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Objective: To evaluate racial and ethnic differences in patient experience among VA primary care users at the Veterans Integrated Service Network (VISN) level. Data Source and Study Setting: We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients‐Patient Centered Medical Home for fiscal years 2016–2019. Study Design: We compared 28 patient experience measures (six each in the domains of access and care coordination, 16 in the domain of person‐centered care) between minoritized racial and ethnic groups (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic, Multi‐Race, Native Hawaiian or Other Pacific Islander [NHOPI]) and White Veterans. We used weighted logistic regression to test differences between minoritized and White Veterans, controlling for age and gender. Data Collection/Extraction Methods: We defined meaningful difference as both statistically significant at two‐tailed p < 0.05 with a relative difference ≥10% or ≤−10%. Within VISNs, we included tests of group differences with adequate power to detect meaningful relative differences from a minimum of five comparisons (domain agnostic) per VISN, and separately for a minimum of two for access and care coordination and four for person‐centered care domains. We report differences as disparities/large disparities (relative difference ≥10%/≥ 25%), advantages (experience worse or better, respectively, than White patients), or equivalence. Principal Findings: Our analytic sample included 1,038,212 Veterans (0.6% AIAN, 1.4% Asian, 16.9% Black, 7.4% Hispanic, 0.8% Multi‐Race, 0.8% NHOPI, 67.7% White). Across VISNs, the greatest proportion of comparisons indicated disparities for three of seven eligible VISNs for AIAN, 6/10 for Asian, 3/4 for Multi‐Race, and 2/6 for NHOPI Veterans. The plurality of comparisons indicated advantages or equivalence for 17/18 eligible VISNs for Black and 12/14 for Hispanic Veterans. AIAN, Asian, Multi‐Race, and NHOPI groups had more comparisons indicating disparities by VISN in the access domain than person‐centered care and care coordination. Conclusions: We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation. [ABSTRACT FROM AUTHOR]

The article is devoted to highlighting the importance of medical care for the population as a factor in the reintegration of the temporarily occupied territories of Ukraine. In accordance with this goal, the essence and peculiarities of health care organization in the de-occupied territory are revealed, and the role of medical care in intensifying the reintegration mechanism is determined. The author emphasizes that the implementation of the state policy on reintegration of the temporarily occupied territories should provide for an appropriate mechanism that would combine various measures aimed at restoring state power in the respective territories, as well as at integrating the local population into the political, cultural, economic and social life of the country. The author emphasizes that by allowing temporary restrictions on the right to healthcare in general and medical care in particular, the State, represented by authorized entities, should provide an effective mechanism for restoring this right after the special legal regime is lifted, or provide appropriate guarantees for the exercise of this right during such a special period. The author identifies the circumstances that indicate the importance of medical care for the population as a factor in the reintegration of the temporarily occupied territories: a) ensuring access to medical care as a key priority; b) involvement of qualified medical personnel from among internally displaced persons, volunteers, representatives of international health organizations and foreign medical specialists; c) implementation of regional medical programs and activities; d) cooperation with international donor organizations to provide humanitarian assistance, prosthetics, rehabilitation, etc.; e) health education campaign to inform the population in a timely manner about medical guarantee programs, reimbursement of medicines, rehabilitation programs, etc. It is stated that taking into account these circumstances will not only promote understanding of the importance of medical care, but will also allow improving the reintegration mechanism and accelerating its implementation to improve the quality of life of people. [ABSTRACT FROM AUTHOR]

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated. [ABSTRACT FROM AUTHOR]

Public Health Consortiums (PHC) in Brazil represent a strategy to enhance regionalization in the Public Health Care System (SUS in Portuguese) and State/interstate/intermunicipal cooperation. The establishment of regional polyclinics aims to improve access to services with greater technological concentration and closer to users’ homes. This study specifically aims to analyze the process of creating PHC and regional polyclinics in Bahia State, based on documental analysis, identifying aspects related to entering the political agenda that facilitate and hinder, the role of state administration, specificities of the composition of these PHC and regional polyclinics. A documental analysis was carried out of the minutes of the Comissão Intergestores Bipartite (CIB-BA) [Bipartite Administrative Commission] from 2015 to 2018 and of constitutive documents of the consortiums established in this state. The Ceará State experience inspired the creation of consortiums in Bahia, especially the structuring of polyclinics. Municipal administrators demonstrated a favorable position regarding the potential of consortiums with cooperation among municipalities. The role of the state government proved to be a facilitating condition, whereas the maintenance of the municipal counterpart in finance constituted a hindering element. The consortiums contributed to the regionalization of health in the state as well as expansion of access to specialized care. [ABSTRACT FROM AUTHOR]

