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Introduction The International Organization for Standardization (ISO) published the ISO 45001 occupational health and safety management system (OHSMS) standard in March 2018, replacing the outdated OHSMS 18001 (ISO, 2018). Unlike [...], Educational institutions can implement the ISO 45001 management system to ensure a safe and healthy environment for all individuals involved. This article proposes a gap analysis method to identify gaps between the existing and desired health and safety conditions in an educational institution. To test the applicability of the method, data from a sample of five high schools in the Merzifon District of Amasya Province in Turkey were used. The results of the gap analysis reveal a notable gap between the existing occupational health and safety conditions and the standards proposed by ISO 45001 in some of the selected educational institutions. This finding highlights the need for these educational institutions to implement the appropriate measures to close this gap. Keywords: gap analysis, ISO 45001, occupational health and safety, education sector, Turkey

Background: Untreated impacted wisdom teeth can lead to complications, including delayed healing and inferior alveolar nerve damage. Delayed management is further complicated by age-related comorbidities. Aim: This study aimed to evaluate the management of impacted wisdom teeth in a teaching dental hospital and identify challenges faced by dental care providers. Materials and Methods: A retrospective radiographic study was conducted using data from electronic medical records and panoramic radiographs of patients. Independent variables included demographics and clinical details of wisdom teeth, such as type and presence of impaction, associated pathology, nerve proximity, second molar resorption, and extraction difficulty. The study assessed the evaluation of dental care provider practices in managing impacted wisdom teeth. Chi-square tests analyzed relationships between management type, provider level, and extraction difficulty. Results: Data from 270 panoramic radiographs and dental records were analyzed. Most cases were not managed (n = 216, 80%), irrespective of extraction difficulty or care provider level (undergraduate vs. graduate). There was no significant association between care provider levels and the type of management or between impaction difficulty and management type (p > 0.05). Conclusions: The findings highlight a lack of proper evaluation and management of impacted wisdom teeth, regardless of the provider's experience. In hospital settings, all care providers should ensure the timely evaluation and management of impacted wisdom teeth to prevent complications. [ABSTRACT FROM AUTHOR]

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Existing literature has emphasized the importance of certain skills vital for student nurses as they prepare for leadership and management roles before becoming registered nurses. This review aims to provide a more comprehensive insight into the essential leadership and management skills identified in previous research. The current study seeks to explore the leadership and management skills necessary to prepare student nurses for their roles in clinical settings. Methods: Following PRISMA-ScR guidelines, studies published in English were retrieved by searching PubMed, ScienceDirect, Scopus, and Google Scholar using the keywords 'student nurse', 'leadership skills', and 'management skills'. After conducting a one-month literature review using the selected keywords in PubMed, ScienceDirect, Scopus, and Google Scholar, we identified 394 citations. From these, fifteen articles were chosen for inclusion in the review. Selected studies primarily involved undergraduate and postgraduate student nurses from various countries. Results: Thematic analysis highlighted that communication skills are crucial for student nurses to become effective clinical leaders, leveraging their educational experiences. Mentorship plays a pivotal role in developing leadership and management skills. Workshops, training, and simulations are also recognized as important in preparing students for these roles. Moreover, self-awareness and understanding of personal skills were identified as critical for building confidence, fostering reflection, strategic planning, and making sound decisions. The literature also underscores the significance of resource management, conflict resolution, risk assessment, and prioritization skills for student nurses. Conclusion: The articles emphasize the importance of student nurses recognizing leadership and management skills before entering clinical practice. However, while various assessment tools and workshops exist to train these skills, the studies suggest that more time and resources are needed to effectively address students' learning needs. [ABSTRACT FROM AUTHOR]

Introduction: Electrical injuries (EIs) represent a significant clinical challenge due to their complex pathophysiology and variable presentation, ranging from minor burns to severe internal organ damage. Despite their prevalence in both; domestic and occupational settings, there remains a rareness of systematic guidelines and comprehensive literature to aid clinicians in effectively managing these injuries. Understanding these factors is crucial for developing protocols that can mitigate the risk of delayed complications, such as cardiac arrhythmias, in patients who initially appear stable. Objectives: This study aims to elucidate the epidemiology, clinical outcomes, and predictors of severe presentation in EIs, providing insights to improve patient assessment and management strategies. Methods: A retrospective study was conducted over 4 years. Data were collected from standardized medical records. The group of patients with severe complications included those who presented a life-threatening cardiac, respiratory, neurological, or biological impairment or died within the first 48 h of the EI. Results: We enrolled 118 cases of electrical injury (EI). Ages ranged from 4 to 82 years, with 31.3% under 15. EI incidence peaked in summer, with 63.5% being home accidents. High-voltage injuries occurred in 13.6%. The most common ED complaints were burns in children (59.5%) and trauma in adults (48.1%). ECG abnormalities correlated with tetany (p = 0.016), and palpitations (p = 0.014). Complications included cardiac arrest (n = 8), rhabdomyolysis (n = 23), and acute renal injury (n = 9). Severe EI was linked to respiratory distress and creatine kinase levels higher than ≥ 253 UI/l. A normal ECG within 1 h post-injury was correlated to a low risk of severe EI. At 2-year follow-up, 43.9% of survivors reported aesthetic sequelae, 25.3% had psychological disorders, and 7% of adults could not return to their previous occupations. Conclusion: EIs are frequent, with diverse clinical presentations requiring multidisciplinary care. Awareness of potential delayed complications is essential, and prevention is crucial. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the risk factors and common presentation characteristics of people in suicidal crisis • To be aware of the vulnerability of people in suicidal crisis • To enhance your understanding of how to support people in suicidal crisis. Emergency departments (EDs) provide critical opportunities for nurses to support suicide prevention. This article details a service evaluation that was undertaken to explore the characteristics and outcomes of people in suicidal crisis at two EDs in the East of England during June 2023. Data routinely collected by the ED mental health liaison team were combined with a retrospective case note review of the local NHS mental health trust’s electronic patient records. Attendees had a mean age of 35 years and seven months, and were often diagnosed with depression or emotionally unstable personality disorder. Most had a history of self-harm and were currently known to mental health services. Suicide-specific interventions were rarely recorded by nurses and relapse behaviours were prevalent after presentation. Local and national suicide prevention strategies should encourage nurses to address gaps in support, thereby improving patients’ experiences in and beyond the ED. [ABSTRACT FROM AUTHOR]

