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Healthcare Systems - Science topic

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How should healthcare systems prioritize patient care when faced with limited health resources, and what ethical considerations arise from these decisions?
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Healthcare systems can improve patient care prioritization under resource constraints by adopting ethical frameworks, utilizing evidence-based decision-making tools, and addressing systemic challenges. By fostering transparency and accountability in the prioritization process, healthcare organizations can better meet the needs of their populations while ensuring equitable access to care.
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The increasing resistance of bacteria to antibiotics has made many infections difficult to treat, posing not only a threat to public health but also a major challenge to healthcare systems worldwide.
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This suggestion takes into account the community aspect: Educate people about the use and management of antibiotics
· Raise awareness of the need to comply with prescriptions (human and animal health).
· Raise awareness of the serious risks of self-medication in the use of antibiotics.
· Communicate about the risks of managing leftover or out-of-date antibiotics.
· Involve communities: provide information on risky attitudes and their consequences at personal and community level; raise community awareness to commit to the fight against resistance.
· Combine efforts by pooling actions in human, animal and environmental health, as well as agriculture, to combat antibiotic resistance more effectively.
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Physician burnout can have far-reaching consequences that extend beyond individual well-being to affect patient care quality, healthcare costs, and the overall functioning of healthcare systems. Understanding and addressing burnout is essential for maintaining a resilient healthcare workforce and ensuring optimal patient outcomes.
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This question is based on the article, "Diagnostic Microbiology from the Beginning to the Future: Regional Antibiograms as Public Health Tools to Slow Down Antibiotic Resistance." The article addresses the special characteristics of infectious diseases in medicine, including the ability to isolate and study the causing agents in conditions similar to those of humans in a laboratory, thereby enabling the identification of the most effective treatments. Through this question, researchers will be able to gain a deeper understanding of how diagnostic microbiology can be used in healthcare systems, specifically to improve patient care and combat antibiotic resistance.
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Antibiotic resistance is a serious worldwide health issue, endangering the effectiveness of antibiotics against bacterial infections. It's vital to promptly and correctly identify bacteria that resist antibiotics to apply the right treatments and stop resistant strains from spreading. A deep comprehension of how resistance works and the development of new medications and vaccines are necessary. This is where national databases and diagnostic microbiology come into play. These tools, referring to national databases and diagnostic microbiology, offer valuable information essential for advancing the development of new medications and vaccines. By compiling data on antibiotic resistance patterns and identifying specific bacterial strains that pose challenges to current treatments, these tools guide researchers in designing novel therapeutic approaches. Additionally, they facilitate the identification of potential targets for drug and vaccine development, enabling scientists to focus their efforts on combating antibiotic-resistant bacteria effectively. In essence, the insights gleaned from national databases and diagnostic microbiology serve as a foundation for innovation in the field of antimicrobial therapeutics, ultimately contributing to the fight against antibiotic resistance.
References:
Uchil, R. R., Kohli, G. S., Katekhaye, V. M., & Swami, O. C. (2014). Strategies to combat antimicrobial resistance. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/jcdr/2014/8925.4529
Yamin, D., Uskoković, V., Wakil, A. M., Goni, M. D., Shamsuddin, S. H., Mustafa, F. H., Alfouzan, W., Alissa, M., Alshengeti, A., Almaghrabi, R., Fares, M. a. A., Garout, M., Kaabi, N. A., Alshehri, A. A., Ali, H., Rabaan, A. A., Aldubisi, F. A., Yean, C. Y., & Yusof, N. Y. (2023). Current and future technologies for the detection of Antibiotic-Resistant Bacteria. Diagnostics, 13(20), 3246. https://doi.org/10.3390/diagnostics13203246
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State ways in which Botswana's health system financed except taxation
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It’s very important issues, motivate health care workforces is one of difficult task in heat systems.
Last year (2022) I conducted a research on V"ALUE-BASED Health Services" in two public hospitals in Bangladesh. Here, I put a question on incentives for work-family harmony.
Following three recommendations was came;
1. Provide work-family harmony allowance
2. Give them 15days family vacations
3. Provision of instance leave in family emergency that will replace by "Reserve Healthcare Workforce".
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An inconsistent data set introduces biases and errors. This can have profound consequences for an AI model trained on such raw data. Biased and inaccurate data can perpetuate healthcare disparities and affect patient outcomes. What solutions have been proffered far in its resolution in order for AI to be effectively deployed in medicine and the medical sciences as well as the general healthcare landscape globally.
