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Khuzaiyah S, Adnani QES, Muthoharoh A, Chabibah N, Widyastuti W, Susiatmi SA, Zuhana N, Ersila W, Barach P, Lee KY. Indonesian COVID-19 lesson: A mixed-methods study on adolescent health status and health services during pandemic. J Child Adolesc Psychiatr Nurs 2024; 37:e12457. [PMID: 38433114 DOI: 10.1111/jcap.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
TOPIC The COVID-19 pandemic affected adolescents' physical and psychological health. There must be specific services to cater to the needs of adolescents during COVID-19 in Indonesia. Lessons learned from previous pandemics will be beneficial for nurses and other health professionals to prepare services for future pandemics. PURPOSE This mixed-method study aimed to examine 459 Indonesian adolescents' health, literacy, preventive measures, and preferred health services during the COVID-19 pandemic. This study also examines sociodemographics, respondent characteristics, health information sources, and media choices. RESULTS A total of 47.5% of adolescents knew about COVID-19, 26.8% experienced physical health changes, and 61.7% considered wearing masks. Adolescent health information came from teachers (26.6%) and the Internet (32.9%). Psychological changes showed 67.8% irritation. Indonesians preferred online counseling (53.8%) and WhatsApp (45.8%) for pandemic health services. COVID-19 literacy did not affect physical or mental health (p > 0.05). CONCLUSIONS Most adolescents reported mental and physical health changes during COVID-19. Our data suggest that adolescents' strong COVID-19 knowledge did not prevent anxiety and other psychological difficulties. The longitudinal studies could be utilized if pandemic demands social and physical distance. The government, as well as nurses, might utilize WhatsApp-based remote online treatment for health services.
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Affiliation(s)
- Siti Khuzaiyah
- Midwifery Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
- Nursing and Midwifery Program, PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | | | - Ainun Muthoharoh
- Pharmacy Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Nur Chabibah
- Midwifery Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Windha Widyastuti
- Nursing Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Sandi Ari Susiatmi
- Midwifery Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Nina Zuhana
- Midwifery Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Wahyu Ersila
- Midwifery Program, Faculty of Health Sciences, Universitas Muhammadiyah Pekajangan Pekalongan, Pekalongan, Central Java, Indonesia
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
| | - Ka Yiu Lee
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Iroz CB, Ramaswamy R, Bhutta ZA, Barach P. Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:332. [PMID: 38481226 PMCID: PMC10935959 DOI: 10.1186/s12913-024-10802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. METHODS We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. RESULTS We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. CONCLUSIONS Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.
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Affiliation(s)
- Cassandra B Iroz
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, UK
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA, USA
- Imperial College, London, UK
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Razum O, Barach P, Bochenek T, Cunningham C, Davidovitch N, Kostoulas P, Lindert J, Lopes H, Prikazsky V, Reid J, Tiljak MK, Middleton J. Statement of the ASPHER Task Force on War and Public Health on the Conflict in Israel/Palestine. Public Health Rev 2024; 45:1607047. [PMID: 38572326 PMCID: PMC10990037 DOI: 10.3389/phrs.2024.1607047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- ASPHER Task Force on War and Public Health, Brussels, Belgium
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- Institute of Inflammation and Ageing, Queen Elizabeth Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Tomasz Bochenek
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Colette Cunningham
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- School of Public Health, University College Cork, Cork, Ireland
| | - Nadav Davidovitch
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- School of Public Health, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- ASPHER Public Health Emergencies Task Force, Brussels, Belgium
| | - Polychronis Kostoulas
- ASPHER Public Health Emergencies Task Force, Brussels, Belgium
- Faculty of Public and One Health, University of Thessaly, Volos, Greece
| | - Jutta Lindert
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- Department of Health and Social Work, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Henrique Lopes
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- ASPHER Public Health Emergencies Task Force, Brussels, Belgium
- NOVA Centre of Global Health, NOVA-IMS, NOVA University of Lisbon, Lisbon, Portugal
| | | | - John Reid
- ASPHER Public Health Emergencies Task Force, Brussels, Belgium
- School of Allied and Public Health, University of Chester, Chester, United Kingdom
| | | | - John Middleton
- ASPHER Task Force on War and Public Health, Brussels, Belgium
- ASPHER Public Health Emergencies Task Force, Brussels, Belgium
- University of Wolverhampton, Wolverhampton, United Kingdom
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Subbe CP, Steinmo SH, Haskell H, Barach P. Martha's rule: applying a behaviour change framework to understand the potential of complementary roles of clinicians and patients in improving safety of patients deteriorating in hospital. Br J Hosp Med (Lond) 2024; 85:1-6. [PMID: 38416522 DOI: 10.12968/hmed.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
AIMS/BACKGROUND Martha's rule stipulates the right of patients and their families to escalate care as a way to improve safety while in hospital. This article analyses the possible impact of the proposed policy through the lens of a behaviour change framework and explores new opportunities presented by the implementation of Martha's rule.. METHODS A descriptive analysis was undertaken of interactions between patients, family, friends and clinicians during clinical deterioration in hospital. The capability-opportunity-motivation behaviour change framework was applied to understand reasons for failure to respond to deterioration. RESULTS Care of deteriorating patients requires recording of vital signs, recognition of abnormalities, reporting through escalation and response by a competent clinician. Regarding the care of patients who deteriorate in hospital, healthcare professionals have capability and motivation to provide safe, high-quality care, but often lack the physical and social opportunity to report or respond through lack of time and peer pressure. Patients and family members have motivation and might have time to support safety systems. Martha's rule or similar arrangements allow healthcare organisations to create opportunities for patients and families to report and escalate care to experts in critical care when they recognise deterioration. CONCLUSIONS The capability-opportunity-motivation behaviour change framework provides insights into the causes of failure to rescue in deteriorating patients and an argument for opportunities through escalation by patients and families through Martha's rule. This might reduce the number of system failures and enable safer care.
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Affiliation(s)
| | - Siri H Steinmo
- inform_us Health Informatics Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Paul Barach
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
- Jefferson College of Population Health, Philadelphia, PA, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
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Doos D, Hughes AM, Pham T, Barach P, Bona A, Falvo L, Moore M, Cooper DD, Ahmed R. Front-Line Health Care Workers' COVID-19 Infection Contamination Risks: A Human Factors and Risk Analysis Study of Personal Protective Equipment. Am J Med Qual 2024; 39:4-13. [PMID: 38127677 DOI: 10.1097/jmq.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Infectious risks escalate with complex donning and doffing personal protective equipment (PPE) protocols. Recent studies suggest that PPE donning and doffing behaviors that deviate from protocol during PPE reuse compounded the risks of health care worker (HCW) self-contamination. This study quantified the occurrence of behaviors associated with known risks in PPE use and reuse. We conducted a prospective study of emergency department HCWs and video-recorded PPE donning and doffing 5 times in simulated patient encounters. Trained coders recorded HCW behaviors according to an evidence-based guide. All 28 participants deviated from the Centers for Disease Control and Prevention (CDC) sanctioned donning and doffing protocol order, and most were documented to have (92.85%) self-contaminated at least once during each simulated clinical encounter. Behaviors that compounded self-contamination due to PPE reuse were also observed. Wide variation in PPE donning and doffing behaviors was found among front-line, experienced HCWs. Future work is needed to determine which deviations put HCWs at increased risk for accidental self-contamination and what changes are needed to the CDC protocol for protecting HCW from infections.
