treating these latent variables as endogenous outcomes? I've read Diamantopoulos et al (2008) and I am not sure how, or if any recommendations for formative latent variables change if the latent variable is the outcome.
If it helps in any way, most of my indicators are categorical, but I also have a few continuous. I was planning on using robust weighted least squares as my estimator and conducting my analyses in Mplus.
Thank you in advance, and let me know if you need more details.
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Gretchen, I think we get into trouble when we try to turn "physical [or mental] health" into an outcome measure. There's no agreed-on measure for that, if we even agreed on what "that" is.
I'd try for more precise constructs like physical function, perceived health status, medical history and distinct biometric values like BP and BMI.
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Primary care environment to prevent depression from opportunistic approach. What is the quality of life implication of that?
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Juan, caro, permítame compartir con usted algunos enlaces que nos han guiado acá en Brasil sobre el tema:
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Failure to rescue is shorthand for failure to rescue (i.e., prevent a clinically important deterioration, such as death or permanent disability) from a complication of an underlying illness (e.g., cardiac arrest in a patient with acute myocardial infarction) or a complication of medical care. Failure to rescue rates used for both research purposes and as quality indicators are typically derived from hospital administrative databases. However, it is not clear how identify it, so what are the best indicators to measure it?
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I also think that retrospective analysis is the only option. Is it accurate to limit failure to rescue to cardiac arrest? Perhaps one of the early warning system frameworks (EWS; http://www.ihi.org/resources/Pages/ImprovementStories/EarlyWarningSystemsScorecardsThatSaveLives.aspx) could be used to expand the conceptualization of "failure to rescue" . It seems that failure to respond, or a delay in response, at any point when the evidence (i.e., vital signs, O2 sat) suggests an intervention could be on a continuum of failure to rescue.  
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The ambiguity and variability in existing literature on the magnitude of socio-economic inequality in self-reported morbidities makes it difficult to set priorities in health policies.
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Policy makers worth their salt would be able to MAKE SENSE  out of the SO CALLED ambiguity and variability in existing literature on the magnitude of socio-economic inequality in self-reported morbidities ; also THE constitutional obligation of the govt. concerned would also guide policy making ( as also will the political compulsions)
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I am currently involved in conducting cost effectiveness study of anti-epileptic drugs. We have collected QOLIE 10 scores from 451 patients using propsective observational method. I would like to receive references for mapping algorithm for calculating utility values from QOL scores of QOLIE 10.
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There are existing QOL surveys that have already been adapted to utility preference criteria. Attached is a paper on the SF12. I have used this extensively and it is super!
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Hi everyone,
Conventional cost function assumes that the hospitals is minimizing cost, or maximizing profit or patients.
However, this is likely not the case for public hospitals in developing countries, in absence of incentive to compete and to self-sustain.
1. So, what are public hospitals in developing countries maximizing / minimizing?
2. How should a cost function for these public hospitals look like? 
3. Is there any literature discussing how should a cost function for public hospitals in developing countries be specified? How similar or different should it be from conventional cost function?
4. Studies from developing countries have used the conventional cost function such as Weaver & Deolalikar (2004) below. Is this correct?
I have tried to look for literature but to no avail.
Would be glad to have some discussion here.
Thank you very much in advanced.
Regards,
Ka Keat
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Thank you everyone for the interesting discussion!
Learned a lot from all your inputs.
I agree that the underlying cost function would be dependent on the setting in which the hospitals are operating.
I would actually like to study the hospitals run by the Ministry of Health, which are tax funded, budget based, and could always use public budget to compensate eventual deficit, to cite a few of you.
I think the MOH hospitals can be described as having a "satisficing" model of behaviour, in which "managers and staff only hope to achieve some level of output and quality within a fixed budget that will satisfy their own expectations and those of higher level managers." (World Bank 1993)
Found a World Bank document discussing this issue:
"Our expectation is, therefore, that even in the absence of an underlying maximisation objective that is universally applicable, a functional relation exists between observed hospital costs and output." (Howard Barnum & Joseph Kutzin 1993. Public Hospitals in Developing Countries: Resource Use, Cost, Financing - Link below.)
Another relevant document which I found useful is this: Adam Wagstaff & Howard Barnum 1992. Hospital Cost Functions for Developing Countries - link below.)
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There are a number of gold nuggets buried in the text, on medical education but also on the financing of the health care system. 
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Well, his concerns are really as pressing now as they were then. We have to decide if we want trained technicians in medical practice or educated doctors for medical practice. I certainly know which of the two I prefer, reaching a stage in my life where I might have to engage with the system at the receiving end.