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Data privacy laws or equivalent for different countries.
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Health 4.0 is a term used to describe the integration of advanced technologies, such as the Internet of Things (IoT), artificial intelligence (AI), and big data analytics, into healthcare systems. The goal of Health 4.0 is to improve patient outcomes, streamline hospital operations, and reduce healthcare costs.
One of the key components of Health 4.0 is the use of electronic health records (EHRs) and other digital technologies to improve communication, collaboration, and data sharing among healthcare professionals, patients, and caregivers. This can lead to more efficient and personalized care, as well as improved patient outcomes.
Another important aspect of Health 4.0 is the use of IoT devices, such as wearable devices and remote monitoring systems, to collect real-time data on patients' health and activity levels. This data can be analyzed using AI and machine learning algorithms to identify patterns and predict potential health issues before they occur. This can help healthcare professionals to provide more targeted and proactive care to patients.
Health 4.0 also includes the use of telemedicine, which allows patients to receive medical advice and treatment remotely, either through video conferencing or through remote monitoring devices. This can improve access to healthcare for patients living in remote or underserved areas, and also allows for more efficient use of healthcare resources.
Overall, Health 4.0 is a holistic approach to healthcare that aims to improve patient outcomes and reduce costs by leveraging advanced technologies in a way that is integrated and coordinated across the entire healthcare system.
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Dear Professor,
Thank you for initiating a discussion on such an interesting topic.
I come from the field of Management. So, I am not directly related to this field. But, when it comes to anything regarding health, then who cannot be related. And, so I am getting into it.
When we start to talk about something like Health 4.0, we need to consider two important aspects related to it. First of all, the required infrastructure. Secondly, the finances involved. In my country (India), both these are obstacles. That Health 4.0 is not a significant matter of discussion anywhere.
I stay in Salt Lake City, Kolkata, West Bengal, in the eastern part of India. Yesterday, my 79 year old father got operated in his left eye for cataract. The surgeon was Dr. Pankaj Rupauliha. During the day, when I was there I was thinking that its been more than 75 years of independence. But still, we have not been able to help common people get access to a surgeon like Dr. Rupauliha. They have to depend on the quacks.
Best regards,
Anamitra.
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Please can you help me with West African countries with similar healthcare systems to Ghana?
What are the criteria?
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You may use the SWOT analysis, in line line with may thematic areas like available infrastructure, human recourse, available modern healthcare technologies, healthcare financing, competitive and comparative advantages and many others in relation to the other west African countries.
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Aim of qualitative research study is to elucidate the migratory push factors determining locally born and educated registered nurses to migrate from the only tertiary level hospital located in the small island, modern metropolitan capital city. in a country maintaining fairly stable economic and political conditions..
Undoubtedly, in consideration of globalization, an escalation in the number of native RNs migrating from a ''destination nation' for nursing migration, has grabbed the attention of healthcare systems stakeholders in the midst of the COVID-19 pandemic, there is no empirical evidence available to provide answers toward the planning and implementation of policies and strategies to stem the flow of these limited human healthcare resources' out of the nation's public healthcare system.
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Migration of labor like healthcare workers depends on several pull and push factors
Pull factors are better opportunities available at the destination sites for career advancement, better remuneration at the destination sites, job security at the pulling site, presence of high technology to make the work more fulfilling and enjoyable, adequate holiday periods for workers at the destination sites, higher and better pensions at the pulling sites and many others.
The push factors includes poor working environment, lack of technology, poor pension, absence of job security, comparatively low salaries etc. are but a few..
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All the countries across the globe have reconstructed the healthcare system responding to the COVID-19 pandemic. Many high quality systems were failed to contain the infection and to deliver adequate treatment.
Which might be a good model for healthcare now and future? Should we focus on primary healthcare or secondary and tertiary one? How to harmonize them to prevent and contain future disasters?
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A health disaster of this kind of pandemic Primary Health care system may not directly control the disaster without the required medical infrastructure. But it is inevitable to maintain all three levels based on the population size. Alongside it is also important a parallel Medical Research and Development in the Pharma sector. So budgets need to be categorized and disbursed accordingly as a proportion to GDP. In countries where GDP growth is slow and low requirements have to be met by external assistance to develop facilities. So the role of local government to global involvement has become the need of such situations.
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There are now 80 million children at increased risk of vaccine-preventable diseases due to COVID19-related disruptions in essential vaccination programs and health services.