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Affiliation(s)
- Devin Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Ashley M Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL
- Center of Innovation for Chronic Complex Health (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL
| | - Trang Pham
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Paul Barach
- Department of Anesthesiology and City of Philadelphia, Jefferson College of Population Health, Thomas Jefferson School of Medicine, PA
- Department of Anesthesiology, Brisbane Queensland, University of Queensland, Australia
| | - Anna Bona
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Lauren Falvo
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malia Moore
- Simulation Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan D Cooper
- Clinical Emergency Medicine, Simulation Education, Department of Emergency Medicine, Simulation Center at Fairbanks Hall, Indiana University School of Medicine, Indianapolis, IN
| | - Rami Ahmed
- Division of Simulation, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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6
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Memon Z, Ahmed W, Muhammad S, Soofi S, Chohan S, Rizvi A, Barach P, Bhutta ZA. Facility-Based Audit System With Integrated Community Engagement to Improve Maternal and Perinatal Health Outcomes in Rural Pakistan: Protocol for a Mixed Methods Implementation Study. JMIR Res Protoc 2023; 12:e49578. [PMID: 38032708 PMCID: PMC10722360 DOI: 10.2196/49578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan. OBJECTIVE This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up. METHODS The implementation of the audit system comprises six phases: (1) identify facility and community leadership through consultative meetings with government district health offices, (2) establish the audit committee under the supervision of district health officer, (3) initiate audit with ongoing community engagement, (4) train the audit committee members, (5) launch the World Health Organization audit cycle (monthly meetings), and (6) quarterly review and refresher training. Data from all deliveries, live births, maternal deaths, maternal near misses, stillbirths, and neonatal deaths will be identified and recorded from four sources: (1) secondary-level care rural health facilities, (2) lady health workers' registers, (3) community representatives, and (4) project routine survey team. Concurrent quantitative and qualitative data will be drawn from case assessments, process analysis, and recommendations as components of iterative improvement cycles during the project. Outcomes will be the geographic distribution of mortality to measure the reach, proportion of facilities initiated to implement an audit system for measuring the adoption, proportion of audit committees with community representation, and proportion of audit committee members' sharing feedback regularly to measure acceptability and feasibility. In addition, outcomes of effectiveness will be measured based on data recording and reporting trends, identified modifiable factors for mortality and morbidity as underpinned by the Three Delays framework. Qualitative data will be analyzed based on perceived facilitators, barriers, and lessons learned for policy implications. Results will be summarized in frequencies and percentages and triangulated by the project team. Data will be analyzed using Stata (version 16; StataCorp) and NVivo (Lumivero) software. RESULTS The study will be implemented for 20 months, followed by an additional 4-month period for follow-up. Initial results will be presented to the district health office and the District Health Program Management Team Meeting in the districts. CONCLUSIONS This study will generate evidence about the feasibility and potential scale-up of a facility-based mortality audit system with integrated community engagement in rural Pakistan. Audit committees will complete the feedback loop linking health care providers, community representatives, and district health officials (policy makers). This implementation approach will serve decision makers in improving maternal and perinatal health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49578.
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Affiliation(s)
| | | | | | | | | | | | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson School of Medicine, Sigmund Freud University, Vienna, Austria
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Guillen-Grima F, Guillen-Aguinaga S, Guillen-Aguinaga L, Alas-Brun R, Onambele L, Ortega W, Montejo R, Aguinaga-Ontoso E, Barach P, Aguinaga-Ontoso I. Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine. Clin Pract 2023; 13:1460-1487. [PMID: 37987431 PMCID: PMC10660543 DOI: 10.3390/clinpract13060130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023] Open
Abstract
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.
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Affiliation(s)
- Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Kystad Helse-og Velferdssenter, 7026 Trondheim, Norway
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1100, Cameroon;
| | - Wilfrido Ortega
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | | | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA 19107, USA;
- School of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, 1020 Vienna, Austria
- Department of Surgery, Imperial College, London SW7 2AZ, UK
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
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Dopelt K, Mordehay N, Goren S, Cohen A, Barach P. "I Believe More in the Ability of the Small Person to Make Big Changes": Innovation and Social Entrepreneurship to Promote Public Health in Israel. Eur J Investig Health Psychol Educ 2023; 13:1787-1800. [PMID: 37754469 PMCID: PMC10529053 DOI: 10.3390/ejihpe13090130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Social entrepreneurship has grown worldwide in recent decades as it attempts to create and implement innovative solutions to social and environmental issues through business strategies. The aim of this study was to explore what motivates public health social entrepreneurs to act, the challenges and barriers they face, achievements, and competencies required for success. As such, we interviewed 15 social entrepreneurs in Israel. Budget issues, regulatory barriers, and struggles against powerful companies were the frequent barriers to success. The interviewees indicated several achievements at the health policy level by positioning and becoming an authority in the field, positively influencing other people's lives. They highlighted the importance of creativity, determination and courage, leadership, and the ability to persevere in the face of overwhelming adverse odds as essential for the social entrepreneur's success. Social entrepreneurship in public health is essential when struggling with health disparities. Nevertheless, recognizing that social entrepreneurship is not a substitute for methodological government planning and accountability is crucial.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel; (N.M.); (S.G.); (A.C.)
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Nila Mordehay
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel; (N.M.); (S.G.); (A.C.)
| | - Shir Goren
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel; (N.M.); (S.G.); (A.C.)
| | - Aviya Cohen
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel; (N.M.); (S.G.); (A.C.)
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA;
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Vienna A-1020, Austria
- Department of Surgery, Imperial College School of Medicine, London SW7 2AZ, UK
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Ryan B, Kako M, Fink R, Şimşek P, Barach P, Acosta J, Bhatia S, Brickhouse M, Fendt M, Fontenot A, Arenas Garcia N, Garner S, Gunduz A, Hardin DM, Hatch T, Malrey-Horne L, MacDermot M, Kayano R, McKone J, Noel C, Nomura S, Novak J, Stricklin A, Swienton R, Tayfur I, Brooks B. Strategies for Strengthening the Resilience of Public Health Systems for Pandemics, Disasters, and Other Emergencies. Disaster Med Public Health Prep 2023; 17:e479. [PMID: 37667881 DOI: 10.1017/dmp.2023.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach. METHODS The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations. RESULTS Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions. CONCLUSIONS The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.
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Affiliation(s)
- Benjamin Ryan
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
- Frist College of Medicine, Belmont University, Nashville, Tennessee, USA
| | - Mayumi Kako
- Hiroshima University, School of Biomedical and Health Sciences, Division of Nursing Science, Hiroshima, Japan
| | - Rok Fink
- University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Perihan Şimşek
- Department of Emergency Aid and Disaster Management, Trabzon University, Trabzon, Turkey
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- University of Queensland School of Medicine, Brisbane, Australia
| | - Jose Acosta
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Sanjaya Bhatia
- United Nations Office for Disaster Risk Reduction Global Education and Training Institute, Incheon, Republic of Korea
| | | | - Matthew Fendt
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Alicia Fontenot
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Nahuel Arenas Garcia
- United Nations Office for Disaster Risk Reduction Regional Office for the Americas and Caribbean, Panama
| | - Shelby Garner
- Gordon E. Inman College of Health Sciences and Nursing, Belmont University, Nashville, Tennessee, USA
| | - Abdülkadir Gunduz
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | | | - Tim Hatch
- Alabama Department of Public Health, Montgomery, Alabama, USA
| | | | - Makiko MacDermot
- World Health Organization Centre of Health Development, Kobe, Japan
| | - Ryoma Kayano
- World Health Organization Centre of Health Development, Kobe, Japan
| | - Joshua McKone
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Chaverle Noel
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | | | - Andrew Stricklin
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas, USA
| | - Raymond Swienton
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas, USA
| | - Ismail Tayfur
- Department of Emergency Medicine, University of Health Sciences, Istanbul, Turkey
| | - Bryan Brooks
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
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10
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Perveen MM, Mayo-Malasky HE, Lee-Wong MF, Tomaska JM, Forsyth E, Gravely A, Klein MA, Trembley JH, Butterick TA, Promisloff RA, Ginex PK, Barach P, Szema AM. Gross Hematuria and Lower Urinary Tract Symptoms Associated With Military Burn Pits Exposures in US Veterans Deployed to Iraq and Afghanistan. J Occup Environ Med 2023; 65:740-744. [PMID: 37367635 PMCID: PMC10487357 DOI: 10.1097/jom.0000000000002919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim of the study is to describe rates of hematuria and other lower urinary tract symptoms, including self-reported cancer rates, among veterans postburn pits emissions exposure during deployment to Iraq and Afghanistan. METHODS US post-9/11 veterans with burn pits emissions exposure confirmed via DD214 forms in the Burn Pits360.org Registry were sent a modified survey. Data were deidentified and anonymously coded. RESULTS Twenty-nine percent of the 155 respondents exposed to burn pits self-reported seeing blood in their urine. The average index score of our modified American Urological Association Symptom Index Survey was 12.25 (SD, 7.48). High rates of urinary frequency (84%) and urgency (76%) were self-reported. Bladder, kidney, or lung cancers were self-reported in 3.87%. CONCLUSIONS US veterans exposed to burn pits are self-reporting hematuria and other lower urinary tract symptoms.
