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Background: Falsified medicines and their international regulation impacts all healthcare sectors and their actors. These regulations aim to strengthen and protect the global pharmaceutical supply chain against falsified medicines. However, an evaluation of the impacts of these regulations on key stakeholders within the legitimate supply chain have not been explored. Objective: This research aimed to evaluate both the positive and negative impacts of falsified medicines regulation on key stakeholders within the global pharmacy sector including including manufacturers, wholesalers, hospital pharmacies, community pharmacy and patients. Design: This research consists of a systematic review and thematic analysis concerning falsified medicines regulation and the subsequent impacts of existing global regulations on healthcare. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist were utilized for reporting in this systematic review. Data sources and methods: A search of three databases, Embase, ProQuest and PubMed, was undertaken to determine studies applicable to the research question. The Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality and risk of bias for all included studies. Results: From the initial 657 studies, a final set of 13 relevant studies were identified. The most frequently reported falsified medicines regulation was the Falsified Medicines Directive (FMD) [n = 11]. The impact of falsified medicines regulation in the literature related to four areas: (1) Financial, (2) Social, (3) Organizational, and (4) Pharmacy Practice. These common themes across the included studies frequently relate to challenges and/or concerns associated with falsified medicines regulation implementation as well as both the logistics and practicality of incorporating falsified medicines regulations into daily operations. Conclusion: Implementation and enforcement of falsified medicines regulation does not yet appear to categorically fulfill the primary aim of the regulations, to strengthen the drug supply chain. However, in recent years, such regulations have challenged the legitimate pharmaceutical supply change actors as they attempt to successfully implement these regulations. Studies mainly detail the negative impacts of regulation during the implementation phase but with the overall benefit pertaining to the prioritization and enhancement of patient care and safety within the healthcare sector.
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Background: Various data quality issues have prevented healthcare administration data from being fully utilized when dealing with problems ranging from COVID-19 contact tracing to controlling healthcare costs. Objectives: (i) Describe the currently adopted approaches and practices for understanding and improving the quality of healthcare administration data. (ii) Explore the challenges and opportunities to achieve continuous quality improvement for such data. Materials and Methods: We used a qualitative approach to obtain rich contextual data through semi-structured interviews conducted at a state health agency regarding Medicaid claims and reimbursement data. We interviewed all data stewards knowledgeable about the data quality issues experienced at the agency. The qualitative data were analyzed using the Framework method. Results: Sixteen themes emerged from our analysis, collected under 4 categories: (i) Defect characteristics: Data defects showed variability, frequently remained obscure, and led to negative outcomes. Detecting and resolving them was often difficult, and the work required often exceeded the organizational boundaries. (ii) Current process and people issues: The agency adopted primarily ad-hoc, manual approaches to resolving data quality problems leading to work frustration. (iii) Challenges: Communication and lack of knowledge about legacy software systems and the data maintained in them constituted challenges, followed by different standards used by various organizations and vendors, and data verification difficulties. (iv) Opportunities: Training, tool support, and standardization of data definitions emerged as immediate opportunities to improve data quality. Conclusions: Our results can be useful to similar agencies on their journey toward becoming learning health organizations leveraging data assets effectively and efficiently.
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Background: Patients with gastroparesis experience severe gastrointestinal symptoms including nausea, vomiting, early satiety, excessive fullness and bloating that can have significant negative effects on their mood, relationship with food/eating, and overall quality of life. The aim of this review was to systematically explore the literature on the social and emotional burdens experienced by patients with gastroparesis. Methods: PubMed and Google Scholar were used to identify potential articles for inclusion. The population of interest was those with abnormal gastric emptying. Studies were excluded if they focused on the effects of a particular treatment for gastroparesis. Thirty-one articles were included based on search criteria. Results: Three themes emerged, including healthcare utilization and opioid use, relationship between gastroparesis and mental health, and the impact of gastroparesis on lifestyle factors including sleep, nutrition, and social engagement. Patients experience challenges from a perceived lack of understanding of medical providers and loved ones and difficult to manage symptoms. Symptom specific anxiety, underlying psychiatric history, and symptom severity are associated with distress around symptoms. Self-reported symptom severity and severity of gastric emptying are not highly correlated. Conclusions: Patients with acute onset and gradually worsening of symptoms over time are likely at increased risk of distress related to their disease. Patients commonly experience isolation from their medical providers and in other social relationships. Treatments aimed not only at reducing the severity of symptoms but also helping patients with gastroparesis engage with the enjoyed aspects of life are essential in mitigating the social and emotional impacts of gastroparesis.