Ahead of UHCDay, read more in STAT Darren Back, VP of Health Investments, about what we can learn from the current PublicHealth crisis and the importance of building more resilient healthcare systems to prevent the next GlobalHealth emergency: https://lnkd.in/djyUk-7 .InfectiousDiseases.HealthForAll ..
Thank you associates and friends on this platform on are discussions and interactions
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My Noble associates and friends here, we may have humbly shared this discussion about a month ago.
Experts have raised this issue at some international Biomedical meetings.
It appears to be an issue being addressed by our senior experts and those in our top Public Health positions.
We are glad, we believe our top experts are taking vital steps.
I nobly greet you all on this our discussion platform
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I am looking at the following factors:
How seriously they take healthcare?
What factors affect their behavior like severity or cost, etc?
Also, other parameters that help in deciding the patient's mindset.
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You can check with the MIMIC-IV dataset.
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Gostaria de saber referências e dados estatísticos dos gastos do sistema de saúde com idosos, quedas e internações evitáveis.
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I understand english please sak in english
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I want to have an idea about the current issues and future challenges of AI in the medical area. For that, I need some technical suggestions on the following questions:
1. How can we combine Big Data Analytics and Machine Learning techniques specifically for healthcare systems?
2. What can we achieve in the above case?
Thanks for your help!
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The recent trend & focus is on statistical approaches of Machine Learning towards data from industry, sciences, medical, business and politics etc.
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We have seen the lack of preparedness to manage the emergency health crisis and almost locked everything other than Corona when it was out of control. It was almost same across the world and after the crisis we have to think more about the reformation of healthcare system. Global cases top 11 million already and COVID-19 causes more than half a million deaths worldwide. The elderly with comorbidity are more vulnerable. The healthcare system everywhere is focusing mainly on COVID-19 management. Unluckily many more patients mainly old cases with hypertension, cardiac problems, chronic obstructive lung diseases or cancers are not getting priority and deaths are acceptable in silence. The vulnerability is more in poor and low income countries where they can’t afford to provide all the necessary healthcare together during the Corona crisis. We saw lots of disparity in healthcare even within the country with regional variations.
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The COVID-19 pandemic provides an opportunity for leaders to redesign healthcare and make it more equitable for all. healthcare disparities are typically mitigated when there are equal lelvels of access to care.
Here is an interesting article discussing this:
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The enforced public health measures and associated economic repercussions brought forth by the COVID-19 pandemic have found their staunch supporters and adversaries. It is not uncommon for two forces to be at odds, but in this case, both forces are necessary for what should be the ultimate goal: Human well-being.
One one side, the strictly imposed restrictions protect people from contracting and spreading the disease over a short period of time, while circumventing the otherwise inevitable overburdening of the healthcare system.
On the other, incurred financial losses, including unemployment and bankruptcy, conflict with the desires for well-being and the public's interest that has driven these same restrictions and public health measures.
This dilemma is not constrained to COVID-19, and can be applied more widely to discussions on the very foundations that healthcare systems and the public's access to them rest.
So where do we draw the line between the benefits of imposed public health measures and their economic repercussions? Who should be responsible for making such decisions? And what factors tip the balance on either end?
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We draw the line between them.
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I am working on a research to assess healthcare systems performance in terms of the flow of orders through networks. Therefore I'm looking for quantitative indicators for the following characteristics:
  • Accesibility: probability to receive attention
  • Continuity: probability to receive different services through once the patient has been received in a healthcare network.
  • Opportunity: how hard does it its to receive attention in a rational term?
  • Integrality: capability of healthcare systems to bring a complete package of different services for patients depending on their diagnosis
  • Resolutivity: posibility to effectively satisfy patient's needs for health services.
Thanks in advance.
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Thanks a lot Frederic Vanswijgenhoven . I'll take a look at this concept of "procurement networks" which seems pretty interesting.
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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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The outbreak of nCoV could become a tragedy for humankind in many countries. People with better health literacy have a better ability to manage their health. Therefore, the governments and the healthcare system should work together with other sectors at different levels to develop effective strategies and programs to manage the infection.
Need more experts' ideas.
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Health literacy is essential not only for personal reasons but the whole society gets the benefits.
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We all know that the healthcare systems around the world are going trough constant changes. The main reason for them is the effort to improve their effectiveness in terms to give people better health and sustain it (edited thanks to the answer of @Andrew William McCulloch).
How do you think - what causes the failure of a healthcare system to achieve its main purpose? Is it:
  • incompetent management;
  • poor health literacy of the population;
  • wrong priority setting (like overfunding care for "healing the problems" instead of preventing them);
  • all of them combined or
  • other reasons...