Copyright of Cuaderno de Pedagogia Universitaria is the property of Pontificia Universidad Catolica Madre y Maestra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A simple and rapid method that is not based on race and ethnicity for classifying people with skin of color is of paramount importance in dermatology. The currently used Fitzpatrick classification of sun-reactive skin types is inadequate. Newer scales that have been used in immigration surveys and sociology studies are not applicable in the office setting. A new, non-racial and non-ethnic, colorimetric scale for skin of color has recently been proposed that is simple to perform. The scale has five colors: very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4) and very dark brown (skin color type 5); an individual with white skin, such as in albinism, would have a skin color type 0 in this classification. In conclusion, the colorimetric scale enables the rapid classification of individuals with skin of color and allows for accurate assessment of skin cancer risk, more appropriate management of cosmetic dermatologic procedures and aesthetic devices, and enhanced ability for focused counseling regarding hair products, skin care interventions, and color-targeted makeup based on the person's skin tone.

Author(s): Manjari Tripathi (corresponding author) [1]; Sandhya Sharma [1]; Avinash Ganapule [1]; Rekha Dwivedi [1]; Kirandeep Kaur [1]; Vasundhara Shukla [2]; Saranya Gomathy [1]; Prarthana Chandra [3]; Rajesh Kumar Singh [...], Background and Objectives: Functional dissociative seizures (FDS) are very common in neurology clinics, they straddle both neurology and psychiatry. In India, scarce resources and guidelines are available for effectively conveying their diagnosis and management, which leads to a substantial gap in care. We aimed to provide an instructional module for FDS, tailored to clinicians, patients, and caregivers in Hindi, to enhance communication of diagnosis and facilitate suitable management strategies. Methods: The instructional module development process was based on clinical settings and expert opinions. A standard translation process was performed to ensure the linguistic and cultural equivalence. Validation was carried out by a panel of 15 validators, comprising 13 neurologists and two psychiatrists, to identify key psychoeducation components and their significance. They were provided a questionnaire consisting of five questions that were related to completeness, understandability, legibility, clarification, and usefulness of educational material for clinicians, patients, and caregivers. Items were rated using a 5-point Likert scale. Results: There was agreement on four items (Q1, Q3, Q4, and Q5), whereas approximately 85% of the validators agreed on the remaining one item (Q2). The instructional module demonstrated high content validity as indicated by both item level-content validity index (0.98) and scale-level content validity index (0.97), alongside content validity ratio and modified kappa statistics. Conclusions: The developed Hindi instructional module for FDS serves as a valuable tool to enhance the communication of FDS diagnosis and dispel misconceptions. This offers a comprehensive resource for clinicians, patients, and caregivers in India, potentially bridging gap in FDS care. Keywords: Instructional module, Functional Dissociative seizures, conversion disorder, World Health Organization, content validity ratio