Background: Technological advances based on mobile health (mHealth), the field of digital health (eHealth) aimed at managing health services and care and their concomitant transformations, have become increasingly important in the 21st century. In this context, care for individuals diagnosed with Chronic Non-Communicable Diseases (CNCDs) deserves to be highlighted. The aim of this study is to present the creation, development and implementation of the Telehealth Center of the Federal University of Viçosa (NUTELES - UFV), for the monitoring and management of health care for individuals with Arterial Hypertension (AH) and/or Diabetes Mellitus (DM). Methods: This study, carried out in 2022 and 2023, involved 374 patients diagnosed with AH and/or DM in the health micro-region of Viçosa/MG, Brazil, comprising nine municipalities. The research aims to describe the creation, development and implementation of a software (NutelesApp) for the collection, storage, management and analysis of epidemiological research in public health, focusing specifically, on the monitoring and management of health care for individuals with AH and/or DM monitored by Primary Health Care (PHC). The parameters collected and analyzed were obtained through a questionnaire applied to patients, consisting of 70 questions, subdivided into 12 classes of questions. The epidemiological survey data was collected using mobile devices and analyzed using computer techniques based on statistical analysis. Once the field teams had completed their work, the files were transferred to servers for general analysis processing, using estimates of means, prevalence and respective standard errors, calculated using the Statistical Package for Social Science (SPSS) program, which takes into account the planning variables and includes the basic weights resulting from the sampling process. This study was approved by the Human Research Ethics Committee and registered, prior to recruitment, by the Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-45hqzmf (Last approval date: 11/30/2022). Results: The information obtained through data collection with subsequent exploratory analysis of epidemiological data using the NutelesApp software suggests that mobile applications intended for the purpose of monitoring and managing healthcare for people with AH and/or DM should address the variables necessary to support a process of understanding the health conditions and/or disease of the individual as a whole and provide short- and long-term learning. Regarding the results of the survey using the software, the variables of 374 people were analyzed. Majority are female (73.2%) and white (43.5%). Most patients are elderly (average 64 years), with blood pressure levels within the normal range for this population, BMI indicates overweight, AC increased risk for cardiovascular events and CC within the recommendation value. All biochemical parameters analyzed were above normal limits. Conclusions: The description of the creation and development of the software includes practical examples of its implementation, the results collected and its applicability in real scenarios, presenting determining criteria that can provide assertive and timely interventions for monitoring and managing the health and/or disease parameters of patients with HA and/or DM. In addition, the beneficial consequences of using this application will extend to health units and their respective management, improving the services provided by PHC and enhancing strategies and actions for health promotion and disease prevention. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistulas are abnormal open connection(s) between the vagina and the urinary tract or the rectum resulting from tragic injuries sustained by mothers during childbirth that lead to urine and/or faecal incontinence. Due to the rapidly growing middle class in sub-Saharan Africa (SSA) and the corresponding quest for hospital delivery and caesarean section, surgery-related (iatrogenic) obstetric fistulas are on the rise. Worryingly, there is scanty data on surgery-related fistulas. This review aims to collate empirical evidence on the magnitude of iatrogenic obstetric fistulas in SSA, generate country-specific data and explore factors that influence obstetric surgery-related fistulas. Methods: All relevant databases, PubMed, LILACS, CINAHL, SCOPUS and Google Scholar will be searched from 1st January 2000 to 31st March 2024 using search terms developed from the major concepts in the title without restrictions by language. The Cochrane Library, African Journals Online, Data Base of African Thesis and Dissertations Including Research (DATAD-R D Space) and preprint repositories will also be searched. Reference lists of relevant studies will be searched and experts in the field will be contacted for additional (unpublished) studies. The search output will be exported to Endnote where duplicate studies will be removed. The deduplicated studies will be exported to Rayyan where study screening and selection will be conducted. At least two authors will independently select studies, extract data and assess quality in the included studies using pretested tools. Disagreements between reviewers will be resolved through discussion. Data analysis will be performed with RevMan 5.4. Comparative binary outcomes will be reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference and standard deviations (SDs) will be used. Non-comparative studies will be analysed as weighted proportions. Heterogeneity between studies will be assessed graphically and statistically, and where a significant level is detected, the random-effects model meta-analysis will be performed. All estimates will be reported with their 95% confidence intervals (CIs). Where data permit, we will conduct subgroup and sensitivity analyses to test the robustness of the estimates on key quality domains. The overall quality of the evidence will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Expected study outcomes: This systematic review and meta-analysis uses rigorous methods and best practices to attempt to collate all empirical evidence and estimate country-specific proportions of iatrogenic (surgery-related) fistulas among obstetric fistula patients across countries in SSA. This review will explore context-specific variables, provide insights into their impact and relate them to the type and experience of personnel performing the obstetric procedures that lead to obstetric fistulas. The findings of the full review are expected to inform the development of national and regional Training Programs for Medical Officers, support the development of a consensus "minimum acceptable standard of care" and inform quality assurance standards for clinicians involved in the provision of surgical obstetric care. [ABSTRACT FROM AUTHOR]

Background: Provision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication‐related harm. Aim: To report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia. Method: A literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period‐prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi‐squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383‐1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non‐identifiable data about human beings. Results: In total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non‐Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%). Conclusion: The study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the proportion of MAPs for First Nations patients was lower compared to the proportion of MAPs for non‐Indigenous patients. Further improvements are required to achieve equity of service provision for First Nations patients and female patients. [ABSTRACT FROM AUTHOR]

Regional centres have smaller workforces in acute diabetes care compared to their metropolitan counterparts. A cross‐sectional audit performed at Albury Hospital identified a high prevalence (34%) of diabetes for inpatients compared with metropolitan centres. The high prevalence highlights the need for all healthcare services to consider appropriate resources for the management of diabetes in people admitted to hospital. [ABSTRACT FROM AUTHOR]

PURPOSE: In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS: The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS: Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P =.0019) and 40.0 to 28.9 days (P =.0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION: Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community. LDAP outreach clinic led to faster lung cancer diagnosis, reduced patient costs, and lessened environmental impact. [ABSTRACT FROM AUTHOR]