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I think we have to start at a more basic level - what is the purpose of healthcare systems - to cure, to provide care, to triage,,, for who? - everyone, those with resources/insurance.... and where,... in hospitals, outpatients centers, primary/general practice settings... for physical and/or mental and/or behavioral health....
I think these systems get into trouble because the choice along these and other dimensions are unclear, or they are trying to do more than one but are resourced for something else. they also suffer from the consequences of changing priorities. These circumstances provide opportunities for ill-informed and mismanagement and inefficiencies. Also, the patients/persons accessing and the staff at all levels also have agendas, may be ill-informed about the purposes and challenges in healthcare and their specific roles and may not agree with or value the stated and actual purposes of healthcare.
It would seem that strong, clear and agreed across stakeholders purposes of healthcare and associated resource allocations (which also require agreement) are elusive but probably needed.
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We measured and compared patient satisfaction in two different healthcare systems in Northern Pakistan. It was published:
Now we want to follow it up to measure any changes in level of patient satisfaction. Is the tool still valid?
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The tool is valid, but the sample is not. Convenience sample was obtained and obviously you are not going to get the same patients. Moreover, the same sample may not be relevant, as patients use hospitals temporarily. So, basically you will have two different independent studies, maybe from the same hospitals, but it cannot be a before-after study to reflect true change in patient satisfaction. If these hospitals have made some changes to their systems to enhance patient satisfaction, then one could compare the previous study to the newer one.
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Dear Professors,
I hope this message finds you well! Currently, I am in the process of editing a forthcoming publication entitled Incorporating the Internet of Things in Healthcare Applications and Wearable Devices, to be published by IGI Global, an international publisher of progressive academic research. I would like to take this opportunity to cordially invite you to submit your work for consideration in this publication.
I am certain that your contribution on this topic and/or other related research areas would make an excellent addition to this publication.
Please visit https://www.igi-global.com/publish/call-for-papers/call-details/3658 for more details regarding this publication and to submit your work. You can also find detailed manuscript formatting and submission guidelines at http://www.igi-global.com/publish/contributor-resources/before-you-write/. If you have any questions or concerns, please do not hesitate to contact me. Thank you very much for your consideration of this invitation, and I hope to hear from you with the chapter proposal by January 30, 2019!
Recommended topics include, but are not limited to, the following: Part – I - Design of sensors and wearable devices for IoT-based Healthcare applications - Emerging wireless technologies for IoT-based Healthcare Systems - Software Defined Networking (SDN) and IoT-based Healthcare Systems - Architectures and models for IoT-based Healthcare applications - Standards for Wireless Body Area Network (WBAN) communication protocols - Wireless MAC protocols for WBAN - Routing for WBAN-based healthcare applications - Security issue, attacks and vulnerabilities in WBAN - Mobility management in WBAN - Wearable Sensor Integration for Healthcare - Emerging Trends in IoT-based Healthcare Systems - Security, Privacy Issues and Challenges in IoT-based Healthcare Systems - Storage Issues and Challenges in IoT-based Healthcare Systems - IoT-based Healthcare Systems for remote health monitoring - Emerging e-Health IoT Applications - Personalized and Patient Centric Healthcare in IoT - Integration of E-health and Internet of Things Part – II - Integration and support of Cloud Computing in IoT-based Healthcare applications - Big Data, Data mining and Data Analytics in IoT-based Healthcare applications - Service oriented architectures and middleware’s for IoT-based Healthcare Systems - Privacy and security in IoT-based Healthcare applications - Machine learning and Deep learning for IoT-based Healthcare Systems - AI based systems for IoT-based Healthcare Systems - Predictive Modeling for Improving Healthcare using IoT - Exploration of health data in IoT - Clinical decision support systems in IoT - Clinical data storage and communication in IoT - Behavior change and analysis models in IoT-enabled personalized healthcare systems - Ontologies, knowledge technologies, semantic web systems in IoT-based Healthcare - Emergent IoT-based Healthcare applications
Important Dates
January 30, 2019: Proposal Submission Deadline February 15, 2019: Notification of Acceptance April 14, 2019: Full Chapter Submission May 14, 2019: Review Results Returned July 9, 2019: Final Acceptance Notification July 23, 2019: Final Chapter Submission
It will be great if you can kindly submit a tentative title, and abstract (minimum 750 words) through IGI editorial discovery(Link given above)
If any queries, kindly contact via E-Mail: pankajavalli@buc.edu.in, karthickselvaraj34@gmail.com
Best Wishes Dr.P.B.Pankajavalli, Mr.G.S.Karthick Editors Incorporating the Internet of Things in Healthcare Applications and Wearable Devices
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Ok
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Interprofessional education is important for healthcare system as it is a team work. Looking for ideas / methods which are effective in improving interprofessional skills in healthcare education.