Introduction Somalia received its first 300 000 doses of coronavirus disease 2019 (COVID-19) vaccines from the COVID-19 Vaccines Global Access (COVAX) initiative on 15 March 2021, (1) and the first [...], Problem By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19). Approach To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children&apos;s Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced. Local setting Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people. Relevant changes The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero- dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns. Lessons learnt Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people&apos;s homes. Probleme Au 31 decembre 2021, seulement 5,5% (861 879/15 670 530) des Somaliens etaient totalement vaccines contre la maladie a coronavirus 2019 (COVID-19). Approche Afin d&apos;accroitre rapidement la couverture vaccinale contre la COVID-19 en 2022, le Ministere de la Sante et ses partenaires (l&apos;Organisation mondiale de la Sante et le Fonds des Nations Unies pour l&apos;enfance) ont adopte une strategie plus reactive. Celle-ci comprenait une microplanification minutieuse, un meilleur ciblage des populations et la fourniture de services de vaccination centres sur les personnes, a proximite de leur domicile. Ces services etaient combines a une vaccination des enfants et a des soins de base, grace au reseau actuel de lutte contre la polio et des agents de sante communautaires. En outre, un outil numerique d&apos;acquisition des donnees relatives a la vaccination contre la COVID-19 ainsi qu&apos;un systeme d&apos;enregistrement electronique via telephone mobile ont ete deployes. Environnement local La Somalie, un Etat fragile et en conflit, a ete confrontee a des difficultes de mise en reuvre de la vaccination contre la COVID-19, notamment en raison de son manque d&apos;experience dans la gestion de campagnes de vaccination massive des adultes, de ses infrastructures inadaptees et d&apos;une penurie de soignants. De plus, l&apos;insecurite qui regne dans certaines regions et la secheresse extreme ont entraine des deplacements a grande echelle. Changements significatifs L&apos;instauration d&apos;une strategie mieux adaptee au contexte a aide la Somalie a vacciner nettement plus de gens contre la COVID-19, et a atteindre 42,1% de couverture vaccinale au 31 decembre 2022. Par ailleurs, 84 600 enfants <> ont recu leur premier vaccin pediatrique durant les campagnes combinees. L&apos;amelioration de la couverture vaccinale a engendre de nombreux benefices pour la sante publique, depassant l&apos;investissement dans les campagnes de vaccination contre la COVID-19. Lecons tirees En definissant une approche contextualisee et sur mesure, il est possible de proceder a la vaccination des adultes, meme dans une region fragile et en conflit. Parmi les facteurs cles figurent une bonne microplanification, le recours aux outils numeriques, un meilleur ciblage des populations, le regroupement des vaccins et la mise a disposition de services de vaccination non loin des habitations. Situacion A 31 de diciembre de 2021, solo el 5,5% (861 879/15 670 530) de la poblacion somali habia sido completamente vacunada contra la enfermedad por coronavirus de 2019 (COVID-19). Enfoque Para aumentar rapidamente la cobertura de la vacuna contra la COVID-19 en 2022, el Ministerio de Sanidad y sus asociados (la Organizacion Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia) adoptaron una estrategia mas receptiva. Esta estrategia incluia una cuidadosa microplanificacion, una mejor seleccion de las poblaciones y la prestacion de servicios de vacunacion centrados en las personas y cercanos a sus hogares. Los servicios se combinaron con la vacunacion infantil y la prestacion de atencion sanitaria basica mediante la red antipoliomielitica existente y los agentes de salud comunitarios. Ademas, se introdujeron una herramienta digital para registrar los datos de vacunacion contra la COVID-19 y un sistema de registro electronico por telefono movil. Marco regional Somalia, un estado fragil y afectado por conflictos, atraveso dificultades a la hora de implementar la vacunacion contra la COVID-19, como la inexperiencia en la gestion de la vacunacion masiva de adultos, la falta de infraestructuras y de personal sanitario. Asimismo, la inseguridad en algunas regiones y la grave sequia provocaron desplazamientos de poblacion a gran escala. Cambios importantes La implementacion de una estrategia mas adaptada al contexto ayudo a Somalia a llegar a un numero mucho mayor de personas con la vacunacion contra la COVID-19 y a una cobertura del 42,1% a 31 de diciembre de 2022. Ademas, 84 600 ninos con dosis cero recibieron su primera vacuna infantil durante las campanas integradas. El aumento de la cobertura ha propiciado beneficios para la salud publica que superan la inversion en las campanas de vacunacion contra la COVID-19. Lecciones aprendidas El despliegue exitoso de la vacunacion de adultos es posible incluso en un entorno fragil y afectado por conflictos mediante la implementacion de un enfoque contextualizado y adaptado. Los factores clave consisten en una buena microplanificacion, el uso de herramientas digitales, una mejor orientacion de la poblacion, la agrupacion de vacunas y la prestacion de servicios de vacunacion cerca de los hogares.