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11
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Xiang N, Hoeft M, Fackler CJ, Chen Z, Barach P. Validation of Bayesian design for broadband microslit panel absorbers using causal inference. J Acoust Soc Am 2023; 154:1471-1481. [PMID: 37675970 DOI: 10.1121/10.0020846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
This paper discusses experimental validations of multilayer microslit panels (MSPs) designed via Bayesian inference to obtain both high sound absorption and wide bandwidth simultaneously. Microslit perforation in thin panels is similar to microperforated panels [Xiang, Fackler, Hou, and Schmitt (2022). J. Acoust. Soc. Am. 151(5), 3094-3103]. MSP absorbers in single-layer configurations are functioning in a limited frequency range. By stacking the MSPs in multiple layered structures, absorbing performance may be widened in frequency ranges while retaining high absorption coefficients. Besides design challenges of multiple MSPs in layered structures to fulfill a practical requirement and minimize fabrication complexity, this paper further discusses challenges in experimental validations when experimental results undesirably deviate from the initial Bayesian design. Causation analysis is applied to the validation efforts where a causal model-based inference effectively provides causal reasoning of fabrication inaccuracies. Along with the causal inference, a causal reasoning conducted in this work can guide corrections due to fabrication inaccuracies during the iterative validation process.
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Affiliation(s)
- Ning Xiang
- Graduate Program in Architectural Acoustics, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Michael Hoeft
- Graduate Program in Architectural Acoustics, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Cameron J Fackler
- Graduate Program in Architectural Acoustics, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Ziqi Chen
- Graduate Program in Architectural Acoustics, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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12
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Dopelt K, Shevach I, Vardimon OE, Czabanowska K, De Nooijer J, Otok R, Leighton L, Bashkin O, Duplaga M, Levine H, MacLeod F, Malowany M, Okenwa-Emegwa L, Zelber-Sagi S, Davidovitch N, Barach P. Simulation as a key training method for inculcating public health leadership skills: a mixed methods study. Front Public Health 2023; 11:1202598. [PMID: 37483956 PMCID: PMC10359821 DOI: 10.3389/fpubh.2023.1202598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method. Methods We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022. Results The questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb's experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions. Conclusion Simulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.
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Affiliation(s)
- Keren Dopelt
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Itamar Shevach
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ofek Eliad Vardimon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jascha De Nooijer
- Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Hagai Levine
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Maureen Malowany
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem-Hadassah, Jerusalem, Israel
| | - Leah Okenwa-Emegwa
- Department of Health Sciences, The Swedish Red Cross University (SRCU), Huddinge, Sweden
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Nadav Davidovitch
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Vienna, Austria
- Department of Surgery, Imperial College School of Medicine, London, United Kingdom
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13
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Hartwell JL, Barach P, Gunter TD, Reed K, Kelker H, Welch J, Olson K, Harry E, Meltzer-Brody S, Quinn M, Ferrand J, Kiely SC, Hartsock J, Holmes E, Schroeder K, Ahmed R. Navigating Work-Life Integration, Legal Issues, Patient Safety: Lessons for Work-Life Wellness in Academic Medicine: Part 1 of 3. Kans J Med 2023; 16:153-158. [PMID: 37377624 PMCID: PMC10291991 DOI: 10.17161/kjm.vol16.19952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
In this series of three manuscripts, we will explore real-life scenarios encountered by clinicians, learners, and researchers in healthcare, which challenge our assumptions and our understanding of how to navigate issues as diverse as mental health, racial diversity, gender discrimination, imposter syndrome, and substance use disorder.
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Affiliation(s)
| | - Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
| | - Tracy D Gunter
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kyra Reed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Heather Kelker
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Julie Welch
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kristine Olson
- Department of Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Elizabeth Harry
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mariah Quinn
- Department of Medicine, University of Wisconsin School of Medicine and Public Health Madison, Madison, WI
| | | | | | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristin Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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14
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Ahmed R, Hartwell JL, Farley H, MacRae J, Rogers DA, Lawrence EC, Brazeau CM, Park EM, Cassidy A, Hartsock J, Holmes E, Schroeder K, Barach P. Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3. Kans J Med 2023; 16:159-164. [PMID: 37377619 PMCID: PMC10291990 DOI: 10.17161/kjm.vol16.19953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
In this second of three manuscripts addressing a range of complex work and personal issues, the authors explore case scenarios with characters who work in the fields of general surgery, orthopedic surgery, anesthesiology, neurology, radiology, and otolaryngology. The medical specialty identifiers help inform some baseline understanding of the demands of that particular profession but are less pertinent than the specifics of each case. In this manuscript, the authors dive into the topics of navigating a lawsuit and professional burnout, personal finances, substance use disorder, demands of clinical work and workplace politics, diversity and inclusion, and dealing with major personal illness. The authors provide practical steps to help the readers deal with similar situations and provide insight to support persons on how to improve support structures.
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Affiliation(s)
- Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | | | - Elizabeth C Lawrence
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM
| | - Chantal Mlr Brazeau
- Department of Family Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eliza M Park
- Departments of Psychiatry and Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Anna Cassidy
- University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
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15
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Barach P, Ahmed R, Agarwal G, Olson K, Welch J, Chernoby K, Hein CL, Anand T, Joseph B, Rosenstein DL, Sotto-Santiago S, Hartsock J, Holmes E, Schroeder K, Hartwell JL. Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3. Kans J Med 2023; 16:165-171. [PMID: 37377621 PMCID: PMC10291980 DOI: 10.17161/kjm.vol16.19954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
In this final manuscript of the three-part series, the authors address issues of imposter syndrome, pregnancy, and parental leave, second victim phenomenon, sexual harassment, response to suicide, and managing a budget while advancing diversity, equity, and inclusion. The case scenarios have learners and non-clinicians as their main characters, bringing attention to the cross-cutting nature of the complex issues we see both in and around a career in medicine.
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Affiliation(s)
- Paul Barach
- Thomas Jefferson School of Medicine, Philadelphia, PA
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Gaurava Agarwal
- Departments of Medical Education and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kristine Olson
- Department of Medicine, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Julie Welch
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kimberly Chernoby
- Department of Emergency Medicine, National Women's Law Center and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christine L Hein
- Department of Emergency Medicine, Tufts University School of Medicine, Maine Medical Center, Portland, ME
| | - Tanya Anand
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ
| | - Bellal Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sylk Sotto-Santiago
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jane Hartsock
- Center for Bioethics, Indiana University, Indianapolis, IN
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Schroeder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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16
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Candido G, Tortù C, Seghieri C, Tartaglia R, Baglioni C, Citti P, Raciti IM, La Regina M, Simonini S, Urbani M, Parretti C, Barach P. Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study. J Infect Public Health 2023; 16:1281-1289. [PMID: 37329608 DOI: 10.1016/j.jiph.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients. METHODS This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes. FINDINGS We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments. INTERPRETATION The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress.
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Affiliation(s)
- Giuseppe Candido
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Costanza Tortù
- Institute of Management, Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Chiara Seghieri
- Institute of Management, Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Riccardo Tartaglia
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Chiara Baglioni
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinic for Sleep Psychotherapy, School of Cognitive Psychotherapy, Rome, Italy
| | - Paolo Citti
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | | | | | | | | | - Chiara Parretti
- Department of Engineering Sciences, Guglielmo Marconi University, Rome, Italy
| | - Paul Barach
- Wayne State University, School of Medicine, Children's Hospital, Detroit, United States; Jefferson College of Population Health, Philadelphia, United States; University of Queensland, Queensland, Australia.
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17
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Hasan BS, Bhatti A, Mohsin S, Barach P, Ahmed E, Ali S, Amanullah M, Ansong A, Banu T, Beaton A, Bolman RM, Borim BC, Breinholt JP, Callus E, Caputo M, Cardarelli M, Hernandez TC, Croti UA, Ejigu YM, Fenton K, Gomanju A, Harahsheh AS, Hesslein P, Hugo-Hamman C, Khan S, Kpodonu J, Kumar RK, Jenkins KJ, Lakhoo K, Malik M, Nichani S, Novick WM, Overman D, Quenot APM, Patton Bolman C, Pearson D, Raju V, Ross S, Sandoval NF, Sholler G, Sharma R, Shidhika F, Sivalingam S, Verstappen A, Vervoort D, Zühlke LJ, Zheleva B. Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework. BMJ Glob Health 2023; 8:e012049. [PMID: 37142298 PMCID: PMC10163477 DOI: 10.1136/bmjgh-2023-012049] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.