This article discusses the meaning of the word "missionary" and its use in today's church. It looks at the biblical, historical and contemporary understandings of a phrase which triggers a variety of responses even among Christians. Some insist that "missionary" has become a discredited term and others hold that it no longer reflects their broader understanding of mission. However, those who still use it find support both in the Scriptures and mission history. Given the similarity of the phrase "missionary" and the biblical term "apostle" one can argue that missionaries are followers of Christ who are sent to continue with the apostolic task without claiming the same authority as the Twelve or the Apostle Paul. Therefore, the preaching of the gospel, the planting of churches and the training of church leaders lie at the heart of their mission. This work might be accompanied by other activities, such as social, educational or medical programmes, but, as demonstrated by the early representatives of the Protestant mission movement, it should always be carried out with sensitivity, respect and humility. [ABSTRACT FROM AUTHOR]

Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritized in national health policies and legislation, there appears to be little research focused on understanding PPP's role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke's (2006) thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximize PPP's role in health system improvement. Finally, the study suggested prioritizing PPP, especially for resource-poor countries, to complement government's efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients' and public needs. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Canadian Studies is the property of University of Toronto Press 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 study seeks to point out the different configurations of Health Care Networks in primary care (AB) and Hospital Care (AH), dimensioned based on coverage, quality, and resolvability characteristics in health macro-regions. Cross-sectional study used the cluster analysis and segmented 103 macro-regions into different profiles of coverage, quality and resolubility: group 1 (high coverage/AB and medium/AH; low quality AB-AH with high resolubility); group 2 (high coverage/AB and low/AH; low quality ABAH with medium resolubility) and group 3 (high coverage/AB and medium/AH; high quality ABAH with high resolubility). Coverage in AB was classified as high for 100% of the Brazilian population and in AH low to 9.70% and medium to 90.29%. Quality/AB-AH is low for 58.54% and high for 41.15%. Resolubility is high for 90.29% and medium for 9.70%. In Brazil, there is expansion of coverage with low quality/AB; shortage of hospital beds and low quality/HA with high resolution. However, in the Southeast and South, high AB-AH quality prevails. The structuring of health networks is still characterized by low resolution, demanding incentives for the governance of inter-federal arrangements. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is implementation of a regional hospital and nursing home decolonization collaborative (coordinated intervention adopted by participating health care facilities) associated with a reduction in multidrug-resistant organisms (MDROs), infection-related hospitalizations, costs, and deaths? Findings: In this quality improvement study of 35 health care facilities in Orange County, California, using quasi-experimental design, chlorhexidine bathing and nasal decolonization were associated with significantly lower MDRO prevalence and incident clinical cultures. Infection-related hospitalizations, associated costs, and deaths among nursing home residents also decreased. Meaning: In this study, a regional decolonization collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in contact precautions was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths. Importance: Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. Objective: To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. Design, Setting, and Participants: This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. Exposures: Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). Main Outcomes and Measures: Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). Results: Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%). Conclusions and Relevance: A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths. This quality improvement study evaluates whether implementation of a decolonization collaborative is associated with reduced regional multidrug-resistant organism prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. [ABSTRACT FROM AUTHOR]

Indonesia still faces challenges in providing healthcare services, and it is crucial to develop an air medical evacuation services system for at least two reasons. Firstly, Indonesia is an archipelagic country and a popular tourist destination. Secondly, there are still significant disparities in the number and types of healthcare facilities and health workers nationwide. To respond to the current situation, the healthcare providers and government have made some efforts regarding air medical evacuation but are showing an unintegrated system. This qualitative study aimed to explore the current implementation of air medical evacuation in Indonesia and to propose an integrated standard procedure that all related stakeholders can adopt at the national and regional levels. The study used a multi-case design analysis, collecting both primary and secondary data. Secondary data was gathered through desk studies to learn related policies and previous studies. Primary data was collected through observation and in-depth interviews with relevant stakeholders, including regulators, service providers, practitioners, and non-governmental organizations. The study found that there is currently a regulatory gap for the implementation of air medical evacuation services in Indonesia. The readiness of the Health Human Resources (HHR) is limited in terms of qualification and competency, and the definitive infrastructure of air medical evacuation requires improvement since the providers continue to use the airport for civil transportation. Besides, the interaction pattern between stakeholders needs to be integrated into standardized procedures. Therefore, the study recommends proposing an integrated standard procedure and actionable recommendations to advocate for all stakeholders. [ABSTRACT FROM AUTHOR]

Background Neuro-oncology care in Ontario, Canada has been historically centralized, at times requiring significant travel on the part of patients. Toward observing the goal of patient-centered care and reducing patient burden, 2 additional regional cancer centres (RCC) capable of neuro-oncology care delivery were introduced in 2016. This study evaluates the impact of increased regionalization of neuro-oncology services, from 11 to 13 oncology centers, on healthcare utilization and travel burden for glioblastoma (GBM) patients in Ontario. Methods We present a cohort of GBM patients diagnosed between 2010 and 2019. Incidence of GBM and treatment modalities were identified using provincial health administrative databases. A geographic information system and spatial analysis were used to estimate travel time from patient residences to neuro-oncology RCCs. Results Among the 5242 GBM patients, 79% received radiation as part of treatment. Median travel time to the closest RCC was higher for patients who did not receive radiation as part of treatment than for patients who did (P  = .03). After 2016, the volume of patients receiving radiation at their local RCC increased from 62% to 69% and the median travel time to treatment RCCs decreased (P  = .0072). The 2 new RCCs treated 35% and 41% of patients within their respective catchment areas. Receipt of standard of care, surgery, and chemoradiation (CRT), increased by 11%. Conclusions Regionalization resulted in changes in the healthcare utilization patterns in Ontario consistent with decreased patient travel burden for patients with GBM. Focused regionalization did not come at the cost of decreased quality of care, as determined by the delivery of a standard of care. [ABSTRACT FROM AUTHOR]