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This is a wonderful question. I typically use focused mentoring within an inter professional team. The interprofessional team research provides a setting where students, fellows, and other trainees gain first hand experience in needed skills such as building and engaging team members, holding colleagues accountable for promised work, negotiating roles and responsibilities on a project, presentation, or paper, and handling disciplinary differences in academic support for team science, culture and communication patterns, and measures of success, .
As challenges emerge, I try to provide opportunities for discussion of both the rewards and challenges of interprofessional team work. More recently, I have been interested in developing resources for trainees in the most important skills needed for interprofessional teams.
Looking for suggestions on resouces for interprofessional training, including any curriculum development on training in interprofessional team research and any program that involve explicit training in the important knowledge and skill domains needed for interprofessional team research.
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readyness
infra structure
standards
evaluation
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I believe you might find this research helpful
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Nurse practitioners and physician assistants hold an important place in the healthcare system. Both nurse practitioners and physician assistants routinely serve the primary and preventative care needs of the patients.
Can a nurse practitioner do as a physician assistant if it is necessity? If not, why?
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Maybe this link could be interesting and useful for you.
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What new and practical issues are important in the management and economics of the healthcare system in the world?
  • Please provide your suggested titles on these topics.
Thank you for answering...
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How about the nearness to death effect. Widely recognised by economists but has never been applied to health care capacity planning and demand forecasting. See papers at http://www.hcaf.biz/2010/Publications_Full.pdf
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What international/national healthcare policies are there for frailty in older people? I am aware of the UK's GP contract, where all GPs are identifying those with frailty in primary care. Australia (my country) has no policies at all. What are other countries doing?
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In Portugal where I did my PhD about Patient Portals, there is no specific measure to address this topic and most of the users in Portugal are younger and more educated than the average, and the usage patterns whithin older people is still very low
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How do psychiatrist, therapist, counselors and substance use treatment professionals integrate modalities in order to meet the need of patients with co-occurring mental illness and substance use disorder?
How do primary care, specialist, psychiatrist, social workers and therapists integrate cohesively and work collaboratively to address those they treat and provide services?
What role does administrators have in facilitating integrations of different modalities of medicine ?
With modern technology bringing everyone and everything closer, why is the American Healthcare System fragmented?
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“Collegiate Recovery Programs: The Integrated Behavioral Health Model”
Regards
Dr. Kamath Madhusudhana
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thanks.
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You could do an assessment with a tool that has been developed and used with medical students (the APSQ-III), reported by Carruthers et al. in 2009 - also visible on research gate. (Carruthers, S., Lawton, R., Sandars, J., Howe, A., & Perry, M. (2009). Attitudes to patient safety amongst medical students and tutors: Developing a reliable and valid measure. Medical teacher, 31(8), e370-e376. and a second reference: Leung, G., Ang, S., Lau, T. C., Neo, H. J., Patil, N. G., & Ti, L. K. (2013). Patient safety culture among medical students in Singapore and Hong Kong. Singapore Med J, 54(9), 501-505.)
This has to be adapted for use in healthcare professionals but gives an insight into the understanding of medical errors.
Secondly, you could assess the experience of healthcare professionals and their assessment of actual patient safety practice with the SAQ, used in the following references:
Abu-El-Noor, N. I., Hamdan, M. A., Abu-El-Noor, M. K., Radwan, A.-K. S., & Alshaer, A. A. (2017). Safety Culture in Neonatal Intensive Care Units in the Gaza Strip, Palestine: A Need for Policy Change. Journal of pediatric nursing, 33, 76-82. and :
Hamdan, M. (2013). Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire. Journal of critical care, 28(5), 886. e887-886. e814. )
I hope this is helpful.
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A Nuclear medicine is a part of a country's national healthcare system. Could you recommend me please a nuclear medicine development plan benchmark?