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Affiliation(s)
- Babar S Hasan
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Areesh Bhatti
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Mohsin
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Paul Barach
- Department of Public Health and Anesthesiology, Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Sulafa Ali
- Department of Pediatrics and Child Health, University of Khartoum, Khartoum, Sudan
- Department of Pediatrics and Child Health, Sudan Heart Center, Khartoum, Sudan
| | - Muneer Amanullah
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Annette Ansong
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Tahmina Banu
- Department of Pediatric Surgery, Chittagong Research Institute for Children, Chittagong, Bangladesh
| | - Andrea Beaton
- The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ralph Morton Bolman
- University of Minnesota, Minneapolis, Minnesota, USA
- Team Heart Inc, Newton Highlands, Massachusetts, USA
| | - Bruna Cury Borim
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - John P Breinholt
- Division Chief, Pediatric Cardiology, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
- Department of Biomedical Sciences, University of Milan, Milan, Italy
| | - Massimo Caputo
- Translational Health Science, University of Bristol, Bristol, UK
| | | | | | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - Yayehyirad M Ejigu
- Department of Cardiothoracic Surgery, King Faisal Hospital, Kigali, Rwanda
| | - Kathleen Fenton
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
- NIH, Bethesda, Maryland, USA
| | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | | | - Christopher Hugo-Hamman
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Sohail Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mahim Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan
| | - Sanjiv Nichani
- Leicester Children's Hospital, Leicester, East Midlands, UK
- Healing Little Hearts Global Foundation, Leicester, UK
| | - William M Novick
- University of Tennessee Health Science Center-Global Surgery Institute, Memphis, Tennessee, USA
- William Novick Global Cardiac Alliance, Memphis, Tennessee, USA
| | - David Overman
- Division of Cardiac Surgery, The Children's Heart Clinic, Children's Minnesota, Minneapolis, Minnesota, USA
- Division of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | | | | | - Dorothy Pearson
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | | | - Shelagh Ross
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Nestor F Sandoval
- Department of Cardiac Surgery, Fundacion cardioinfantil -la Cardio.Instituto de cardiopatías Congenitas, Universidad del Rosario, Bogota, Colombia
| | - Gary Sholler
- Heart Center for Children, Sydney Children's Hospital Network, University of Sydney, Sydney, New South Wales, Australia
| | | | - Fenny Shidhika
- Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Amy Verstappen
- President, Global Alliance for Rheumatic and Congenital Hearts, Memphis, Tennessee, USA
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, SAMRC Francie Van Zil Drive Parow, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics Red Cross War Memorial Hospital, University of Cape Town, Cape Town, South Africa
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18
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Edwards N, Dunn S, Barach P, Vaughan L. The Wolfson Prize: designing the hospital of the future. Future Healthc J 2023; 10:27-30. [PMID: 37786505 PMCID: PMC10538682 DOI: 10.7861/fhj.2022-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The 2021 Wolfson Economics Prize asked how new hospitals should be designed to radically improve patient experiences, clinical outcomes, staff wellbeing and integration with wider health and social care. With a major programme to rebuild and renew hospitals in England underway, the Prize offered an opportunity to understand current thinking about hospitals and their future place. Methods The 41 submissions that were identified as 'most promising' were reviewed and subjected to framework analysis. Emerging themes were identified and discussed iteratively. Results Five dominant themes were identified: a calming environment; systems of care; distribution of services; use of technology; and going green. Several tensions and trade-offs were evident across the submissions and a number of gaps were identified in the knowledge base that need to be remedied to ensure that new hospitals are safe and efficient. Conclusion The previous approach to building new hospitals, with its over-riding drive to reduce costs, has not served the UK well. New ways of thinking about hospital building and design are urgently needed, especially the funding of research and the creation of a national repository devoted to design solutions and post-build evaluations of new hospitals.
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Affiliation(s)
| | | | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, USA and Sigmund Freud University, Vienna, Austria
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19
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Subbe CP, Goodman A, Barach P. Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes. Acute Med 2023; 21:182-189. [PMID: 36809449 DOI: 10.52964/amja.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Co-design in acute care is challenged by the inability of unwell patients to participate in the process and the often transient nature of acute care. We undertook a rapid review of the literature on co-design, co-production and co-creation of solutions for acute care that were developed with patients. We found limited little evidence for co-design methods in acute care. We adapted a novel design driven method (BASE methodology) that creates stakeholder groups through epistemological criteria for the rapid development of interventions for acute care. We demonstrated feasibility of the methodology in two case studies: A mHealth application with checklists for patients undergoing treatment for cancer and a patient held record for self-clerking on admission to hospital.
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Affiliation(s)
- C P Subbe
- DM, FRCP, Ysbyty Gwynedd, Bangor and Senior Clinical Lecturer, School of Medical Sciences, Bangor University, Bangor LL57 2DG, UK
| | - A Goodman
- Senior Lecturer in Design, Bangor University, Bangor, Gwynedd, LL57 2DG
| | - P Barach
- Clinical Professor, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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20
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Dopelt K, Davidovitch N, Davidov N, Plot I, Boas H, Barach P. "As if we are branded with the mark of Cain": stigma, guilt, and shame experienced by COVID-19 survivors in Israel - a qualitative study. Curr Psychol 2023:1-14. [PMID: 36684454 PMCID: PMC9838295 DOI: 10.1007/s12144-023-04241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Stigma is associated with harmful health outcomes, and it fuels social and health inequalities. It can undermine social cohesion and encourage social exclusion of groups, which may contribute to secrecy about disease symptoms, avoidance of disease testing and vaccination, and further spread of a contagious illness. Stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose a threat to effective interpersonal and social relationships. In this qualitative study, we delved into the stigmatization experiences of twenty COVID-19 recovered patients during the COVID-19 first wave, using in-depth semi-structured interviews conducted during November 2020. Using thematic analysis, we found that the process of stigmatization was all-encompassing, from the stage of diagnosis throughout the duration of the disease and the recovery phases. On the basis of the data, we hypothesized that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging and insidious effects during infectious disease pandemics such as COVID-19, and reduce infectious disease-related stigma. Interventions should address provision of emotional support frameworks for the victims of stigmatization and discrimination that accompany the COVID-19 pandemic and future pandemics. This study was conducted in the early days of the COVID-19 pandemic, when uncertainty about the disease was high and fear of contamination fueled high levels of stigmatization against those who became ill with Covid-19.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nikol Davidov
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Ira Plot
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Hagai Boas
- Department of Politics and Governance, Ben Gurion University of the Negev, Beer Sheva, Israel
- The Van Leer Jerusalem Institute, Jerusalem, Israel
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA USA
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21
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Bashkin O, Otok R, Kapra O, Czabanowska K, Barach P, Baron-Epel O, Dopelt K, Duplaga M, Leighton L, Levine H, MacLeod F, Neumark Y, Paillard-Borg S, Tulchinsky T, Mor Z. Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis. Int J Public Health 2022; 67:1605303. [PMID: 36618436 PMCID: PMC9812945 DOI: 10.3389/ijph.2022.1605303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,*Correspondence: Osnat Bashkin,
| | - Robert Otok
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Ori Kapra
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Kasia Czabanowska
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA, United States,Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Lore Leighton
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Hagai Levine
- The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat-Gan, Israel
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Yehuda Neumark
- Hadassah Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Zohar Mor
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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22
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Parretti C, Tartaglia R, La Regina M, Venneri F, Sbrana G, Mandò M, Barach P. Improved FMEA Methods for Proactive Health Care Risk Assessment of the Effectiveness and Efficiency of COVID-19 Remote Patient Telemonitoring. Am J Med Qual 2022; 37:535-544. [PMID: 36250651 PMCID: PMC9622365 DOI: 10.1097/jmq.0000000000000089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The COVID-19 pandemic exposed the need to more effectively harness and leverage digital tools and technology for remote patient monitoring (RPM). RPM gained great popularity given the need to provide effective, safe, efficient, and remote patient care. RPM is based on noninvasive digital technologies aimed at improving the safety and efficiency of health care delivery. We report on an RPM program in which 200 COVID-19 patients were followed remotely to evaluate the effectiveness in treating and monitoring patients in home settings. We analyzed the inherent risks using mixed methods, including failure mode and effect analysis, a prospective, team-based risk management methodology structured to identify high-risk process system failures before they occur in telemonitoring of remote patients. The RPM saved lives and improved decision-making during the pandemic and helped prevent the health system's collapse. The failure mode and effect analysis-based assessment offers important insights and considerations for evaluating future RPM implementation and direction. RPM solutions are technically feasible, staff friendly, and can achieve high adherence rates. Rigorous and ongoing evaluation of devices and platforms is essential to clarifying their value and guiding national health and insurance health coverage decisions and adoption programs.