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica 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: Lack of a validated assessment of maternal risk-appropriate care for use in population data has prevented the existing literature from quantifying the benefit of maternal risk-appropriate care. The objective of this study was to develop a measure of hospital maternal levels of care based on the resources available at the hospital, using existing data available to researchers. Methods: This was a secondary data analysis. The sample was abstracted from the American Hospital Association Annual Survey Database for 2018. Eligibility was limited to short-term acute general hospitals that reported providing maternity services as measured by hospital reporting of an obstetric service level, obstetric services, or birthing rooms. We aligned variables in the database with the ACOG criteria for each maternal level of care, then built models that used the variables to measure the maternal level of care. In each iteration, the distribution of hospitals was compared to the distribution in the CDC Levels of Care Assessment Tool Validation Pilot, assessing agreement with the Wilson Score for proportions for each level of care. Results were compared to hospital self-report in the database and measurement reported with another published method. Results: The sample included 2,351 hospitals. AHA variables were available to measure resources that align with ACOG Levels 1, 2, and 3. Overall, 1219 (51.9%) of hospitals reported resources aligned with Maternal Level One, 816 (34.7%) aligned with maternal level two, and 202 (8.6%) aligned with maternal level Three. This method overestimates the prevalence of hospitals with maternal level one compared to the CDC measurement of 36.1% (Mean 52.9%; 95% CI47.2%—58.7%), and likely includes hospitals that would not qualify as level one if all resources required by the ACOG guidelines could be assessed. This method underestimates the prevalence of hospitals with maternal critical care services (Level 3 or 4) compared to CDC measure of 12.1% (Mean 8.1%; 95%CI 6.2% – 10.0%) but is an improvement over hospital self-report (24.7%) and a prior published method (32.3%). Conclusions: This method of measuring maternal level of care allows researchers to investigate the value of perinatal regionalization, risk-appropriate care, and hospital differences among the three levels of care. This study identified potential changes to the American Hospital Association Annual Survey that would improve identification of maternal levels of care for research. [ABSTRACT FROM AUTHOR]

Background: Regionalization of surgical care shifts higher acuity patients to larger centers. Hospital-associated infections (HAIs) are important quality measures with financial implications. In our ongoing efforts to eliminate HAIs, we examined the potential role for inter-hospital transfer in our cases of HAI across a multihospital system. Hypothesis: Surgical patients transferred to a regional multihospital system have a higher risk of National Healthcare Safety Network (NHSN)-labeled HAIs. Patients and Methods: The analysis cohort of adult surgical inpatients was filtered from a five-hospital health system administration registry containing encounters from 2014 to 2021. The dataset contained demographics, health characteristics, and acuity variables, along with the NHSN defined HAIs of central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and Clostridioides difficile infection (CDI). Univariable and multivariable statistics were performed. Results: The surgical cohort identified 92,832 patients of whom 3,232 (3.5%) were transfers. The overall HAI rate was 0.6% (528): 86 (0.09%) CLABSI, 133 (0.14%) CAUTI, and 325 (0.35%) CDI. Across the three HAIs, the rate was higher in transfer patients compared with non-transfer patients (CLABSI: n = 18 (1.3%); odds ratio [OR], 4.79; CAUTI: n = 25 (1.8%); OR, 4.20; CDI: n = 37 (1.1%); OR, 3.59); p < 0.001 for all. Multivariable analysis found transfer patients had an increased rate of HAIs (OR, 1.56; p < 0.001). Conclusions: There is an increased risk-adjusted rate of HAIs in transferred surgical patients as reflected in the NHSN metrics. This phenomenon places a burden on regional centers that accept high-risk surgical transfers, in part because of the downstream effects of healthcare reimbursement programs. [ABSTRACT FROM AUTHOR]

To evaluate the theoretical impact of regionalizing cytoreductive surgery for ovarian cancer (OC) to high-volume facilities on patient travel. We retrospectively identified patients with OC who underwent cytoreduction between 1/1/2004–12/31/2018 from the New York State Cancer Registry and Statewide Planning and Research Cooperative System. Hospitals were stratified by low-volume (<21 cytoreductive surgical procedures for OC annually) and high-volume centers (≥21 procedures annually). A simulation was performed; outcomes of interest were driving distance and time between the centroid of the patient's residence zip code and the treating facility zip code. Overall, 60,493 patients met inclusion criteria. Between 2004 and 2018, 210 facilities were performing cytoreductive surgery for OC in New York; 159 facilities (75.7%) met low-volume and 51 (24.3%) met high-volume criteria. Overall, 10,514 patients (17.4%) were treated at low-volume and 49,979 (82.6%) at high-volume facilities. In 2004, 78.2% of patients were treated at high-volume facilities, which increased to 84.6% in 2018 (P <.0001). Median travel distance and time for patients treated at high-volume centers was 12.2 miles (IQR, 5.6–25.5) and 23.0 min (IQR, 15.2–37.0), and 8.2 miles (IQR, 3.7–15.9) and 16.8 min (IQR, 12.4–26.0) for patients treated at low-volume centers. If cytoreductive surgery was centralized to high-volume centers, median distance and time traveled for patients originally treated at low-volume centers would be 11.2 miles (IQR, 3.8–32.3; P <.001) and 20.2 min (IQR, 13.6–43.0; P <.001). Centralizing cytoreductive surgery for OC to high-volume centers in New York would increase patient travel burden by negligible amounts of distance and time for most patients. • The impact on patient travel from ovarian cancer surgery regionalization to high-volume centers has not been studied. • Centralizing ovarian cancer surgery in New York State would increase patient travel by negligible distance and time. • These findings could have future implications for patient education and health policy on the regionalization of care. [ABSTRACT FROM AUTHOR]