Introduction Health-care technology includes medical devices, procedures and systems, as well as medicines and vaccines, and involves the application of organized knowledge and skills. (1-3) Such technology plays a crucial [...], Health-care technology is central to boosting the productivity and quality of health-care systems. In many sub- Saharan African countries, however, medical device management systems are weak or absent. The aim of this article is to illustrate, using a case study, how policy reforms can help ensure policy on health-care technology is translated into everyday practice and how an integrated systems approach can enhance the operation of medical device management. Between 2011 and 2023, a plan to improve medical device management systems in the United Republic of Tanzania was developed and implemented through Swiss-Tanzanian cooperation within the Health Promotion and System Strengthening Project. The availability of biomedical engineers was increased through new training courses and the creation of permanent positions in government. Moreover, additional district and regional maintenance and repair workshops were built, and a National Centre for Calibration and Training was established to ensure the correct functioning of medical devices. The introduction of an electronic medical device management system provided health facilities and the health ministry with data on the operational status of medical devices and the need for repairs and spare parts. Every level of government was encouraged to allocate more human and financial resources to medical device management. Following this decade-long effort, the percentage of functioning equipment increased substantially, and costs were reduced by repairing rather than replacing equipment. The project also demonstrated the value of an integrated, system-strengthening approach that considered personnel, maintenance and repair facilities, documentation and management, and government policy and budgeting. Les technologies jouent un role crucial dans le renforcement de la productivite et de la qualite des systemes de sante. Pourtant, dans de nombreux pays d&apos;Afrique subsaharienne, les systemes de gestion des dispositifs medicaux sont limites, voire inexistants. Cet article a pour but d&apos;illustrer, au moyen d&apos;une etude de cas, comment les reformes peuvent contribuer a faire en sorte que les politiques en matiere de technologies sanitaires soient appliquees au quotidien, et comment une approche integree peut ameliorer la gestion des dispositifs medicaux. Entre 2011 et 2023, un plan visant a developper les systemes de gestion des dispositifs medicaux en Republique-Unie de Tanzanie a ete defini et mis en reuvre en collaboration avec la Suisse, dans le cadre du Projet de Promotion et de Renforcement du Systeme de Sante. De nouvelles formations et la creation de postes permanents au sein du gouvernement ont permis d&apos;accroitre la disponibilite des ingenieurs biomedicaux. En outre, des ateliers supplementaires d&apos;entretien et de reparation ont ete construits dans differentes regions et districts, tandis qu&apos;un Centre National d&apos;Etalonnage et de Formation a ouvert ses portes pour assurer le bon fonctionnement des dispositifs medicaux. Lintroduction d&apos;un systeme electronique de gestion des dispositifs medicaux a fourni aux etablissements de soins de sante et au Ministere de la Sante des donnees concernant le statut operationnel de ces dispositifs, ainsi que les reparations et pieces detachees requises. Chaque niveau de pouvoir a ete encourage a attribuer davantage de ressources humaines et financieres a la gestion des dispositifs medicaux. Au terme de dix ans d&apos;efforts, le pourcentage d&apos;equipements en etat de marche a considerablement augmente et les couts ont diminue grace au recours a la reparation plutot qu&apos;au remplacement. Le projet a egalement demontre l&apos;importance d&apos;une approche integree, qui consiste a renforcer le systeme en tenant compte du personnel, de l&apos;entretien et des installations de reparation, de la documentation et de la gestion, mais aussi de la politique gouvernementale et du budget. La tecnologia aplicada a la atencion sanitaria es fundamental para impulsar la productividad y la calidad de los sistemas sanitarios. Sin embargo, en muchos paises del Africa subsahariana los sistemas de gestion de los productos sanitarios son deficientes o inexistentes. El objetivo de este articulo es ilustrar, mediante un estudio de caso, como las reformas politicas pueden ayudar a garantizar que la politica sobre tecnologia de la atencion sanitaria se convierta en una practica cotidiana y como un enfoque de sistemas integrados puede mejorar el funcionamiento de la gestion de los productos sanitarios. Entre 2011 y 2023, se elaboro un plan para mejorar los sistemas de gestion de los productos sanitarios en la Republica Unida de Tanzania, que se implemento a traves de la cooperacion suizo-tanzana en el marco del Proyecto de Promocion de la Salud y Fortalecimiento del Sistema. Se aumento la disponibilidad de ingenieros biomedicos mediante nuevos cursos de formacion y la creacion de puestos permanentes en el gobierno. Ademas, se construyeron talleres de mantenimiento y reparacion adicionales de distrito y regionales, y se establecio un Centro Nacional de Calibracion y Formacion para garantizar el correcto funcionamiento de los productos sanitarios. La introduccion de un sistema electronico de gestion de productos sanitarios proporciono a los centros sanitarios y al Ministerio de Sanidad datos sobre el estado operativo de los productos sanitarios y la necesidad de reparaciones y piezas de repuesto. Se animo a todos los niveles de gobierno a asignar mas recursos humanos y financieros a la gestion de los productos sanitarios. Tras este esfuerzo de una decada, el porcentaje de equipos en funcionamiento aumento notablemente y los costes se redujeron al reparar los equipos en lugar de sustituirlos. El proyecto tambien demostro el valor de un enfoque integrado de refuerzo del sistema que tenia en cuenta el personal, las instalaciones de mantenimiento y reparacion, la documentacion y la gestion, y la politica y los presupuestos gubernamentales.

Measles virus is one of the most infectious pathogenic agents and has a basic reproduction number ([R.sub.0]) of 12-18, indicating that each infected person could infect 12-18 other susceptible persons [...]