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Objectives: To determine the prevalence of diabetic retinopathy and undiagnosed diabetes among Delaware nursing home and assisted care facility residents. Methods: This cross-sectional study involved the statistical analysis of comprehensive eye examination records of 2,063 nursing home residents residing in 18 facilities and 4 assisted living facilities in Delaware from 2005 to 2009. Descriptive statistical analyses were conducted to identify the rates of retinal dot and blot hemorrhages and existing systemic diabetes diagnoses. Results: The mean age of nursing home and assisted care facility residents was 77 years (range 9-104), and 64.4% were over the age of 80. Most residents were female (61.1%) and white (72.5%). 3.6% of the 2,063 nursing home residents had blot or dot hemorrhages in one or both eyes. 32.8% had a type 1 or type 2 diabetes diagnosis. Of the ones with a positive dot and blot hemorrhage finding, 56.8% had a diagnosis of diabetes, and 43.2% did not. Discussion: There was a high prevalence of dot and blot hemorrhages without a systemic diagnosis of diabetes, indicating a need for regular eye care among residents.
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Objective: The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults' COVID-19 infection status. Methods: In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis. Results: Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited. Conclusions: Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.
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Disparities in accessing advanced stroke treatment have been recognized as a policy challenge in multiple countries, including Japan, necessitating priority solutions. Nevertheless, more practical healthcare policies must be implemented due to the limited availability of healthcare staff and financial resources in most nations. This study aimed to evaluate the supply and demand balance of mechanical thrombectomy (MT) and identify areas with high priority for enhancing stroke centers. The target area of this study was Hokkaido, Japan. We adopted the capacitated maximal covering location problem (CMCLP) to propose an optimal allocation without increasing the number of medical facilities. Four realistic scenarios with varying levels of total MT supply capacity for Primary stroke centers and assuming a range of 90 minutes by car from the center were created and simulated. From scenarios 1 to 4, the coverage increased by approximately 53% to 85%, scenarios 2 and 3 had 5% oversupply, and scenario 4 had an oversupply of approximately 20%. When the supply capacity cap was eliminated and 8 PSCs received 31 or more patients, they became priority enhancement targets. The CMCLP estimates demand coverage considering the supply and demand balance and indicates areas and facilities where MT supply capacity enhancement is a priority.
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Oral diseases pose a significant burden on global healthcare. While many oral conditions are preventable and manageable through regular dental office visits, a substantial portion of the population faces obstacles in accessing essential and affordable quality oral healthcare. In this mini review, we describe the issue of inequity and bias in oral healthcare and discuss various strategies to address these challenges, with an emphasis on the application of artificial intelligence (AI). Recent advances in AI technologies have led to significant performance improvements in oral healthcare. AI also holds tremendous potential for advancing equity in oral healthcare, yet its application must be approached with caution to prevent the exacerbation of inequities. The "black box" approaches of some advanced AI models raise uncertainty about their operations and decision-making processes. To this end, we discuss the use of interpretable and explainable AI techniques in enhancing transparency and trustworthiness. Those techniques, aimed at augmenting rather than replacing oral health practitioners' judgment and skills, have the potential to achieve personalized dental and oral care that is unbiased, equitable, and transparent. Overall, achieving equity in oral healthcare through the responsible use of AI requires collective efforts from all stakeholders involved in the design, implementation, regulation, and utilization of AI systems. We use the United States as an example due to its uniquely diverse population, making it an excellent model for our discussion. However, the general and responsible AI strategies suggested in this article can be applied to address equity in oral healthcare on a global level.