Objective: To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. Methods: All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). Results: Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. Conclusions: Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high‐level, high‐volume maternity throughout the territory; this suggests closing down high‐volume units and improving low‐volume ones to maintain coherent mapping. Synopsis: High‐volume facilities improve maternal and neonatal outcome after delivery. Distance from hospital is associated with a worse neonatal outcome. [ABSTRACT FROM AUTHOR]

Aims and background: Intentional violence is a public health crisis requiring an urgent and innovative response. Prior to 2019, there was only one hospital-based violence intervention program (HVIP) in Virginia. The rise in gun violence in recent years underscored the urgent need to expand beyond a one-center approach into a regional approach to violence through a network of HVIPs. This study notes the early feasibility and implementation of the regionalization of HVIPs across competing health systems. Materials and methods: In collaboration with several partners, an evidence-based HVIP program led a technical assistance center (TAC) and conducted site visits across nine facilities in three health systems. This was followed by a systematic, combined, regional-based approach to HVIP development. Data from each facility were collected prospectively, with point-of-care feedback given during site visits and weekly coaching sessions. Results: Between July 2019 and June 2021, program development support from TAC included six collective seminars, 151 coaching sessions, and 67 weekly meetings with program faculty and stakeholders. HVIPs were established in nine facilities during this time, and 2,259 patients were enrolled. Over half of patients were African American (64%) and between the ages 18 and 59 (77%). Around 60 and 17% were secondary to assault and domestic violence (DV), respectively. The most common services used were information and referrals (100%) and emotional support and/or safety planning (72%). Conclusion and clinical significance: The use of a well-established HVIP as a TAC could serve as an effective model for regionalization of violence intervention efforts, which is the next logical step in mitigating the impact of violence. [ABSTRACT FROM AUTHOR]

This cost analysis, from a societal perspective, compared the cost difference of a networked teletrial model (NTTM) with four regional hubs versus conventional trial operation at a single metropolitan specialist centre. The Australian phase 3 cancer interventional randomised controlled trial included 152 of 328 regional participants (patient enrolment 2018–2021; 6‐month primary end point). The NTTM significantly reduced (AU$2155 per patient) patient travel cost and time and lost productivity. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that infects the respiratory system by attacking the mucous and epithelial cells. This infection commonly leads to an increase in lymphocyte count as an immune response to invading pathogens. Moreover, antibodies bind and inactivate foreign substances to destroy pathogens and inhibit their replication. These mechanisms prompt the objective of this study, which was to define the relationship between lymphocyte count and SARS-CoV-2 antibody level. This analytical observational study used a cross-sectional approach with quantitative analysis methods and purposive sampling. Healthy donors who had received coronavirus disease (COVID-19) vaccines provided the samples for this study. A total of 30 blood samples were collected from the Blood Transfusion Center of the Indonesian Red Cross Surabaya Area. This study was conducted in May 2022 at two distinct locations. The examination of lymphocytes was carried out using the flow cytometry method in the Hematology Laboratory, Department of Medical Laboratory Technology, Politeknik Kesehatan Kemenkes Surabaya, Surabaya, Indonesia. In addition, the antibody titer test using the enzyme-linked immunosorbent assay (ELISA) method was performed in the Immunoserology Laboratory of the Surabaya Health Laboratory Center, Surabaya, Indonesia. The analysis revealed an average lymphocyte concentration of 2.2633 x 10³/µl and an average antibody level of 0.2197 according to the optical density (OD) ratio. The data analysis was performed using Spearman's rank correlation statistical test (p<0.005), and the results indicated a lack of significance with p=0.262. In conclusion, there is no relationship between total lymphocyte count and SARS-CoV-2 antibody level. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

The article "Geographic Disparities in Availability of Hospital-Based Cardiac Services Across the United States" published in Circulation highlights the significant differences in access to cardiac services in the US, particularly disadvantaging rural areas and the southern region. The study found that rural counties had higher odds of lacking essential cardiac services compared to urban areas, with regional disparities also playing a significant role. The lack of cardiac services in rural areas contributes to elevated coronary heart disease mortality rates, emphasizing the need for innovative solutions and policy support to improve access to care in these underserved communities. [Extracted from the article]

Background: Palliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia's rural and regional health care settings. Methods: A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders. Results: Participants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers. Conclusions: Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models. [ABSTRACT FROM AUTHOR]