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Affiliation(s)
- Chiara Parretti
- Department of Science Engineering, Marconi University, Italy
| | | | | | | | - Giovanni Sbrana
- Department of Eemergency, South East Tuscany Healtcare Agency, Italy
| | - Massimo Mandò
- Department of Eemergency, South East Tuscany Healtcare Agency, Italy
| | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA
- Sigmund Freud University, Vienna, Austria
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23
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Ramaswamy R, Ramaswamy V, Holly M, Bartels S, Barach P. Building local decision-making competencies during COVID-19: Accelerating the transition from learning healthcare systems to learning health communities. Learn Health Syst 2022; 7:e10337. [PMID: 36247203 PMCID: PMC9538137 DOI: 10.1002/lrh2.10337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The persisting and evolving COVID-19 pandemic has made apparent that no singular policy of mitigation at a regional, national or global level has achieved satisfactory and universally acceptable results. In the United States, carefully planned and executed pandemic policies have been neither effective nor popular and COVID-19 risk management decisions have been relegated to individual citizens and communities. In this paper, we argue that a more effective approach is to equip and strengthen community coalitions to become local learning health communities (LLHCs) that use data over time to make adaptive decisions that can optimize the equity and well-being in their communities. Methods We used data from the North Carolina (NC) county and zip code levels from May to August 2020 to demonstrate how a LLHC could use statistical process control (SPC) charts and simple statistical analysis to make local decisions about how to respond to COVID-19. Results We found many patterns of COVID-19 progression at the local (county and zip code) levels during the same time period within the state that were completely different from the aggregate NC state level data used for policy making. Conclusions Systematic approaches to learning from local data to support effective decisions have promise well beyond the current pandemic. These tools can help address other complex public health issues, and advance outcomes and equity. Building this capacity requires investment in data infrastructure and the strengthening of data competencies in community coalitions to better interpret data with limited need for advanced statistical expertise. Additional incentives that build trust, support data transparency, encourage truth-telling and promote meaningful teamwork are also critical. These must be carefully designed, contextually appropriate and multifaceted to motivate citizens to create and sustain an effective learning system that works for their communities.
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Affiliation(s)
- Rohit Ramaswamy
- Cincinnati Children's Hospital Medical CenterJames M Anderson Center for Health Systems ExcellenceCincinnatiOhioUSA
| | | | - Margaret Holly
- Department of Health Policy and ManagementUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Sophia Bartels
- Department of Health BehaviorUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Paul Barach
- College of Population HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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24
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Bashkin O, Otok R, Leighton L, Czabanowska K, Barach P, Davidovitch N, Dopelt K, Duplaga M, Okenwa Emegwa L, MacLeod F, Neumark Y, Raz MP, Tulchinsky T, Mor Z. Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study. Front Public Health 2022; 10:990353. [PMID: 36117595 PMCID: PMC9479633 DOI: 10.3389/fpubh.2022.990353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023] Open
Abstract
The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,*Correspondence: Osnat Bashkin
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Kasia Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States,College of Population Health, Sigmund Freud University, Vienna, Austria
| | - Nadav Davidovitch
- Faculty of Health Sciences, Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beersheba, Israel,The Israeli Association of Public Health Physicians (IPAPH), Israeli Medical Association, Ramat Gan, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel,Faculty of Health Sciences, Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beersheba, Israel
| | - Mariusz Duplaga
- Faculty of Health Sciences, Department of Health Promotion and e-Health, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Leah Okenwa Emegwa
- Department of Health Sciences, The Swedish Red Cross University College (SRCUC), Huddinge, Sweden
| | - Fiona MacLeod
- School of Public Health, University College Cork, Cork, Ireland
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - Maya Peled Raz
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa, Israel
| | | | - Zohar Mor
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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25
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Uramatsu M, Maeda H, Mishima S, Takahashi M, Wada J, Amano K, Barach P, Miki T. Serious hazards of transfusion: evaluating the dangers of a wrong patient autologous salvaged blood in cardiac surgery. J Cardiothorac Surg 2022; 17:182. [PMID: 35974374 PMCID: PMC9382733 DOI: 10.1186/s13019-022-01931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The past half century has seen the near eradication of transfusion-associated hazards. Intraoperative cell salvage while widely used still poses significant risks and hazards due to human error. We report on a case in which blood collected from a patient with lung cancer was mistakenly administered to a patient undergoing cardiac surgery who should have received his own collected blood. The initial investigation found that the cause of the patient harm was violations of procedures by hospital personnel. A detailed investigation revealed that not only violations were the cause, but also that the underlying causes included haphazard organizational policies, poor communication, workload and staffing deficiencies, human factors and cultural challenges. CASE PRESENTATION On August 14, 2019, a 72-year-old male was admitted to our hospital for angina pectoris and multivessel coronary artery disease. Cardiac surgery was performed using an autologous salvage blood collection system, and there were no major problems other than the prolonged operation time. During the night after the surgery, when the patient's blood pressure dropped, a nurse retrieved a blood bag from the ICU refrigerator that had been collected during the surgery and administered it at the physician's direction, but at this time neither the physician nor the nurse performed the required checking procedures. The blood administered was another patient's blood taken from another surgery the day before; an ABO mismatch transfusion occurred and the patient was diagnosed with DIC. The patient was discharged 65 days later after numerous interventions to support the patient. An accident investigation committee was convened to analyze the root causes and develop countermeasures to prevent a recurrence. CONCLUSION This adverse event occurred because the protocol for intraoperative blood salvage management was not clearly defined, and the procedure was different from the standard transfusion practices. We developed a new workflow based on a human factors grounded, systems-wide improvement strategy in which intraoperative blood collection would be administered before the patient leaves the operating room to completely prevent recurrence, instead of simply requiring front-line staff to do a double-check. Implementing strong systems processes can reduce the risk of errors, improve the reliability of the work processes and reduce the likelihood of patient harm occurring in the future.
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Affiliation(s)
- Masashi Uramatsu
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Hideyuki Maeda
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, 1-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Shiro Mishima
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Megumi Takahashi
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Wada
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kagehiro Amano
- Department of Laboratory Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Paul Barach
- Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.,University of Queensland School of Medicine, Brisbane, Australia.,Medical University of Graz, Graz, Austria
| | - Tamotsu Miki
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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26
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Loibner M, Barach P, Wolfgruber S, Langner C, Stangl V, Rieger J, Föderl-Höbenreich E, Hardt M, Kicker E, Groiss S, Zacharias M, Wurm P, Gorkiewicz G, Regitnig P, Zatloukal K. Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory. Front Psychol 2022; 13:901244. [PMID: 35936273 PMCID: PMC9353000 DOI: 10.3389/fpsyg.2022.901244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.
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Affiliation(s)
- Martina Loibner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Paul Barach
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stella Wolfgruber
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christine Langner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Julia Rieger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Melina Hardt
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Eva Kicker
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Silvia Groiss
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Philipp Wurm
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
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27
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Doos D, Barach P, Alves NJ, Falvo L, Bona A, Moore M, Cooper DD, Lefort R, Ahmed R. The Dangers of Reused Personal Protective Equipment: Healthcare Workers and Workstation Contamination. J Hosp Infect 2022; 127:59-68. [PMID: 35688273 PMCID: PMC9172254 DOI: 10.1016/j.jhin.2022.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
Abstract
Background Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. Methods In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. Results All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. Conclusion PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.
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Affiliation(s)
- D Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - P Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA; University of Queensland, Brisbane, Queensland, Australia
| | - N J Alves
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L Falvo
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Bona
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Moore
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - D D Cooper
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Lefort
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Doos D, Barach P, Sarmiento E, Ahmed R. Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing. J Emerg Med 2022; 62:337-341. [PMID: 35131132 PMCID: PMC8814906 DOI: 10.1016/j.jemermed.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. OBJECTIVE The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. METHODS The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. RESULTS All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. CONCLUSIONS The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.