Introduction The coronavirus disease 2019 (COVID-19) pandemic posed a considerable challenge for governments, affecting health, the economy and citizens' well-being. (1) The pandemic exposed weaknesses in health systems, such as [...], Objective To explore the definition and operationalization of resilience in health system performance assessments in European Union countries. Methods We conducted multiple empirical case study analyses. We identified relevant cases through a literature review from 2014 to 2023 using Google Scholar and through a snowball technique to retrieve additional information. We included only documents that explicitly mentioned resilience in health system performance assessments. We performed a content analysis to identify common patterns in defining resilience. Findings The final sample consisted of six countries: Belgium, Croatia, Czechia, Estonia, Ireland and Italy. Each country adopted a distinct approach to conceptualizing resilience, with countries prioritizing specific aspects based on lessons learnt from the coronavirus disease 2019 (COVID-19) pandemic. Some countries focused on maintaining essential health-care services and protecting vulnerable groups. Other countries prioritized management capacity, staff preparedness, digital health utilization and strengthening of primary health care. Content analysis revealed six resilience definitions derived from the key performance indicators: addressing unmet needs and maintaining outcomes; protecting vulnerable groups; acquiring and using resources; having trained and prepared staff in place; using digital health; and strengthening primary health care. Conclusion Integration of resilience into the health profiles of European Union countries preceded its inclusion in national health system performance assessments, the latter of which became more prominent after the COVID-19 pandemic. Variations in interpretations within health system performance assessments reflect differences in indicators and policy responses. [phrase omitted] [phrase omitted] Objectif Explorer la definition et la mise en reuvre de la resilience dans l&apos;evaluation des performances des systemes de sante au sein des pays de l&apos;Union europeenne. Methodes Nous avons effectue plusieurs analyses d&apos;etudes de cas empiriques. Nous avons identifie les cas pertinents en procedant a une revue de la litterature publiee entre 2014 et 2023 sur Google Scholar et en appliquant la technique de type <> pour obtenir des informations supplementaires. Nous n&apos;avons retenu que les documents qui mentionnaient explicitement la resilience dans les evaluations des performances des systemes de sante. Enfin, nous avons examine les contenus afin de reperer les modeles les plus courants dans la definition de la resilience. Resultats Lechantillon final etait compose de six pays : la Belgique, la Croatie, l&apos;Estonie, l&apos;Irlande, l&apos;Italie et la Republique tcheque. Chacun de ces pays a adopte une approche differente dans sa conceptualisation de la resilience, certains ayant donne la priorite a des aspects specifiques en fonction des lecons qu&apos;ils ont tirees de la pandemie de maladie a coronavirus 2019 (COVID-19). Quelques-uns se sont concentres sur le maintien des services de sante essentiels et la protection des groupes vulnerables. D&apos;autres ont privilegie les capacites de gestion, la preparation du personnel, l&apos;utilisation des technologies numeriques et le renforcement des soins de sante primaires. Lanalyse des contenus a revele six definitions de la resilience derivees des indicateurs cles de performance : repondre aux besoins non satisfaits et assurer le maintien des resultats ; proteger les groupes vulnerables ; acquerir et exploiter les ressources ; disposer de personnel forme et prepare ; deployer des technologies numeriques ; et enfin, consolider les soins de sante primaires. Conclusion La resilience figurait dans les profils sanitaires de certains pays de l&apos;Union europeenne avant d&apos;etre integree dans les mecanismes d&apos;evaluation des performances des systemes de sante nationaux, ayant gagne en importance apres la pandemie de COVID-19. Les divergences d&apos;interpretation observees dans le cadre de ces evaluations refletent les variations au niveau des indicateurs et des solutions politiques. [phrase omitted] Objetivo Explorar la definicion y la puesta en practica de la resiliencia en las evaluaciones del rendimiento de los sistemas sanitarios en los paises de la Union Europea. Metodos Se realizaron multiples analisis de estudios de casos empiricos. Se identificaron casos relevantes mediante una revision bibliografica de 2014 a 2023 utilizando Google Scholar y mediante una tecnica de bola de nieve para recuperar informacion adicional. Se incluyeron solo los documentos que mencionaban explicitamente la resiliencia en las evaluaciones del rendimiento del sistema sanitario. Se realizo un analisis de contenido para identificar patrones comunes en la definicion de resiliencia. Resultados La muestra final estaba formada por seis paises: Belgica, Croacia, Chequia, Estonia, Irlanda e Italia. Cada pais adopto un enfoque distinto para conceptualizar la resiliencia, dando prioridad a aspectos especificos basados en las lecciones aprendidas de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19). Algunos paises se centraron en mantener los servicios sanitarios esenciales y proteger a los grupos vulnerables. Otros paises priorizaron la capacidad de gestion, la preparacion del personal, la utilizacion de la salud digital y el fortalecimiento de la atencion primaria. El analisis de contenido revelo seis definiciones de resiliencia derivadas de los indicadores clave de rendimiento: abordar las necesidades insatisfechas y mantener los resultados; proteger a los grupos vulnerables; adquirir y utilizar recursos; contar con personal capacitado y preparado; utilizar la salud digital; y fortalecer la atencion primaria de salud. Conclusion La integracion de la resiliencia en los perfiles sanitarios de los paises de la Union Europea precedio a su inclusion en las evaluaciones del rendimiento de los sistemas sanitarios nacionales, estas ultimas mas destacadas tras la pandemia de la COVID-19. Las variaciones en las interpretaciones dentro de las evaluaciones del rendimiento de los sistemas sanitarios reflejan diferencias en los indicadores y las respuestas politicas.