This paper explores the Organization of Turkic States' (OTS) support in aiding Central Asian republics to address their historical legacies, focusing on the period following Russian influence from the 18th century. Employing a postcolonial theoretical lens, it examines the post-independence phase of these republics, highlighting the OTS' role in promoting regional cooperation, cultural revitalization, and social unity. The paper discusses the challenges faced by these nations in various sectors such as economics and linguistics, assessing the OTS' capacity to support their development, given its resources and relative position amidst other significant regional entities. Additionally, it delves into broader regional developmental strategies and their implications for the OTS' objectives. The paper underscores the importance of strategic autonomy for Central Asia in the context of evolving regional dynamics. It concludes by recognizing the OTS' potential in contributing to the region's progress, presenting a comprehensive view of the intricate regional landscape and the OTS' part in fostering growth and development in Central Asia. [ABSTRACT FROM AUTHOR]

Background: Fibrillary (FGN) and immunotactoid (IT) glomerulonephritis are uncommon. Aims: To evaluate the prevalence, clinicopathological correlations and outcomes of FGN and IT in our regional centre in Australia. Methods: We interrogated a renal biopsy database for cases of FGN and IT from 2000 to 2020. Data included demographics, serum creatinine, haematuria status, proteinuria, comorbidities and histopathological findings. Results: We had 14 cases of FGN and t of IT. The mean presenting age was 59.8 years, and 42.9% were males. No patients with FGN had dysproteinaemia, whereas both patients with IT had chronic lymphocytic leukaemia. At presentation, 75% of patients with FGN and both patients with IT had haematuria; all had proteinuria. Mean albumin‐creatinine ratio at presentation was 254 mg/mmol for FGN and 604 mg/mmol for IT. Mean presenting serum creatinine was 149 μmol/L for FGN and 95 μmol/L for IT. Four patients with FGN (28.6%) received immunomodulatory therapy. The prognosis of FGN was poor, with six patients (46.2%) reaching end‐stage kidney disease after a median of 42 months (range 1–96 months). All patients presenting with proteinuria <30 mg/mmol entered complete remission; patients with higher‐grade proteinuria exhibited progressive chronic kidney disease. Patients with IT had complete remission with treatment of underlying haematological disease. Conclusion: FGN is rare, with poor response to immunomodulatory therapy. It carries poor renal prognosis. Less proteinuria at diagnosis may predict a more benign disease course. IT is associated with haematological malignancy and carries better prognosis and response to treatment. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic required expanding the health services capacity in Brazilian states and municipalities. This study analyzed the geographic distribution of the health resources provision in the country in the period before the pandemic. Objective: This study aimed to describe the availability of health resources in the 133 intermediate geographic regions of Brazil in 2018 according to the human development index (HDI). Method: Data on population coverage of the family health strategy, number of outpatient consults and hospitalizations, public investment in health, total number of hospital beds, beds maintained by SUS, intensive care unit (ICU) beds, and ICU beds maintained by SUS were obtained from the Ministry of Health and IBGE. the association of variables with the HDI of the intermediate regions was assessed using Pearson’s correlation. Results: The indices of health resources had higher average values for the South and Southeast regions, whereas the Central West ranked intermediate values. The HDI correlated positively with health resources. The coverage by family health strategy had an inverse distribution and was higher in the North and Northeast regions. Conclusions: Monitoring the health system at the intermediate region level can be a useful strategy to promote access and reduce health inequalities in Brazil. In 2018, the intermediate regions were unevenly prepared to meet their populations’ health needs and reflected the inverse care law. This scenario was the starting point for the response to the COVID-19 pandemic in 2020. [ABSTRACT FROM AUTHOR]

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica 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.)

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. 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.)

Introduction: Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. Objective: To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. Design: Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. Findings: There were 2773 participants with 1372 participants in the pre‐implementation group and 1401 in the post‐implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre‐implementation, 6 (0.4%) post‐implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. Discussion: This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. Conclusion: The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy. [ABSTRACT FROM AUTHOR]

Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralized program involving a multidisciplinary clinic in a region comprising 7 municipalities. Helping patients with adequate performance status get the right treatment helped to reduce 90-day mortality after radical cystectomy from 37% to 1.9%.

Purpose: The aim of this study is to analyze Turkey's blood collection efficiency at the regional level between 2018 and 2021 and discuss managerial implications. Design/methodology/approach: The authors utilize data envelopment analysis (DEA) to evaluate the efficiency scores of the 18 regions for which the Turkish Red Crescent is responsible. The data set is obtained from the General Directorate of Blood Services in the Turkish Red Crescent. Findings: The results reveal that the efficient regions over the years did not substantially change, and regions that were consistently efficient for a four-year period are identified. Another finding is that COVID-19 did not affect the blood collection efficiency of the regions. Moreover, the findings illustrate that concentrating on the operations would contribute more to the blood collection efficiency than changing the scale size. Furthermore, the authors observe that the service population is by far the most important variable in determining the efficiency of the regions. Originality/value: In this study, the authors present a multi-dimensional perspective on the performance evaluation of blood collection operations. In addition, the authors present blood bank managers' feedback on the performance evaluation model, outlining managerial implications. Furthermore, the authors explore the effects of the pandemic on blood collection in Turkey and illustrate the changes in efficiency throughout a distinct period that incorporates the pandemic. The study would provide a guide for blood bank managers to improve the performance of their organizations. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic can lead to burnout among health workers. The study aimed to know the prevalence of burnout among resident doctors and its relation to resilience. Methodology: An online anonymous cross-sectional study was done at the sole COVID nodal center of Telangana, India, using a three-part questionnaire E-mailed to all the resident doctors. It included a consent form, sociodemographic data, the Copenhagen Burnout Inventory to measure burnout, and the Brief Resilience Coping Scale to measure resilience. Data were analyzed using SPSS statistical software version 22.0 (IBM). P value was considered statistically significant below 0.05 and all tests were two-tailed. Results: Personal burnout (53.6%) was highest followed by work-related burnout (46.4%) and client-related burnout (40.8%). All three domains of burnout showed a significant negative correlation with scores of resilience (personal burnout [r = −0.240), work burnout (r = −0.203), and client burnout [r = −0.212]; P ≤ 0.001). Conclusion: Client-related burnout has increased when compared to nonpandemic times. Burnout was inversely associated with resilience, suggesting a role for resilience as a protective factor. [ABSTRACT FROM AUTHOR]