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Affiliation(s)
- Devin Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana,Reprint Address: Devin Doos, MD, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FT 3, Indianapolis, IN 46202
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania,University of Queensland, Brisbane, Queensland, Australia
| | - Elisa Sarmiento
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Lewis S, Jones GM, Barach P, Tomos H, Davies M, Eckley B, Dowell HR, Subbe CP. How To Hospital: barriers to developing a patient 'Hospital Survival Guide' to support information transfer during ward-rounds on the patient journey from admission to hospital to discharge. BMJ Open Qual 2022; 11:bmjoq-2021-001556. [PMID: 34983802 PMCID: PMC8728439 DOI: 10.1136/bmjoq-2021-001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022] Open
Abstract
Clinicians can enable patients to actively participate in their care but communication with patients is often poor and highly variable. The aim of this study was to explore patients’ understanding of their current illness while in hospital and using a codesign process to create prototype tools to facilitate better communication during ward rounds. A mixed-methods, multistep design with step 1: Application of a questionnaire addressing domains of care in the acute medical unit; step 2: Development of communication aids that were codesigned with active help of patients, students and a specialist in user centric design to address patient needs and step 3: Evaluation of tools with patients in four Plan–Do–Study–Act cycles. In the initial survey of 30 patients 12 (40%) patients did not know what their diagnosis was and 5 (17%) did not know the results of recent key tests. 20 (67%) patients felt that staff communication and coordination could be improved. An intervention was prototyped with four variations: (1) An A6 ward-round summary sheet completed by doctors during ward rounds. The system worked well but was highly person dependent. (2) An A4 patient-owned diary (‘How to Hospital’) that contained information about key processes in hospital and space to document conversations from rounds and prompts for questions. 10 patients read the diary and commented favourably but did not complete any pages. (3) ‘Diary-cards’: a basic set of information cards was given to patients on admission to hospital. (4) Patient specific ‘diary-cards’ were completed by clinicians—10 forms were piloted during rounds and improved subsequent day information retention of diagnosis to 80%. Our study identified interventions that were feasible but remained person-dependent. The patients’ ownership of information in relation to their care might facilitate retention and satisfaction but the optimal format for these interventions for enhancing communication remains unclear.
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Affiliation(s)
| | | | - Paul Barach
- Pediatrics, Wayne State University, Detroit, Michigan, USA.,Thomas Jefferson University; College of Population Health, Philadelphia, Pennsylvania, USA
| | - Hawys Tomos
- Royal College of Art: School of Design, London, UK
| | - Mari Davies
- Cardiff University; School of Medicine, Cardiff, UK
| | | | | | - Christian Peter Subbe
- Medicine, Ysbyty Gwynedd, Bangor, UK .,Medicine, Bangor University School of Medical Sciences, Bangor, UK
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Silverstein A, Dudaev A, Studneva M, Aitken J, Blokh S, Miller AD, Tanasova S, Rose N, Ryals J, Borchers C, Nordstrom A, Moiseyakh M, Herrera AS, Skomorohov N, Marshall T, Wu A, Cheng RH, Syzko K, Cotter PD, Podzyuban M, Thilly W, Smith PD, Barach P, Bouri K, Schoenfeld Y, Matsuura E, Medvedeva V, Shmulevich I, Cheng L, Seegers P, Khotskaya Y, Flaherty K, Dooley S, Sorenson EJ, Ross M, Suchkov S. Evolution of biomarker research in autoimmunity conditions for health professionals and clinical practice. Progress in Molecular Biology and Translational Science 2022; 190:219-276. [DOI: 10.1016/bs.pmbts.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dopelt K, Bachner YG, Urkin J, Yahav Z, Davidovitch N, Barach P. Perceptions of Practicing Physicians and Members of the Public on the Attributes of a "Good Doctor". Healthcare (Basel) 2021; 10:healthcare10010073. [PMID: 35052237 PMCID: PMC8775310 DOI: 10.3390/healthcare10010073] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Since physician–patient relationships are a central part of the medical practice, it is essential to understand whether physicians and the general public share the same perspective on traits defining a “good doctor”. Our study compared the perceptions of physicians and members of the public on the essential traits of a “good doctor.” We conducted parallel surveys of 1000 practicing specialist-physicians, and 500 members of the public in Israel. Respondents were asked about the two most important attributes of a “good doctor” and whether they thought the physicians’ role was to reduce health disparities. Many physicians (56%) and members of the public (48%) reported that the role of physicians includes helping to reduce health disparities. Physicians emphasized the importance of non-technical skills such as humaneness and concern for patients as important traits of a “good doctor,” while the public emphasized professional and technical skills. Internal medicine physicians were more likely than surgeons to emphasize humaneness, empathy, and professionalism. Future research should focus on actionable approaches to bridge the gap in the perceptions between the groups, and that may support the formation of caring physicians embedded in a complex array of relationships within clinical and community contexts.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ben Tzvi St. 12, Ashkelon 78211, Israel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; (Y.G.B.); (J.U.); (Z.Y.); (N.D.)
- Correspondence: ; Tel.: +972-548-139-933
| | - Yaacov G. Bachner
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; (Y.G.B.); (J.U.); (Z.Y.); (N.D.)
| | - Jacob Urkin
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; (Y.G.B.); (J.U.); (Z.Y.); (N.D.)
| | - Zehava Yahav
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; (Y.G.B.); (J.U.); (Z.Y.); (N.D.)
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; (Y.G.B.); (J.U.); (Z.Y.); (N.D.)
| | - Paul Barach
- Department of Pediatrics, School of Medicine, Jefferson College of Population Health, Wayne State University, Philadelphia, PA 19107, USA;
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, A-1020 Vienna, Austria
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Abstract
The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil.,Academy of Leadership Sciences Switzerland, Switzerland
| | | | - Paul Barach
- Academy of Leadership Sciences Switzerland, Switzerland.,Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.,Interdisciplinary Research Institute for Health Law & Science, Sigmund Freud University, Vienna, Austria
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Abstract
Outsourcing in health care has become increasingly common as health system administrators seek to enhance profitability and efficiency while maintaining clinical excellence. When clinical services are outsourced, however, the outsourcing organization relinquishes control over its most important service value: high-quality patient care. Farming out work to an external service provider can have many unintended results, including inconsistencies in standards of care; harmful medical errors; declines in patient and employee satisfaction; and damage to clinicians' morale and income, and to the health organization's culture, reputation, and long-term financial performance. Research on outsourcing in the areas of emergency medicine, radiology, laboratory services, and environmental services provides concerning evidence of potentially large downsides when outsourcing is driven by short-term cost concerns or is planned without diligently considering all of the ramifications of not keeping key clinical and nonclinical services in-house. To better equip health system leaders for decision-making about outsourcing, we examine this body of literature, identify common pitfalls of outsourcing in specific clinical and nonclinical health services and scenarios, explore alternatives to outsourcing, and consider how outsourcing (when necessary) can be done in a strategic manner that does not compromise the values of the organization and its commitment to patients.
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Affiliation(s)
- Leonard L Berry
- Mays Business School, Texas A&M University, College Station, TX; Institute for Healthcare Improvement, Boston, MA.
| | | | - Nandini Ramani
- Mays Business School, Texas A&M University, College Station, TX
| | - Paul Barach
- Wayne State University School of Medicine, MI; Jefferson College of Population Health, Philadelphia, PA; Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
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Brambilla A, Sun TZ, Elshazly W, Ghazy A, Barach P, Lindahl G, Capolongo S. Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation. Int J Environ Res Public Health 2021; 18:ijerph182111478. [PMID: 34769993 PMCID: PMC8583089 DOI: 10.3390/ijerph182111478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022]
Abstract
Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.
