Diagnostic performance of a computer-aided system for tuberculosis screening in two Philippine cities

Background and Objectives@#The Philippines faces challenges in the screening of tuberculosis (TB), one of them being the shortage in the health workforce who are skilled and allowed to screen TB. Deep learning neural networks (DLNNs) have shown potential in the TB screening process utilizing chest radiographs (CXRs). However, local studies on AIbased TB screening are limited. This study evaluated qXR3.0 technology's diagnostic performance for TB screening in Filipino adults aged 15 and older. Specifically, we evaluated the specificity and sensitivity of qXR3.0 compared to radiologists' impressions and determined whether it meets the World Health Organization (WHO) standards.@*Methods@#A prospective cohort design was used to perform a study on comparing screening and diagnostic accuracies of qXR3.0 and two radiologist gradings in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Subjects from two clinics in Metro Manila which had qXR 3.0 seeking consultation at the time of study were invited to participate to have CXRs and sputum collected. Radiologists' and qXR3.0 readings and impressions were compared with respect to the reference standard Xpert MTB/RiF assay. Diagnostic accuracy measures were calculated. @*Results@#With 82 participants, qXR3.0 demonstrated 100% sensitivity and 72.7% specificity with respect to the reference standard. There was a strong agreement between qXR3.0 and radiologists' readings as exhibited by the 0.7895 (between qXR 3.0 and CXRs read by at least one radiologist), 0.9362 (qXR 3.0 and CXRs read by both radiologists), and 0.9403 (qXR 3.0 and CXRs read as not suggestive of TB by at least one radiologist) concordance indices. @*Conclusions@#qXR3.0 demonstrated high sensitivity to identify presence of TB among patients, and meets the WHO standard of at least 70% specificity for detecting true TB infection. This shows an immense potential for the tool to supplement the shortage of radiologists for TB screening in the country. Future research directions may consider larger sample sizes to confirm these findings and explore the economic value of mainstream adoption of qXR 3.0 for TB screening.

Integrated primary healthcare delivery of hypertension and diabetes services: A task analysis of nurses and doctors in Rural Philippines

Objectives@#This study aimed to describe the roles and responsibilities of doctors and nurses in managing conditions like hypertension and diabetes in rural areas.@*Methods@#This study employed a cross-sectional study design using the task analysis methodology. A self-administered questionnaire derived from a national health practice guideline was used. A combination of frequency, criticality, and performance was assessed to identify tasks that needed attention by educators and policymakers.@*Results@#Of the 142 health workers who participated in the study, 81% were nurses and 19% were doctors. The tasks most frequently performed by these professionals were taking vital signs (88.7%), recording patient history (87.3%), and advising patients on regular follow-ups (86.6%). In terms of criticality, the top three tasks were performing diagnostic tests for acute chest pain (50.8%), diagnosing neurological disorders (49.2%), and referring patients for specialized tests at other facilities (43.6%). However, the tasks perceived as most challenging or outside their capability were the Fagerstorm test for assessing nicotine dependence (57.5%), the AUDIT tool for identifying binge drinkers (55.5%), and fundoscopy for diagnosing diabetic retinopathy (54%).@*Conclusion@#The primary care practice of the participants typically involved tasks that are centered on health promotion or disease prevention. Many of the tasks are shared by doctors and nurses, with some highly critical tasks performed less frequently due to a lack of training. Pre-service courses may need to be revised to ensure that health professionals have the required skills to carry out shared tasks.

Acceptability of task shifting primary care diabetes self-management education services to volunteer barangay health workers in a Philippine City

Objective@#The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines.@*Methods@#This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants.@*Results@#Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care.@*Conclusion@#Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability.

Rationing of nursing care and its relationship to nurse practice environment in a tertiary public hospital

@#<p style="text-align: justify;"><strong>Objectives:</strong> The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses' perception of their practice environment.</p><p style="text-align: justify;"><strong>Methods:</strong> The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses' practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing.</p><p style="text-align: justify;"><strong>Results:</strong> Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).</p><p style="text-align: justify;"><strong>Key Words:</strong> Health Care Rationing, Health Facility Environment, Nursing Care</p>

Acceptability of task shifting primary care diabetes self-management education services to volunteer barangay health workers in a Philippine City

Objective@#The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines. @*Methods@#This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants. @*Results@#Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care. @*Conclusion@#Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability

Nurse staffing during the SARS, MERS, and Ebola epidemics: A narrative review

Background@#The COVID-19 pandemic has put an immense strain on health systems worldwide. Nurses at the front line are prone to experience several staffing issues facing ever-increasing stresses to the health care system by a pandemic situation. The staffing experiences of nurses in this context can have a significant impact on current nursing practice and existing policies.@*Objective@#To carry out a synthesis of the scientific evidence available on the staffing experiences of nurses during the SARS, MERS, and Ebola epidemics.@*Method@# A narrative review was conducted. A literature search was carried out in PubMed, Scopus, and CINAHL databases. All studies describing nurses' experiences were included regardless of methodology. Atotal of 16 articles was included in the review.@*Results@#Narrative synthesis revealed ten themes from the results of the articles: training, staffing ratios and models, shifting models, volunteer staffing, skill mix, planning staffing needs, hospital preparedness, communication, effects of workload, and structured workflow processes.@*Conclusions@#Nurses are pivotal to the healthcare response to infectious disease pandemics and epidemics. The results of this review should provide a basis for nurse managers and administrators on how they can actively engage in supporting the staffing concerns and issues of nurses during the COVID-19 pandemic.