Introduction Functioning primary care is essential for improving population health. A greater emphasis on primary care in the health-care system can reduce costs, improve access and reduce inequities in population [...], Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia&apos;s largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale. [phrase omitted] [phrase omitted] Objectif Determiner s&apos;il est possible de creer un tableau de bord des performances de soins de sante primaires en utilisant les donnees du DHIS2 issues des plus grandes regions urbaines (Addis-Abeba), agricoles (Oromia) et pastorales (Somali) d&apos;Ethiopie. Methodes Nous avons extrait 26 elements de donnees transmis au DHIS2 par 12 062 etablissements de sante pour la periode allant du 1er juillet 2022 au 30 juin 2023. En nous focalisant sur l&apos;efficacite, la securite et l&apos;experience vecue par les patients, nous avons defini 14 indicateurs de performances pour les soins de sante primaires, couvrant des domaines tels que la sante reproductive, maternelle et infantile, le virus de l&apos;immunodeficience humaine, la tuberculose, la prise en charge des maladies non transmissibles et la prescription d&apos;antibiotiques. Nous avons evalue l&apos;exhaustivite des donnees en calculant le pourcentage d&apos;etablissements produisant un rapport mensuel, avant d&apos;examiner la presence de valeurs aberrantes extremes et la validite externe. Resultats A l&apos;echelle regionale, c&apos;est a Addis-Abeba (82,9 %) que l&apos;exhaustivite moyenne pour l&apos;ensemble des elements de donnees etait la plus elevee, suivie d&apos;Oromia (66,2 %) et de Somali (52,6 %). Dans toutes les regions, les cliniques privees affichaient un faible taux d&apos;exhaustivite compris entre 38,6 % au Somali et 58,7 % a Addis-Abeba. Nous n&apos;avons trouve que quelques valeurs aberrantes (334 sur 816 578 observations) et avons constate un haut degre de validite externe pour 11 des 14 indicateurs de performances des soins de sante primaires. Toutefois, le degre de validite du taux de maintien du traitement antiretro viral sur 12 mois ainsi que de la proportion de patients avec une hypertension ou un diabete sous controle s&apos;est revele moindre. Conclusion Le DHIS2 ethiopien contient des informations utiles pour mesurer les performances des soins de sante primaires a l&apos;aide de methodes analytiques simples, tant au niveau national que regional et selon les types d&apos;etablissements. Malgre les quelques problemes qui subsistent en termes de qualite, ce dispositif de gestion des informations sanitaires represente une precieuse source de donnees pour elaborer des outils permettant d&apos;evaluer les performances du systeme de sante a l&apos;echelle nationale. [phrase omitted] Objetivo Explorar la viabilidad de crear un tablero de rendimiento de la atencion primaria utilizando datos DHIS2 de las principales regiones urbanas (Addis Abeba), agrarias (Oromia) y pastorales (Somali) de Etiopia. Metodos Se extrajeron 26 elementos de datos notificados por 12 062 centros sanitarios a DHIS2 para el periodo comprendido entre el 1 de julio de 2022 y el 30 de junio de 2023. A partir de indicadores de eficacia, seguridad y experiencia de los usuarios, se elaboraron 14 indicadores del rendimiento de la atencion primaria que abarcan la salud reproductiva, materna e infantil, el virus de la inmunodeficiencia humana, la tuberculosis, la atencion de enfermedades no transmisibles y la prescripcion de antibioticos. Se evaluo la exhaustividad de los datos al calcular el porcentaje de centros que informaban cada mes y se examino la presencia de valores atipicos y de la validez externa. Resultados A nivel regional, el nivel medio de exhaustividad de todos los datos fue mas alto en Addis Abeba (82,9%), seguida de Oromia (66,2%) y Somalia (52,6%). Las clinicas privadas de todas las regiones presentaban un bajo nivel de exhaustividad, que oscilaba entre el 38,6% en Somalia y el 58,7% en Addis Abeba. Solo se encontraron unos pocos valores atipicos (334 de 816 578 observaciones) y se observo que la validez externa era alta para 11 de los 14 indicadores de rendimiento de la atencion primaria. Sin embargo, la tasa de retencion del tratamiento antirretroviral a los 12 meses y los porcentajes de pacientes con diabetes o hipertension controladas mostraron una escasa validez externa. Conclusion El DHIS2 etiope contiene informacion para medir el rendimiento de la atencion primaria, utilizando metodos analiticos sencillos, a escala nacional y regional y por tipo de centro. A pesar de los problemas de calidad de los datos que aun persisten, el sistema de informacion sobre la gestion sanitaria es una fuente de datos importante para generar medidas de evaluacion del rendimiento del sistema sanitario a escala nacional.

Objective: To provide a strong foundation for the use of high-intensity laser therapy in carpel tunnel syndrome, we conducted a systematic review and meta-analysis to investigate the outcomes of short- and long-term follow-up studies. Design: This is a systematic review and meta-analysis. Results: Sample sizes of included studies ranged from 16 to 98 patients (N = 308). Overall, a significant difference between the treatment and control groups were found across majority of the measures. Studies using a 4-wk follow-up period, however, only found significantly greater benefits for high-intensity laser therapy in visual analog scale compared with placebo (P = 0.0191), transcutaneous electrical nerve stimulation (P = 0.0026), and low-intensity laser therapy 20 J/cm2 (P < 0.0002), and exercise (P < 0.0001). For improvement in visual analog scale score over a long treatment period, high-intensity laser therapy was also preferred over control group (P < 0.0071). Insufficient evidence exists to determine effect of high-intensity laser therapy on nerve conduction examinations. The only statistically significant differences observed in examinations were in relation to sensory nerve action potential (P = 0.0083) and sensory nerve conduction velocity (P = 0.0468). Conclusions: Moderate evidence exists regarding efficacy of high-intensity laser therapy compared with placebo, high-intensity laser therapy + wrist splint, and exercise in a short period of follow-up time but evidence on long-term follow-up is limited. [ABSTRACT FROM AUTHOR]

Purpose: The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden. Design/methodology/approach: Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061). Findings: The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results. Originality/value: The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development. [ABSTRACT FROM AUTHOR]

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INTRODUCTION Medical assistants (MAs) are among the fastest growing occupations within the US primary care workforce, (1) but little is known about organizational factors associated with MA support levels for [...], This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, P https://doi.org/10.1370/afm.3100