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Affiliation(s)
- Andrea Brambilla
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Center for Healthcare Architecture (CVA), Division of Building Design, Department Architecture and Civil Engineering (ACE), Chalmers University of Technology, SE-412 96 Goteborg, Sweden
- Correspondence: ; Tel.: +39-0223995140
| | - Tian-zhi Sun
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
| | - Waleed Elshazly
- School of Architecture and Urban Planning (AUIC), Politecnico di Milano, 20133 Milan, Italy; (W.E.); (A.G.)
| | - Ahmed Ghazy
- School of Architecture and Urban Planning (AUIC), Politecnico di Milano, 20133 Milan, Italy; (W.E.); (A.G.)
| | - Paul Barach
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Medicine and Law, Sigmund Freud University, 1020 Vienna, Austria
| | - Göran Lindahl
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Center for Healthcare Architecture (CVA), Division of Building Design, Department Architecture and Civil Engineering (ACE), Chalmers University of Technology, SE-412 96 Goteborg, Sweden
| | - Stefano Capolongo
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
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Brubakk K, Svendsen MV, Deilkås ET, Hofoss D, Barach P, Tjomsland O. Hospital work environments affect the patient safety climate: A longitudinal follow-up using a logistic regression analysis model. PLoS One 2021; 16:e0258471. [PMID: 34653217 PMCID: PMC8519418 DOI: 10.1371/journal.pone.0258471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background Occupational worker wellness and safety climate are key determinants of healthcare organizations’ ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units. Methods Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean score and a binary outcome to measure study outcomes. The relationship between the hospital unit characteristics and the observed changes in the safety climate was analyzed by linear and logistic regression models. Results A work environment conducive to safe incident reporting, innovation, and teamwork was found to be significant for positive changes in the safety climate. In addition, a work environment supportive of patient needs and staff commitment to their workplace was significant for maintaining a mature safety climate over time. Conclusions A supportive work environment is essential for patient safety. The characteristics of the hospital units were significantly associated with the unit’s safety climate scores, hence improvements in working conditions are needed for enhancing patient safety.
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Affiliation(s)
- Kirsten Brubakk
- Department of Human Resources, South Eastern Norway Regional Health Authority, Hamar, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital Trust, Skien, Norway
| | - Ellen Tveter Deilkås
- Department of Quality Improvement and Patient Safety, Norwegian Directorate of Health, Oslo, Norway
- Unit for Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Department of Health and Inequality, National Institute of Public Health, Oslo, Norway
| | - Paul Barach
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States of America
- Jefferson College of Population Health, Philadelphia, Pennsylvania, United States of America
- Sigmund Freud University, Vienna, Austria
| | - Ole Tjomsland
- Department of Health, South Eastern Norway Regional Health Authority, Hamar, Norway
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Subbe CP, Tomos H, Jones GM, Barach P. Express check-in: developing a personal health record for patients admitted to hospital with medical emergencies: a mixed-method feasibility study. Int J Qual Health Care 2021; 33:6354901. [PMID: 34410422 DOI: 10.1093/intqhc/mzab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient participation is increasingly recognized as a key component in the redesign of healthcare processes and is advocated as a means to improve patient safety. OBJECTIVE To explore the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to the hospital. METHODS design: prospective iterative development and feasibility testing of personal health records; setting: an acute medical unit in a university-affiliated hospital; participants: patients admitted to hospital for medical emergencies; interventions: we used a design-led development of personal health record prototypes and feasibility testing of records completed by patients during the process of emergency admission. 'Express-check-in' records contained items of social history, screening questions for sepsis and acute kidney injury in addition to the patients' ideas, concerns and expectations; main outcome measures: the outcome metrics focused on feasibility and a selection of quality domains, namely effectiveness of recording relevant history, time efficiency of the documentation process, patient-centredness of resulting records and staff and patient feedback. The incidence of sepsis and acute kidney injury were used as surrogate measures for assessing the safety impact. RESULTS The medical record prototypes were developed in an iterative fashion and tested with 100 patients, in which 39 patients were 70 or older and 25 patients were classified as clinically frail. Ninety-six per cent of the data items were completed by patients with no or minimal help from healthcare professionals. The completeness of these patient records was superior to that of the corresponding medical records in that they contained deeply held beliefs and fears, whereas concerns and expectations recorded by patients were only mirrored in a small proportion of the formal clinical records. The sepsis self-screening tool identified 68% of patients requiring treatment with antibiotics. The intervention was feasible, independent of the level of formal education and effective in frail and elderly patients with support from family and staff. The prototyped records were well received and felt to be practical by patients and staff. The staff indicated that reading the patients' documentation led to significant changes in their clinical management. CONCLUSIONS Medical record accessibility to patients during hospital care contributes to the co-management of personal healthcare and might add critical information over and above the records compiled by healthcare professionals.
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Affiliation(s)
- Christian P Subbe
- Department of Medicine, Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, UK.,School of Medical Sciences, Bangor University, Brigantia Building, Bangor LL57 2DG, UK
| | - Hawys Tomos
- Helen Hamlyn Centre for Design, Royal College of Art, Howie Street, Battersea, London SW11 4AY, UK
| | - Gwenlli Mai Jones
- Cardiff University, Penrhosgarnedd, Bangor LL57 2PW, UK.,Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, UK
| | - Paul Barach
- Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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Warm EJ, Ahmad Y, Kinnear B, Kelleher M, Sall D, Wells A, Barach P. A Dynamic Risk Management Approach for Reducing Harm From Invasive Bedside Procedures Performed During Residency. Acad Med 2021; 96:1268-1275. [PMID: 33735129 DOI: 10.1097/acm.0000000000004066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Internal medicine (IM) residents frequently perform invasive bedside procedures during residency training. Bedside procedure training in IM programs may compromise patient safety. Current evidence suggests that IM training programs rely heavily on the number of procedures completed during training as a proxy for resident competence instead of using objective postprocedure patient outcomes. The authors posit that the results of procedural training effectiveness should be reframed with outcome metrics rather than process measures alone. This article introduces the as low as reasonably achievable (ALARA) approach, which originated in the nuclear industry to increase safety margins, to help assess and reduce bedside procedural risks. Training program directors are encouraged to use ALARA calculations to define the risk trade-offs inherent in current procedural training and assess how best to reliably improve patient outcomes. The authors describe 5 options to consider: training all residents in bedside procedures, training only select residents in bedside procedures, training no residents in bedside procedures, deploying 24-hour procedure teams supervised by IM faculty, and deploying 24-hour procedure teams supervised by non-IM faculty. The authors explore how quality improvement approaches using process maps, fishbone diagrams, failure mode effects and analyses, and risk matrices can be effectively implemented to assess training resources, choices, and aims. Future research should address the drivers behind developing optimal training programs that support independent practice, correlations with patient outcomes, and methods that enable faculty to justify their supervisory decisions while adhering to ALARA risk management standards.
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Affiliation(s)
- Eric J Warm
- E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Yousef Ahmad
- Y. Ahmad is an internal medicine resident, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Benjamin Kinnear
- B. Kinnear is associate professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Matthew Kelleher
- M. Kelleher is assistant professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dana Sall
- D. Sall is assistant professor of medicine, University of Arizona College of Medicine Phoenix, and program director, HonorHealth Scottsdale Thompson Peak Internal Medicine Residency Program, Scottsdale, Arizona
| | - Andrew Wells
- A. Wells is a cardiology fellow, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul Barach
- P. Barach is clinical professor, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, and lecturer, Jefferson College of Population Health, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7906-698X
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Quintão VC, Simões CM, Munoz GEH, Barach P, Carmona MJC. A Brazilian national preparedness survey of anesthesiologists during the coronavirus pandemic. Braz J Anesthesiol 2021; 71:184-187. [PMID: 33706998 PMCID: PMC7972987 DOI: 10.1016/j.bjane.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vinícius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Disciplina de Anestesiologia, São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, Serviços Médicos de Anestesia, São Paulo, SP, Brazil.
| | - Claudia Marquez Simões
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Disciplina de Anestesiologia, São Paulo, SP, Brazil; Hospital Sírio-Libanês, Serviços Médicos de Anestesia, São Paulo, SP, Brazil
| | - Gibran Elias Harcha Munoz
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Disciplina de Anestesiologia, São Paulo, SP, Brazil
| | - Paul Barach
- Wayne State University, School of Medicine, Children's Hospital, Detroit, United States; Jefferson College of Population Health, Philadelphia, United States; University of Queensland, Queensland, Australia
| | - Maria José Carvalho Carmona
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Disciplina de Anestesiologia, São Paulo, SP, Brazil
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Massaro M, Tamburro P, La Torre M, Dal Mas F, Thomas R, Cobianchi L, Barach P. Non-pharmaceutical Interventions and the Infodemic on Twitter: Lessons Learned from Italy during the Covid-19 Pandemic. J Med Syst 2021; 45:50. [PMID: 33675427 PMCID: PMC7936238 DOI: 10.1007/s10916-021-01726-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic changed expectations for information dissemination and use around the globe, challenging accepted models of communications, leadership, and social systems. We explore how social media discourse about COVID-19 in Italy was affected by the rapid spread of the virus, and how themes in postings changed with the adoption of social distancing measures and non-pharmaceutical interventions (NPI). We used topic modeling and social network analysis to highlight critical dimensions of conversations around COVID-19: 1) topics in social media postings about the Coronavirus; 2) the scope and reach of social networks; and 3) changes in social media content as the nation moved from partial to full social distancing. Twitter messages sent in Italy between February 11th and March 10th, 2020. 74,306 Tweets sent by institutions, news sources, elected officials, scientists and social media influencers. Messages were retweeted more than 1.2 million times globally. Non-parametric chi-square statistic with residual analysis to identify categories, chi-square test for linear trend, and Social Network Graphing. The first phase of the pandemic was dominated by social media influencers, followed by a focus on the economic consequences of the virus and placing blame on immigrants. As the crisis deepened, science-based themes began to predominate, with a focus on reducing the spread of the virus through physical distancing and business closures Our findings highlight the importance of messaging in social media in gaining the public's trust and engagement during a pandemic. This requires credible scientific voices to garner public support for effective mitigation. Fighting the spread of an infectious disease goes hand in hand with stemming the dissemination of lies, bad science, and misdirection.