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The nuclear medicine service
Plans for the establishment of a nuclear medicine service must address the following points:
(a) Level of service needed;
(b) Equipment specifications;
(c) Human resource development;
(d) Site preparation;
(e) Adherence to building, fire and security codes;
(f) Delivery and testing of equipment;
(g) Procedure manuals and department policy;
(h) Service administration;
(i) Official opening ceremony;
(j) Marketing;
(k) Programmes for:
—Physician interactions,
—Continuous clinical evaluation,
—Quality control,
—Initiation of research projects;
(l) Future developments.
The IAEA document suggested by Dr. George C, Giakos is an excellent document that can be used to answer all questions you may have on this subject.
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Nursing documentation methods for patients receiving bladder instillations of BCG. Which methods are used in the urology outpatients department
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There are two categories of documentation methods in nursing such as documentation by inclusion and documentation by exception. In the former, nurse practitioners make note of all assessment findings, nursing interventions and client outcomes on an ongoing, regular basis. In the latter, they make note of negative findings and this documentation is completed when review findings, nursing interventions or client outcomes show a variation from the established assessment norms / standards of care prevailing in a particular practice setting. The common documentation methods in these categories are focus charting, SOAP charting and narrative charting. Nurse practitioners can select any of these methods, but ensure that the selected method reflects client care needs and the context of practice. Focus Charting This documentation method focuses on particular client concerns/behaviors, a change in the client’s condition/behavior, or a significant event in the client’s treatment determined during the assessment. In the documentation, three columns are utilized for focus charting or F-DAR chartin.
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Dear Researchers,
I would like to know what health economic research (analytical) methods for understanding variations in costs and health outcomes within and across countries you see as most advanced and practical in aplication?
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The attached files are references for you. You can study a disease's cost of western medicine and Chinese medicine or acupuncture treatment.
Acupuncture treatments through well-trained acupuncturist do not induce any side effects. 
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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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Dear Reader,
Please find below the detailled description of my current research and a couple of specific questions. I am glad for any opinion/input that you have on the topic, so please don't feel forced to answer the entire set of questions!
Many thanks and best regards
Stephan Schmidbauer
Preface
Combination treatments are an ever-increasing presence in oncology. In terms of explicitly approved drug combinations, the question is how the (additive) prices of these combinations can be reconciled with the financial power of the public healthcare system. If a clear advantage to overall survival can be demonstrated in a head-to-head clinical trial, the combination in question will usually be reimbursed. Often, however, manufacturers will refer to historical comparisons, one-arm trials, surrogate endpoints or adapted pathways for approval in order to provide evidence of efficacy. Despite subsequent approval, this leaves a significant degree of uncertainty in relation to efficacy and safety of new combination drugs. On the other hand, results on efficacy and safety in comparisons of phase II and III trials are frequently revealed to be in direct contrast (up to 50% of combinations are eventually found to be ineffective and/or unsafe, cf. doi:10.1038/nbt.2786 pmid:24406927).
A further case for consideration is the simultaneous administration (or sequential, if necessary) of drugs approved only as monotherapies; so-called “free combinations”. Aside from a pharmacological rationale, there is often no evidence to support such a regimen, yet the costs are additive.
  1. What data on efficacy, safety and (additional) benefit would you demand before reimbursing (as a payer) or prescribing (as a doctor) combination therapy instead of a monotherapy?
  2. Are surrogate parameters sufficient evidence of additional benefit in view of the significant (additional) cost of combination therapies?
  3. Do you differentiate between explicitly approved and “free” combinations when prescribing or reimbursing? (E.g. pertuzumab + trastuzumab vs. trastuzumab + anti-PD1; i.e. https://clinicaltrials.gov/ct2/show/NCT02129556?term=pembrolizumab+AND+breast&rank=1)
  4. How will you meet the financial challenges posed to your healthcare system by the foreseeable spread of combination drugs?
    • A:In your opinion, are the current combination drugs fairly priced?
    • B:Given that the value (to patient–relevant benefit) contributed by the individual partner of a drug combination  is normally unknown (i.e. it is unclear whether x months of drug 1 and y months of drug 2 contribute to i.e. Overall Survival ), how would you determine fair prices for the combination drugs?
  5. Do you view drugs reaching the market via accelerated approval processes more critically than drugs with full approval? If so, why? Do you reimburse/prescribe differently depending on the route to approval?
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Dear Stephan, this article, which I enclose, is not on the drug combinations in oncology. However, it addresses the issues of effectiveness, ethics and costs related to the introduction of new oncology drugs. I hope it will be useful to you.