Having co-designed and co-implemented an alternative approach to medical education in the context of a rural medical school has demonstrated that education of physicians in an interactive, patient/person/human focused way is rewarding for all involved in the process and results in accelerated performance at the cognitive, technical and interpersonal level - something that may be even more pertinent in our times of more rapid change than at the beginning of the 20th century.
I would rather see an emphasis being put back on understanding basic physiological functioning rather than more "evidence-based medicine". The interconnected nature of physiological networks and their regulation results in "whole system (body)" changes, the current preoccupation with achieving "normality" of single surrogate indicators of disease within an EBM framework has to result in dys-regulation of the whole system resulting in the many undesired unintended side effects of contemporary treatment approaches. The appreciation of the dynamic mechanisms of health and disease make evidence a moving feast - today's best evidence all to often turns out to be yesterday's great fallacy (may be that the nature of medical practice since its beginnings, best evidence resulted in leaching the king to death).
I hope this discussion may result in a broader discourse of "what medicine is all about".
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Relatively little is known about the association between ageing and health care costs in middle- and low-income countries - whereas, in high income countries, available data does not yet point to a clear answer - with income elasticity and patient expectations, time to death, the type of service (inpatient or outpatient), and expensive technology, all possibly contributing more to increased spending than ageing populations.
See for example, Asia in the ageing century: Part III - Health care. www.cepar.edu.au/media/113850/asia_in_the_ageing_century_-_part_iii_-_healthcare.pdf
Any relevant and recent (last 5 years) analyses, published or in the grey literature, would be appreciated.
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Dear Jose-Ignacio and Sandra,
Do appreciate your responses. What I am looking for is recent published or unpublished literature/data on health systems responses to population ageing, the determinants and drivers in LMICs. The NCD burden will certainly be one component of health system expenditures unless we can change the trajectory of ageing at an earlier stage in life.
Sincerely, Paul
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I am looking for journals and articles that focus on decentralization of healthcare systems, more so in Africa. For example from National level, to regional boundaries, to the local boundaries.
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"Heath Care Management Science" and "Operations Research for Health Care"
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Health Literacy is defined as the ability to read and unerstand basic medical
and health information. According to several sources more than one third of the population in North America  has no health / medical literacy. The outcomes are estimated  at more than 100 bilion USD for the health care sector with additional
negative cosequences like : innability to understand inform concern documents,
innability to access and use adequate and proper health/medical info on the net
etc. The next generation should aquire this through school teaching programes
- What you dear fellows think about ?
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This is an interesting conversation about health literacy. I personally feel much of the responsibility for educating patients falls on the health care providers. There are many excellent tools to raise awareness of the issues and I though I would share a few here. Pfizer, the pharmaceutical company, has been a huge advocate for Clear Health Communication for years and I applaud their efforts. They have a new tool, A Health Literacy Assessment Tool for Patient Care and Research called the Newest Vital Sign (NVS) available in English & Spanish. It helps providers assess what the patient knows, and then using some of their clear health communication skills (in the link provided) we as health professionals can work to better communicate and get feedback on what the patient understands about their illness and any treatment options we are recommending.
The American Medical Association has a really powerful video on health literacy in America. Watch it to really see what we are missing by not looking for health literacy, it's been around for a while, but wow. (Every time I watch it I am moved by the impact of health literacy on patients.) We should never assume anything, plain language is important and it is not the patient's responsibility to tell us they "don't get it", because they will not. Providers need to think about this issue and I am glad it is being discussed here. There are great resources out there.
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A local health service has recently introduced a, add on service to assist GPs in offering better service to people with chronic mental illness, after four years, there is need to determine whether that service is having desired outcomes.
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And thank you Sheila, I will look at Alastair's paper. Much appreciated.
Interesting take on this, Ariel's suggestion above was to consider an objective measure, my initial take was Clinician's self-report (not so objective) and your suggestion adds in the consumer preference.
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i intend to research of whether there are specific provisions for the poor and the vulnerable in the Nigerian National Health Bill 2014. They key questions include, are  the provisions rights or privileges; who is eligible and who is to advocate for the poor? I would like read about other researchers critique of Health Bill in relation to equity and inequity in the Nigerian health system.
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Yes Westin.  The Nigerian Government is attempting to implement a free basic minimum health services (whatever that means) to all Nigerians and also to implement another category of exemption from payment from health services for an unspecified poor and vulnerable group to be determined by the health minister. Apart from the problem of eligibility, there is lack of a legal framework for the enforcement of these services in the 2014 National Health Bill and health system. In other words, from the Government’s point of view, these provisions are merely privileges and governmental philanthropy and not rights to health care. The citizens cannot seek redress in the court if government fails to implement this policy effectively.