INTRODUCTION Team-based care, established as the gold standard model for providing care more than a decade ago, (1) allows integrated clinical teams with different and complementary skills and perspectives to [...], PURPOSE Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care. https://doi.org/10.1370/afm.3099

INTRODUCTION Low back pain (LBP) is a high-burden health problem worldwide, and its management represents a serious challenge for health systems. (1-4) The burden caused by LBP is mainly explained [...], PURPOSE To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care. METHODS We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). RESULTS We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability ([beta], -2.94; 95% CI, -3.63 to -2.24; P[less than or equal to].001), pain ([beta], -0.88; 95% CI, -1.18 to -0.57; P[less than or equal to].001), perceived effect of treatment ([beta], 1.40; 95% CI, 0.97 to 1.82; P[less than or equal to].001), and health-related quality of life ([beta], 0.11; 95% CI, 0.08 to 0.14; P[less than or equal to].001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC. https://doi.org/10.1370/afm.3104

Clinical laboratory testing plays a critical role in health care, public health surveillance, and emergency response. A detailed study by the Lewin Group for the Centers for Disease Control and [...], Context.--Two major categories of laboratories performing nonwaived testing under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are the Certificate of Accreditation (CoA) and Certificate of Compliance (CoC) laboratories. Accreditation organizations collect more detailed laboratory personnel information than the Centers for Medicare & Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES). Objective.--To estimate total numbers of testing personnel and testing volumes in CoA and CoC laboratories, by laboratory type and state. Design.--We developed a statistical inference method by using the respective correlations between testing personnel counts and test volume by laboratory type. Results.--QIES reported 33 033 active CoA and CoC laboratories in July 2021. We estimated testing personnel to be 328 000 (95% CI, 309 000-348 000), which is supported by the count of 318 780 reported by the US Bureau of Labor Statistics. There were twice as many testing personnel in hospital laboratories as in independent laboratories (158 778 versus 74 904, P < .001). Independent laboratories had the highest test volume per person, which was twice as high as physician office laboratories (62 228 versus 30102, P < .001). Hospital and independent laboratories comprised 34% of all CoA and CoC laboratories but performed the largest portion of testing (81 %). Physician office laboratories, accounting for 44% of all CoA and CoC laboratories, performed a comparatively low proportion of total tests (9%). Conclusions.--Numbers of testing personnel vary considerably by laboratory type and across states. These data can provide valuable insight when assessing laboratory workforce training needs and planning for public health emergencies. doi: 10.5858/arpa.2022-0345-0A

ABSTRAK Energi, terutama dalam bentuk listrik merupakan salah satu kebutuhan esensial bagi manusia. Untuk memproduksi listrik dibutuhkan berbagai macam proses, termasuk melalui kombinasi pembangkitan tenaga gas dan uap. Dalam proses produksi, suatu Pembangkit Listik Tenaga Gas dan Uap (PLTGU) menghasilkan berbagai macam jenis limbah, diantaranya yang terkategori sebagai limbah Bahan Berbahaya dan Beracun (B3). Studi ini bertujuan untuk mengidentifikasi sumber timbulan dan mengevaluasi pengelolaan limbah B3 di suatu PLTGU di Kota Palembang, Sumatera Selatan. Metode yang digunakan berupa observasi detail dan analisis kepatuhan pengelolaan limbah B3 berdasarkan peraturan perundangan yang berlaku. Selama masa observasi, limbah B3 yang dihasilkan berupa minyak pelumas bekas atau oli bekas, sludge oil, kain majun bekas, kemasan bekas B3, filter bekas dari fasilitas pengendalian pencemaran udara, limbah terkontaminasi, sludge IPAL, dan limbah kimia hasil analisis laboratorium. Secara umum, PLTGU tersebut telah melakukan pengelolaan limbah B3 dengan memadai, terutama di tahapan pelabelan, pengemasan, dan penyimpanan. Pengangkutan dan pengolahan limbah B3 dikerjasamakan dengan pihak ketiga yang telah memiliki izin terkait. Pengelolaan limbah B3 di suatu industri menjadi penting agar tidak menimbulkan dampak negatif ke lingkungan dan kesehatan manusia. Kata kunci: evaluasi, limbah B3, pengelolaan, PLTGU ABSTRACT Energy especially in form of electricity is one of essential needs for human. To produce electricity, various processes are needed, including a combination of gas and steam power generation. In the production process, a Combined Cycle Gas-Fired Power Plant (CCGP) generates various type of wastes, including those categorized as Hazardous and Toxic Waste. The study aims to identify sources and to evaluate the hazardous waste management at a gas and steam power plant located in Palembang City, South Sumatra. The method used was detailed observation and analysis of hazardous and toxic waste management compliance based on applicable laws and regulations. During observation period, hazardous and toxic waste generated including used lubricating oil or used oil, sludge oil, used cloth, used hazardous and toxic packaging, used filters from air pollution control facilities, contaminated waste, sludge WWTP, and chemical waste resulting from laboratory analysis. In general, the gas and steam power plant has managed hazardous and toxic waste adequately, especially in the labeling, packaging and storage stages. Transporting and processing of hazardous and toxic waste was carried out in collaboration with third parties who have the relevant permits. Hazardous and toxic waste management in an industry is important so that it does not cause negative impacts to the environment and human health. Keywords: evaluation, CCGP, hazardous waste, management

High-quality evaluation is critical for health systems because it enables the best use of scarce resources and helps policy-makers learn what works best in their setting. What works cannot be [...]