Best regards, Maurizio
Cancer drugs, survival, and ethics
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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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Hi, I'm carrying out a research that aims at investigating the relationship between the Diagnosis Related Group weight (DRGW) and the complexity of the procedure. in other words, I'm interested in knowing if the DRGW is dependent on the complexity of the procedures or not. My experience is that the DRGW is exponentially increasing with the complexity (Italian dataset analysis), but I would be pleased to have a feedback or literature of reference. Moreover, I hypothesize that there would be a relation also between the volume of the procedures provided and the complexity of the same procedures.  Can anyone help me in my research?
Thanks in advance.
Cinzia Muriana
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I would like to write a report on the current issues facing the healthcare services in norway at this point in time. I have been informed that there has been much debate in to the transition of the role of leadership between health professionals and central government; however, I cannot find any valid literature on the subject. If anyone could give me some ideas of where to look or have any articles they could share with me I would be very grateful. Thank you.  
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Dear Gabriel Jarvis, Hi, With kind regards, Attachments for your question. 
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value steam mapping ; lean manufacturing ; 
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 Thanks Nam Dv
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cause the typical calculation is usually applied in the manufacturing system whereby it used number of workstation, the demand of the product being produced and etc. in the healthcare system, there are only staff working hour and the fluctuate number of patient. so what is the indicator can be used?
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Dr. Wahida:
If you are referring to healthcare staffing for physicians, NPs, PAs, RNs, RTs, etc, there are specific staffing ratio guidelines depending on the type of healthcare setting.  For instance, most critical care areas only allow for no more than 2 patients per RN whereas most emergency departments (ED) staff with a 3 to 4 patients per RN.  In the USA there are regional differences and my work has been on the west coast which all follow the same staffing guidelines.  Most in-patient units will staff based on the current census, where the ED will staff based on what the normal flow is throughout the department.  Hope that answers you question.
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Market interested in is Singapore. 
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Hi Oindrila!
Basically there could be several factors determine the choice of provider. From the socio-economic perspective, income (or monthly per capita expenditure may be used as a proxy), gender, education, social/ethnic background, age, religion, occupation, access to insurance facilities, living condition, geographic location etc. are mostly responsible for choice of provider. However, these are only demand side factors. On the supply side, there may be many factors too; like availability of (different type of) facility, cost structure across different facilities, availability of medicine etc. determine choice of provider. There are plenty of good literature in this area. I would suggest you to consult few literature for better understanding of the issue.
Thanks!    
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I'm looking for reimbursement information for the Japanese market. I'm also interested in the structure of reimbursement and also of the healthcare system in relation to dialysis - what is the split between private insurance and public funding.
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I can not give answer  I am not include in that
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Can a healthcare system achieve both equity and efficiency objectives at the same time? Would you say equity and efficiency are complementary or contradictory concepts in healthcare?
Governments and policymakers often seek to provide healthcare to all citizens based on their health needs. Thus, all persons should have full and equal access to healthcare commensurate to their health needs no matter where they are or the cost. However, due to increasing cost of healthcare, there is also the need to ensure prudent and efficient use of resources. Can the equity drive co-exist with efficiency? Should one be achieved before the other. 
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This is a good question and replaying is not an easy task.
Public economics’ models teach that there is a trade-off between equity and efficiency, and for efficiency I mean allocative (Pareto) efficiency. An example could be the copayment for the health services. If there is universal coverage, Governments introduce it to avoid welfare loss  due to patients moral hazard (in the absence of a price). However, this instrument is against equity because it is viewed as a tax on the poorest or on the sickest. So its use should be avoided where the demand of services is rigid (for example chronic patients) whereas it is efficient on services for which the demand is elastic.
For what is concerning health systems as a whole, it is possible to find systems where both inequity and inefficiency are present (such as the USA model – very high per capita health expenses – and almost 48 million people without health insurance ) and models where there is a balance between efficiency and equity (such as the British NHS or the Italian SSN). In Italy for example we have low per capita expenses, universal coverage and good health outcomes, such as life expectancy.
But, of course,  if it is the Government who rules the service supply, as Buchanan suggests, the excess of demand due to moral hazard could be controlled for by controlling the supply….with possible consequences such as long waiting times.
As told before, it is difficult to answer within few lines. As someone already suggested within this blog, the aims of a good health care system should be conjugating both the objectives.
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Telemedicine on the battlefield
telemedicine in military hospitals
telemedicine in the healthcare system of war veterans
individual sensors of life in the military
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The methods of evaluation at NICE (UK) include a component called fairness.  That might be placed into play should there be proven ethnic differences in responses to a proposed protocol or protocol change.