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Background: Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods: We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings: We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion: Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.
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Background and objectives Problematic use of smartphones among healthcare workers can affect their performance, patient care, safety, care outcomes, and patient satisfaction. The aim of this study was to determine the prevalence of problematic use of smartphones and the relationship between the problematic use of smartphones and sleep quality among healthcare workers in Qassim, Saudi Arabia. Methods We enrolled 393 healthcare workers conveniently selected online for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. For sleep quality, we used the Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to assess the association of problematic use of smartphones with sleep quality. IBM SPSS Statistics, version 23.0 (IBM Corp., Armonk, NY) was used for analyses. Results The prevalence of smartphone addiction (SMA) was 59.0%, and 30.5% were at high risk for addiction. The mean PSQI score was 11.56 ± 2.1 out of 21. It was found that female gender was associated with poor sleep quality (adjusted B = 0.45, p-value = 0.049). On the other hand, SMA was also significantly associated with poor sleep quality (adjusted B = 0.90, p-value = 0.016). Conclusion There is a high prevalence of problematic use of smartphones among healthcare workers, which is associated with poor sleep quality. Given the significant occurrence of problematic smartphone use among healthcare professionals and its detrimental effects on sleep quality, it is crucial for public health initiatives to devise and execute suitable preventive measures, such as smartphone use policies at work and education of workers.
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CONTEXT: Spiritual care is recognition of patient and caregiver spiritual/religious needs and attention to those needs. Caregivers of African American hospice patients are more likely to report worse emotional/religious support. Yet, spiritual care delivery and roles of community clergy and chaplains for African American hospice patients are not well understood. OBJECTIVES: Examine who provides spiritual care to African American hospice patients and caregivers. METHODS: Partnering with large, urban/suburban community hospice, we interviewed caregivers of deceased African American hospice patients (n = 12), their clergy (n = 3) and chaplains (n = 5). Using a phenomenological qualitative study design, we coded transcripts and deceased patient chart data and conducted thematic analysis to identify themes. RESULTS: Community clergy and chaplains tend to not interact and provide different aspects of emotional, religious and spiritual support to hospice patients and families. Clergy and chaplains agreed that rapport and openness of the patient were main factors in meeting spiritual care needs. Clergy provided interaction with a trusted person and connection to church, congregational support, religious beliefs/theology, and practices. Chaplains focused on present needs and issues of death and dying. CONCLUSION: Clergy and chaplains have distinct, complementary roles in providing spiritual care to African American hospice patients and families. Both are needed to provide desired spiritual care for African American hospice patients and their caregivers. Robust spiritual care programs need to ensure chaplains have sufficient time to spend with patients and families and incorporate collaboration, handoffs and integrated processes for clergy and chaplains. Research is needed on effectively including clergy in hospice spiritual care delivery.
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Although many women experience body dissatisfaction, treatment options that prevent the onset of more serious conditions are limited in accessibility. As such, digital interventions may be an appropriate alternative resource to address restricted treatment options. This study provides statistical syntheses of the evidence for digital body image interventions for non-clinical adult women. A systematic literature search identified 19 studies (N = 2424) that tested the effect of a digital body image intervention compared to a control condition. Study results were synthesised using random effects models, and small to medium statistically significant effect sizes indicated that digital interventions were beneficial in increasing overall global satisfaction (g = 0.43) and reducing cognitive body dissatisfaction (g = 0.36). These meta-analytic findings provide evidence for the efficacy of digital body image interventions for non-clinical adult women. Intervention type was not found to be a statistically significant moderator, which may suggest that a range of intervention types can produce similar reductions in body dissatisfaction. Overall, digital body image interventions may be a feasible option to alleviate body dissatisfaction, particularly for women who may be unable to access conventional treatment.