Objectives: To describe the demographics, presentation characteristics, clinical features and cardiac outcomes for Aboriginal and Torres Strait Islander patients who present to a regional cardiac referral centre ED with suspected acute coronary syndrome (ACS). Methods: This was a single‐centre observational study conducted at a regional referral hospital in Far North Queensland, Australia from November 2017 to September 2018 and January 2019 to December 2019. Study participants were 278 Aboriginal and Torres Strait Islander people presenting to an ED and investigated for suspected ACS. The main outcome measure was the proportion of patients with ACS at index presentation and differences in characteristics between those with and without ACS. Results: ACS at presentation was diagnosed in 38.1% of patients (n = 106). The mean age of patients with ACS was 53.5 years (SD 9.5) compared with 48.7 years (SD 12.1) in those without ACS (P = 0.001). Patients with ACS were more likely to be male (63.2% vs 39.0%, P < 0.001), smokers (70.6% vs 52.3%, P = 0.002), have diabetes (56.6% vs 38.4%, P = 0.003) and have renal impairment (24.5% vs 10.5%, P = 0.002). Conclusions: Aboriginal and Torres Strait Islander patients with suspected ACS have a high burden of traditional cardiac risk factors, regardless of whether they are eventually diagnosed with ACS. These patients may benefit from assessment for coronary artery disease regardless of age at presentation. [ABSTRACT FROM AUTHOR]

The levels of gynecologic care provides a framework for patients, hospitals, and clinicians to guide where elective surgery can be done most safely and effectively. Systems of care have been established for obstetrics, trauma, and neonatology. An American College of Obstetricians and Gynecologists Presidential Task Force was established to develop a care system for gynecologic surgery. A group of experts who represent diverse perspectives in gynecologic practice proposed definitions of levels of gynecologic care using the Delphi method. The goal is to improve the quality of gynecologic surgical care performed in the United States by providing a framework of minimal institutional requirements for each level. Subgroups developed draft criteria for each level of care. The entire Task Force then met to reach consensus regarding the levels of care final definitions and parameters. The levels of gynecologic care framework focuses on systems of care by considering institutional resources and expertise, providing guidance on the provision of care in appropriate level facilities. These levels were defined by the ability to care for patients of increasing risk, complexity, and comorbidities, organizing gynecologic care around hospital capability. This framework can also be used to inform the escalation of care to appropriate facilities by identifying patients at risk and guiding them to facilities with the skills, expertise, and capabilities to safely and effectively meet their needs. The levels of gynecologic care framework is intended for use by patients, hospitals, and clinicians in the United States to guide where elective surgery can be done most safely and effectively by specialists and subspecialists in obstetrics and gynecology. The key features of the levels of gynecologic care include ensuring provision of risk-appropriate care and regionalization of care by facility capabilities. [ABSTRACT FROM AUTHOR]

Around 118.5 million blood donations are collected annually to save precious lives. The donated blood may also be associated with blood-borne infections. With around 247 million population, Pakistan is an endemic country for viral hepatitis, and there is a high risk of having asymptomatic blood donors among healthy donors. Viral hepatitis is 2.5% prevalent in the general population, and blood donation and its screening have become grave health concerns for Pakistani health authorities. Asymptomatic viral hepatitis needs screening to rule out subliminally diseased individuals, as recommended by the World Health Organization. Knowing the prevalence of the transfusion transmissible infectious (TTIs) agents in healthy blood donors helps assess the disease burden in any population, boosts treatment rates, and precludes dreaded complications in the affected people. The objective of the current study was to determine the prevalence and trends of significant TTIs among blood donors visiting the Armed Forces Institute of Transfusion (AFIT), Rawalpindi, Pakistan. A total of 15,405 blood donors were screened for HBV, HCV, HIV, malaria, and syphilis during this cross-sectional descriptive study. Most donors had an O-positive blood group; AB-negative donors were only 0.7%. Out of the study population, we reported 1.06% HBV, 0.54% HCV, 0.19% HIV, and 0.31% syphilis-positive asymptomatic blood donors. However, no blood donor was found positive for malaria. The Punjab province was reported as the most burdened for TTIs, and youngsters aged 18–27 years were mainly positive, indicating the need to conduct national-level awareness campaigns about TTIs. The stakeholders need to strengthen the blood collection guidelines, and effective performance should be strictly monitored through internal and external audits considering the aim of reaching non-infectious blood products. [ABSTRACT FROM AUTHOR]