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are there useful books for see application of system dynamics modeling in healthcare Problems? Also,for teaching in Graduate Classes of Healthcare System Engineering,it be suitable.
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You may find "Resilient Health Care" (Erik Hollnagel, Jeffrey Braithwaite, Robert L Wears (editors), Ashgate Publishing 2013) and "Resilient Health Care Volume 2" (Robert L Wears, Erk Hollnagel, Jeffrey Braithwaite (editors), Ashgate Publishing 2015) to be useful texts.
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Suggestions of recent articles or journals will be much appreciated!
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Thank you, George - Quite interesting observation!
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I am conducting a discrete event simulation research for the management of patients flow in an emergency unit of a healthcare system but pose with a problem of getting a suitable software that can help me analyse the data obtained.  
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Hi Umar M. Modibbo,
AnyLogic is an often preferred simulation software recently by academia. It enables users to multi method modelling. You can find samples of AnyLogic models including emergency room model in this link:
Best wishes.
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What are the various applications of digital electronics, embedded systems and wireless sensor networks in Healthcare?
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Heart monitoring to prevent heart failure or in the case of sport parctice, blood test for Glycemic insufficiency, ....
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I am conducting a research project on the use of research and program adaptation and was wondering if anyone would like to provide there professional input.  I have a series of question I would like to ask and administrator or practitioner who has used evidence based research to begin or change a program. 
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Thank You Michael, I will send you a message with few questions I have in mind.
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I'm looking at the health system, the performance results versus the district leadership.
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My thought are that what you are creating is a culture shift.  For that to happen the managers at every level must create a culture for improvement and safety.  This involves creating a learning culture that but begin at the front line and must include everyone.  What you want to strive for is "ownership" not buy-in.  Buy-in is a very superficial agreement, ownership is just that they own the process and the changes.  It is a much deeper level of engagement.  Creating a learning culture is what you will what to move toward, where everyone one from clincial staff to the housekeeping staff participate in the improvement of care,  they own the process and outcomes.  The patients are important to them.  Suggest looking at the text, "Knowledge for Action" by Chris Argyris.  Also including some Dartmouth articles that might help you, they are older but the theories still apply, they are the core of what most are doing for system change.  Also look at what IHI.org is doing about system change.
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hospital bed allocation optimization to hospital wards
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Please recommend research articles which discuss the efficacy of slum and informal settlement based women groups, based on studies, authors, or collaborators conducted in such slums, informal settlements in India, Bangladesh, Pakistan, and countries in Africa.
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I know a graduate of UNCG did her dissertation on homeless women in Greensboro NC. I had not met her, but contacting University of North Carolina at Greensboro, NC library may allow you to get a copy of the dissertation
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I am looking at the impact of activity-based funding on the length of stay (LOS) in the hospital. I will run three models: 1) 2009 vs 2010; 2) 2009 vs 2011; 3) 2009 vs 2012. For the treatment groups I have same percentile distribution till 90 percentile. Is it a problem? Conceptually, this is expected because the reduction in LOS will occur from the patients who stays longer. I am taking log of the dependent variable. I get reasonable results. I found a small statistically significant coefficient for the interaction term in the third period. The question is: is it worth doing because of the distribution issue. I personally see no problem, but one of my colleagues thinks I shouldn't proceed with this project.
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I'm adding consideration from Ariel answer. Are you sure that from 2009 till 2012 no changing in technology (drugs, pathways) occoured in the hospital? And the same no changing from personnel capacity?
Ciao
Davide
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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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How do we implement a metamodel that is built on another metamodel (meta-metamodel) to support a domain specific framework for a healthcare system management?
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As said Cristiano, to create your metamodel, you should use EMF. You can use Ecore Tools to create it easily : https://www.eclipse.org/ecoretools/
Then, you can use Sirius to easily create your designers. They will relied directly on your metamodel and you are fully free to customize the behavior and the graphical style of each concept: http://eclipse.org/sirius/
All these projects are OpenSource and mature.
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I would like to explore and your opinions regarding healthcare international accreditation. What are the challenges facing by our healthcare forces during the preparation and the actual survey?
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Healthcare accreditation is a very demanding process, but you must encourage everybody to give their best, because it certainly can improve the way you treat your patients. I think the biggest challenge for healthcare professionals is time management, because your work doesn't stop during the accreditation process. Another challenge is how to involve doctors, nurses and other health professionals and change their mindset. But it's an amazing experience, with good results for all.