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BACKGROUND: In South Korea, various quality assessments have been introduced to improve the quality of care; thus, the overall quality level of medical institutions has improved. However, gaps still exist between medical institutions. AIM: This study evaluated the impact of medical institutions' quality management efforts on securing medical staff and healthcare-associated infections in intensive care units (ICUs). METHODS: This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. We also measured healthcare-associated infection rates, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics. RESULTS: Healthcare-associated infections occurred in approximately 2% of patients with ventilators or catheters. Ventilator-associated pneumonia significantly increased in institutions with a decline in grade (IRR: 2.038, 95% CI: 1.426â2.915). In institutions with an upgrade in grade, infections associated with the central venous catheter (IRR: 0.484; 95% CI: 0.330â0.711) and urinary catheter (IRR: 0.587, 95% CI: 0.398â0.866) decreased. CONCLUSIONS: Although quality assessment has been introduced in ICUs in South Korea, some gaps remain among medical institutions. Differences were observed in securing medical resources through the quality management efforts of medical institutions, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.
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Identity Development Evolution and Sharing (IDEAS) reduces provider stigma, but few have been trained to implement IDEAS, highlighting a need for implementation strategies that facilitate uptake. We evaluated whether external facilitation successfully supported IDEAS implementation and whether IDEAS reduced provider stigma within and across sites irrespective of implementation barriers and facilitators. Key informants from 10 sites completed interviews and surveys of appropriateness, acceptability, and feasibility. Interviews were analyzed using the Consolidated Framework for Implementation Research guidelines. Intervention effectiveness was measured via paired t tests of pre-/post-quantitative data on provider stigma completed by practitioners who attended the training. Ten sites successfully implemented IDEAS via external facilitation; 58 practitioners from nine sites completed pre- and post-surveys. Data showed significant decreases in stigma after the intervention. IDEAS, supported by external facilitation, is a feasible, acceptable, and appropriate means of reducing stigma among occupational therapy practitioners.
External Facilitation Supports the Successful Use of "Identity Development Evolution and Sharing" (IDEAS)An Intervention That Effectively Reduces Harmful Biases Among Occupational TherapistsThis study is important for clinical managers and other change agents wishing to address provider biases in healthcare settings. The study expands an existing program for reducing healthcare provider bias called "Identity Development Evolution and Sharing" or "IDEAS." IDEAS is a program created by an occupational therapist who sought to improve healthcare experiences for those who have been harmed by implicit biases among healthcare providers. IDEAS involves watching filmed stories of people who have been harmed by stigma within healthcare and then having a reflective discussion about the film, creating a safe space in which providers can evaluate their biases and consider ways in which they might make positive changes. This study is important for managers and other change agents because it highlights characteristics of organizations that can both support and hinder the use of IDEAS in clinical settings. These factors can be taken into consideration prior to using an intervention such as IDEAS to support the degree to which an organization succeeds at implementing the program. This study also explains how the creator of IDEAS provides external support to facilitate staff in leading an IDEAS intervention. In addition, this study will be of interest to implementation scholars and/or people who would like to learn more about methods for measuring barriers and facilitators to integrating new programs in clinical settings.
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Dr. Kadambini Ganguly was a trailblazing Indian physician and social reformer. As one of the first female graduates and practitioners of Western medicine in India, she broke numerous barriers in a field dominated by men. Her contribution to medicine, particularly in women's healthcare, and her engagement in social reform through the Brahmo Samaj and the Indian National Congress, caused significant progress toward gender equality and social justice. This article looks back on her academic accomplishments, medical career, social activism, and lasting legacy, emphasizing her profound influence on medicine and society in India.
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BACKGROUND: Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. AIMS: To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. METHOD: A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. RESULTS: A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. CONCLUSION: Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.
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Transdermal healthcare systems have gained significant attention for their painless and convenient drug administration, as well as their ability to detect biomarkers promptly. However, the skin barrier limits the candidates of biomolecules that can be transported, and reliance on simple diffusion poses a bottleneck for personalized diagnosis and treatment. Consequently, recent advancements in transdermal transport technologies have evolved toward active methods based on external energy sources. Multiple combinations of these technologies have also shown promise for increasing therapeutic effectiveness and diagnostic accuracy as delivery efficiency is maximized. Furthermore, wearable healthcare platforms are being developed in diverse aspects for patient convenience, safety, and on-demand treatment. Herein, a comprehensive overview of active transdermal delivery technologies is provided, highlighting the combination-based diagnostics, therapeutics, and theragnostics, along with the latest trends in platform advancements. This offers insights into the potential applications of next-generation wearable transdermal medical devices for personalized autonomous healthcare.