ObjectiveRegionalization directs patients to high-volume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery.Data sources/study settingStatewide inpatient data from eleven states between 2000 and 2012.Study designMortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital case-volume, categorized into low-, medium-, and high-volume tertiles.Data collection/extraction methodsWe used Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) to select pediatric cardiac surgery discharges.Principal findingsIn total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low-, medium-, and high-volume hospitals. Mortality decreased over time, but remained higher in low- and medium-volume hospitals. High-volume hospitals had lower odds of mortality and cost than low-volume hospitals (odds ratio [OR] 0.59, P

Introduction: The federally funded Region 1 Regional Disaster Health Response System (RDHRS) and the American Burn Association partnered to develop a model regional disaster teleconsultation system within a Medical Emergency Operations Center (MEOC) to support triage and specialty consultation during a no-notice mass casualty incident. Our objective was to test the acceptability and feasibility of a prototype model system in simulated disasters as proof of concept. Methods: We conducted a mixed-methods simulation study using the Technology Acceptance Model framework. Participating physicians completed the Telehealth Usability Questionnaire (TUQ) and semistructured interviews after simulations. Results: TUQ item scores rating the model system were highest for usefulness and satisfaction, and lowest for interaction quality and reliability. Conclusions: We found high model acceptance, but desire for a simpler, more reliable technology interface with better audiovisual quality for low-frequency, high-stakes use. Future work will emphasize technology interface quality and reliability, automate coordinator roles, and field test the model system. [ABSTRACT FROM AUTHOR]

Background: One of the most effective strategies to improve the access of community members to health services is to regionalize health services. The purpose of this study is to examine and prioritize measures that could help to counteract obstacles and problems in implementing the regionalization of healthcare in Iran. Methods: The study relied on a mixed research method, including qualitative and quantitative phases. First, by conducting semi-structured interviews and analyzing them through qualitative content analysis, the obstacles and measures were identified. In the quantitative phase, the obstacles identified were weighted using the fuzzy best-worst method (FBWM), and the measures were then prioritized through the fuzzy TOPSIS (FTOPSIS) method. Results: The obstacles were categorized into four main dimensions: "infrastructural," "political," "human resources," and "managerial." Among the 15 obstacles identified, "absence of performance guarantees" was the most important obstacle, while "insufficient education" was the least important obstacle to the regionalization of healthcare services in Iran. Meanwhile, the following eight measures that could help to overcome the obstacles were extracted from the interviews: "conducting a needs assessment," "providing clinical guidelines," "employing specialized human resources," "reinforcing the referral system," and "preparing electronic health records," "enhancing education and information dissimilation," "building executive support," and "providing cost-effective equipment and technology." "Employing specialized human resources" was also the most effective measure to overcome the obstacles. Conclusions: Iranian healthcare policy-makers can use the empirical findings of this investigation to accelerate the implementation of Iran's regionalization plan to improve the access of community members to healthcare services. [ABSTRACT FROM AUTHOR]

Objective: To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. Design: Multiphase, observational study including a prospective study and a cross‐sectional survey. Setting: Two regional Queensland Hospitals. Participants: Cancer specialist AHPs (n = 13 in a prospective study; n = 7 in a cross‐sectional survey) and generalist AHPs (n = 36 in a cross‐sectional survey), across six disciplines from two regional hospitals and cancer services. Main Outcome Measures: Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. Results: Over 10‐months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs—laryngectomy pre‐operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. Conclusion: There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on‐boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

ABSTRACT BACKGROUND: In Latin America, liver cancer is one of the top causes of cancer mortality. It is the fifth most common cause of death among malignant tumors in Mexico and is the leading cause in Hidalgo State (43.8% of the population living in poverty). OBJECTIVE: To conduct a correlational analysis on the main risk factors for liver cancer in Hidalgo State, Mexico, including municipal disaggregation and comparison with the national level. DESIGN AND SETTING: Cross-sectional, correlational, descriptive and comparative epidemiological study using Mexican governmental databases covering 1990-2019. METHODS: A comprehensive review of the databases of the General Directorate of Health Information (DGIS) was performed to analyze official death figures, hospital discharges and national and municipal population projections, using specific search criteria defined in the Global Burden of Disease classification, based on the risk factors for liver cancer. RESULTS: Liver cancer rates showed an evident rise in Hidalgo (183%), moving from 21st place in Mexico in 1990 to 9th place in 2019. This increase was correlated with alcoholism. An increasing trend for liver cancer deaths, of 133.89%, is projected for 2030. Females and the population over 60 years of age are more affected. There are some critical regions with liver cancer death rates twice the national rate or more. CONCLUSION: Targeted effective public health strategies should be structured by identifying, characterizing and regionalizing critical marginalized municipalities that are vulnerable to alcoholism and other risk factors for liver cancer. This approach may be helpful for other states in Mexico or similar countries.

ObjectivesTo evaluate the impact of previous local treatment on survival in men with newly diagnosed metastatic castration-resistant prostate cancer.MethodsWe carried out a retrospective study of patients newly diagnosed with metastatic castration-resistant prostate cancer in the year 2000 or later from eight Veterans Affairs Medical Centers. Patients were categorized based on prior local therapy (none, prostatectomy ± radiation or radiation alone). Overall and cancer-specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to test the association between prior local treatment and survival.ResultsOf 729 patients, 284 (39%) underwent no local treatment, 176 (24%) underwent radical prostatectomy ± radiation and 269 (37%) underwent radiation alone. On multivariable analysis, men with prior prostatectomy had improved overall (hazard ratio 0.71, P = 0.005) and cancer-specific survival (hazard ratio 0.55, P

Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families. [ABSTRACT FROM AUTHOR]