Copyright of European Journal of Social Work is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This systematic review aimed to assess the effectiveness of various treatment approaches utilized in emergency rooms to manage severe primary headaches. PRISMA criteria were followed in the course of this investigation. The treatment of severe headaches in the emergency department (ED) was the subject of a comprehensive search on the databases MEDLINE, EMBASE, and Cochrane, which covered the years 2014-2024. The relevant literature references were searched manually to find further research which was not found in the electronic search. This systematic review comprised seven investigations; two were conducted in Turkey, two in Iran, and three in the United States. In three investigations, the effects of lidocaine solution were evaluated; in the others, the effects of sodium valproate and ibuprofen, bupivacaine on the blockade of the greater occipital nerve and sphenopalatine ganglion and acetaminophen were examined. Two studies employed a numerical rating scale, four researchers used a visual analog scale, and one study used a 0-10 scale to quantify pain. Intranasal lidocaine is a useful treatment option for ED patients with severe headaches. Sodium valproate was more effective in the ED at reducing severe headaches. Greater occipital nerve blocks could be a helpful treatment for patients with acute migraine in the ED. Acute severe headaches treated with IV acetaminophen, prochlorperazine, and diphenhydramine in the ED resulted in statistically significant pain relief. [ABSTRACT FROM AUTHOR]

Objective. Intrahepatic cholestasis of pregnancy (ICP) significantly impacts the maternal and fetal safety. Research on the role of clinical pharmacists in guiding drug therapy for this condition remains limited. This study aimed to evaluate the effectiveness of graded pharmaceutical care for women with intrahepatic cholestasis of pregnancy and to provide a theoretical foundation for clinical pharmacist services. Study Design. This study comprises a pre‐and‐post analysis of women with intrahepatic cholestasis of pregnancy (ICP) treated between December 2019 and June 2023 at a tertiary hospital in Jiangsu province. Each group consisted of 102 participants. The control group received standard treatment, while the guardianship group received graded pharmacological care provided by a clinical pharmacist. The effectiveness of pharmacological monitoring by clinical pharmacists was assessed by comparing and analyzing clinical outcome indicators, quality management indicators, safety indicators, and economic factors. Results. The guardianship group exhibited a noteworthy 12.8% reduction in combined adverse pregnancy outcome and more effective management of total prenatal bile acids compared to the control group (16.05 µmol/L vs. 22.85 µmol/L, P < 0.05). The guardianship group displayed superior rationalization of therapeutic drugs and medication duration (P < 0.05). The cost‐benefit analysis revealed a favorable economic impact concerning medication costs but did not indicate economic significance regarding total inpatient costs. Conclusion. The implementation of a graded pharmaceutical care model by a clinical pharmacist holds the potential to enhance outcomes for women experiencing intrahepatic cholestasis during pregnancy, mitigate adverse pregnancy results, optimize the rational utilization of therapeutic medications, and yield positive economic results. [ABSTRACT FROM AUTHOR]

The digital age is characterized by rapid development, growth, innovation, and disruption. Organizations must adapt to the new digital landscape to remain competitive. Digital transformation involves more than just implementing new technologies. A digital transformation strategy is a plan for organizations to utilize IT technologies and methods to create new value and drive growth. The development and implementation of such a strategy have become central concerns for many organizations in research management. In this article, we discuss the technological potentials and challenges of digital transformation and propose a decision-making model using transformation technologies. [ABSTRACT FROM AUTHOR]

Purpose: Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children. Methods: A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries. Findings/Results: Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7–18 years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14 months after injury and was 100/100. Conclusions: Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures—97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status. Level of evidence IV: Systematic review of Level-II–IV studies. Prospero Registration No CRD42021290899. [ABSTRACT FROM AUTHOR]

This study's purpose is to extend our understanding of school leadership for student learning by identifying high-leverage teacher evaluation practices that improve teaching. A partnership with a state education agency administered a teacher questionnaire regarding evaluation practices multiple times in one semester, then linked teacher responses to their next within-semester observation score. Broadly, teachers reported on scoring practices, the facilitation of post-observation conferences, feedback characteristics, and post-conference supports for evaluation-informed professional learning. Fixed effect regressions effectively compare observation scores and teacher-reported evaluation practices within the same teacher or teacher-by-evaluator pairing over four months while controlling for month-to-month influences on performance. The methods remove several serious confounders plausibly affecting related estimates in prior work. The analysis identifies six high-leverage teacher-reported evaluation practices, most of which apply to post-conference practices linking evaluation to professional learning. The evidence refines the academic understanding of leadership for student learning and implies that leadership preparation and in-service programs might emphasize the six high-leverage evaluation practices to promote active use among practicing leaders. Policymakers might ensure that aspiring and in-service leaders can develop these practices and that there are strong links between teacher evaluation and professional learning systems for school leaders to use. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes. Design/methodology/approach: In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders. Findings: The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept. Originality/value: The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool. [ABSTRACT FROM AUTHOR]