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INTRODUCTION: Medical imaging's critical role in diagnosis requires prompt and precise image interpretation. Numerous radiology departments, especially in low-resourced settings, encounter challenges such as a shortage of radiologists in their operational setup. This study explored the perceptions of radiographers and radiologists from low-resourced departments in a single country regarding operational challenges and potential solutions in image interpretation. METHODS: A qualitative approach was utilised, involving heads of departments, senior radiographers, and radiologists with a minimum of 5 years of experience, from three major state referral hospitals. Face-to-face, semi-structured interviews were conducted in November 2022, using an interview guide that included questions on the challenges encountered during image interpretation and the proposed solutions. Data analysis was conducted using Atlas.ti version 9.0, following the four-step content analysis method. All participants willingly provided consent to participate in the study. RESULTS: Ten participants, comprising two radiologists and eight radiographers participated in the study. The research identified three main themes: image interpretation pathways, image interpretation operational challenges and proposed solutions for image interpretation. In addition, a total of 10 subthemes were generated from the three main themes. CONCLUSION: The study revealed critical challenges and the need to explore the formal inclusion of radiographers in image interpretation, as a way to improve efficiency. However, a comprehensive assessment of the image interpretation system, encompassing radiographers' knowledge and competence, is recommended for context-specific, empirical-based modifications to enhance service provision.
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This paper argues that one aspect of re-imagining evaluation in health planning and management is for leaders and clinicians to develop comfort with vulnerability when engaging in service evaluations. Starting with an exploration of how the service user voice is traditionally expressed in healthcare evaluation, the paper then proceeds to explore the particular role and challenges faced by clinician-evaluators, including their role as 'privileged interlocutors' in conversations with service users. The tensions in reconciling the role of the clinician as an expert, with the related but different skills needed for effective discourse in qualitative evaluation are explored, and it is asserted that it is important for clinicians and leaders to be comfortable in showing and working with vulnerability when evaluating healthcare interventions. Clinicians are already skilled in holding discourse with service users, and extending the communication repertoire to include the management of emotion and expression of vulnerability is achievable and rewarding. The paper concludes that the ability to hold a vulnerable stance when conducting evaluation can have benefits in reducing defensiveness, encouraging a truer sense of enquiry and amplifying the service user voice.
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Early mortality experienced by people living with mental health issues (hereon termed consumers) is largely preventable. Healthcare professionals perceive healthcare system inadequacies such as diagnostic overshadowing, stigma and fragmentation of physical and mental healthcare services can be resolved through effective integration approaches. Service- and individual-level integration approaches involve multidisciplinary teams collaborating and coordinating care to holistically meet consumers' physical and mental health needs. Evidence suggests appropriately trained healthcare professionals can deliver effective integrated treatment without financial or organisational restructuring. Specialist nursing positions such as Physical Health Nurse Consultants can support and integrate physical and mental health care. Consumers report the Physical Health Nurse Consultant as providing dedicated, integrated, coordinated and holistic mental and physical health care. This study aimed to explore the Physical Health Nurse Consultant role from the perspectives of healthcare professionals. A qualitative exploratory study design was used. Fourteen healthcare professionals participated in individual interviews or focus groups. Interview recordings were transcribed, and thematically analysed. Three themes were identified: (i) role functions, including integration of physical and mental health care, (ii) impact on consumer physical health outcomes and (iii) impact on service delivery. Healthcare professionals perceive the Physical Health Nurse Consultant effectively integrates physical and mental health care and subsequently support the continuation and embedding of the role in routine practice. Future research is required to explore healthcare professionals' experiences and perceptions of how these roles be translated to routine clinical practice. Examining the professional development requirements, service provider constraints and economic implication to achieve these outcomes also warrants attention.