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Affiliation(s)
- Maurizio Massaro
- Dipartimento di Management, Università Ca' Foscari, Venice, Italy
| | | | - Matteo La Torre
- Dipartimento di Economia, Università G. d'Annunzio, Chieti-Pescara, Italy
| | - Francesca Dal Mas
- Ipazia Observatory on Gender Research, Rome, Italy
- Lincoln International Business School, University of Lincoln, Lincoln, UK
| | - Ronald Thomas
- Department of Pediatrics, School of Medicine, Central Michigan University, Mt Pleasant, MI, USA
| | - Lorenzo Cobianchi
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy.
- Dipartimento di Scienze Chirurgiche, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Paul Barach
- Wayne State University School of Medicine, Detroit, MI, USA
- Jefferson College of Population Health, Philadelphia, PA, USA
- Sigmund Freud University, Vienna, Austria
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Abstract
The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.
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Affiliation(s)
- Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Rami A. Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica M. Ray
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Humera Khan
- Department of Internal Medicine, Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Patrick G. Hughes
- Department of Emergency Medicine, Florida Atlantic University College of Medicine, Boca Raton, FL
| | | | - Marc A. Auerbach
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
- College of Population Health, Thomas Jefferson University, Philadelphia, PA
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Abstract
OBJECTIVES Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research. DESIGN Scoping review to map existing evidence and identify gaps for future research. DATA SOURCES PubMed, the Cochrane Library, EMBASE, Trial registers. STUDY SELECTION Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.Results from identified studies were grouped around common themes of safety measures. RESULTS The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety. CONCLUSIONS Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs.
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Affiliation(s)
- Christian Peter Subbe
- School of Medical Sciences, Bangor University, Bangor, UK
- Medicine, Ysbyty Gwynedd, Bangor, UK
| | | | - Paul Barach
- Pediatrics, Wayne State University, Detroit, Michigan, USA
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Barach P, Ahmed R, Nadel ES, Hafferty F, Philibert I. COVID-19 and Medical Education: A Four-Part Model to Assess Risks, Benefits, and Institutional Obligations During a Global Pandemic. Mayo Clin Proc 2021; 96:20-28. [PMID: 33413818 PMCID: PMC7584423 DOI: 10.1016/j.mayocp.2020.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Barach
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI; Jefferson College of Population Health, Philadelphia, PA; The University of Queensland, Australia, St Lucia, Australia.
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Emergency Medicine, Indianapolis
| | - Eric S Nadel
- Department of Emergency Medicine, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Frederic Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, MN
| | - Ingrid Philibert
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
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Romani G, Dal Mas F, Massaro M, Cobianchi L, Modenese M, Barcellini A, Ricciardi W, Barach P, Lucà R, Ferrara M. Population Health Strategies to Support Hospital and Intensive Care Unit Resiliency During the COVID-19 Pandemic: The Italian Experience. Popul Health Manag 2020; 24:174-181. [PMID: 33373536 DOI: 10.1089/pop.2020.0255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities.
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Affiliation(s)
- Gabriele Romani
- Hospital Health Direction, Public Health Agency, Azienda AUSL Modena, Modena, Italy
| | - Francesca Dal Mas
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, United Kingdom
| | - Maurizio Massaro
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy.,General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Amelia Barcellini
- Department of Radiation Oncology, National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Health Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy.,Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paul Barach
- Wayne State University School of Medicine, Detroit, Michigan, USA.,Jefferson College of Population Health, Philadelphia, Pennsylvania, USA.,Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University Vienna, Austria
| | - Rossella Lucà
- Institute of Biochemistry and Cell Biology - National Research Council (CNR), Rome, Italy.,ISOPROG-Somatolink EPFP Research Network, Philadelphia, Pennsylvania, USA and Caltanissetta, Italy
| | - Maria Ferrara
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
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Barach P, Fisher SD, Adams MJ, Burstein GR, Brophy PD, Kuo DZ, Lipshultz SE. Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? Prog Pediatr Cardiol 2020; 59:101254. [PMID: 32837144 PMCID: PMC7274978 DOI: 10.1016/j.ppedcard.2020.101254] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America
- Jefferson College of Population Health, Philadelphia, PA, United States of America
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Vienna, Austria
| | - Stacy D Fisher
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - M Jacob Adams
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Gale R Burstein
- Erie County Department of Health, Buffalo, NY, United States of America
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Patrick D Brophy
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
- Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, United States of America
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
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45
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De Bie Dekker AJR, Dijkmans JJ, Todorovac N, Hibbs R, Boe Krarup K, Bouwman AR, Barach P, Fløjstrup M, Cooksley T, Kellett J, Bindels AJGH, Korsten HHM, Brabrand M, Subbe CP. Testing the effects of checklists on team behaviour during emergencies on general wards: An observational study using high-fidelity simulation. Resuscitation 2020; 157:3-12. [PMID: 33027620 DOI: 10.1016/j.resuscitation.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical teams struggle on general wards with acute management of deteriorating patients. We hypothesized that the Crisis Checklist App, a mobile application containing checklists tailored to crisis-management, can improve teamwork and acute care management. METHODS A before-and-after study was undertaken in high-fidelity simulation centres in the Netherlands, Denmark and United Kingdom. Clinical teams completed three scenarios with a deteriorating patient without checklists followed by three scenarios using the Crisis Checklist App. Teamwork performance as the primary outcome was assessed by the Mayo High Performance Teamwork scale. The secondary outcomes were the time required to complete all predefined safety-critical steps, percentage of omitted safety-critical steps, effects on other non-technical skills, and users' self-assessments. Linear mixed models and a non-parametric survival test were conducted to assess these outcomes. RESULTS 32 teams completed 188 scenarios. The Mayo High Performance Teamwork scale mean scores improved to 23.4 out of 32 (95% CI: 22.4-24.3) with the Crisis Checklist App compared to 21.4 (20.4-22.3) with local standard of care. The mean difference was 1.97 (1.34-2.6; p < 0.001). Teams that used the checklists were able to complete all safety-critical steps of a scenario in more simulations (40/95 vs 21/93 scenarios) and these steps were completed faster (stratified log-rank test χ2 = 8.0; p = 0.005). The self-assessments of the observers and users showed favourable effects after checklist usage for other non-technical skills including situational awareness, decision making, task management and communication. CONCLUSIONS Implementation of a novel mobile crisis checklist application among clinical teams was associated in a simulated general ward setting with improved teamwork performance, and a higher and faster completion rate of predetermined safety-critical steps.
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Affiliation(s)
- A J R De Bie Dekker
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - J J Dijkmans
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - N Todorovac
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - R Hibbs
- Integral Business Support Ltd, Wrexham, United Kingdom
| | - K Boe Krarup
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - A R Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - P Barach
- Department of Anesthesiology and Critical care, Wayne State University School of Medicine, Detroit; Jefferson College of Population Health, PA, USA
| | - M Fløjstrup
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute and Internal Medicine, The Christie Hospital, Manchester, United Kingdom
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - A J G H Bindels
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd and Bangor University, Bangor, United Kingdom
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Van Zundert TCRV, Barach P, Van Zundert AAJ. Revisiting safe airway management and patient care by anaesthetists during the COVID-19 pandemic. Br J Anaesth 2020; 125:863-867. [PMID: 32972715 PMCID: PMC7834300 DOI: 10.1016/j.bja.2020.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Tom C R V Van Zundert
- Department of Anaesthesia and Critical Care, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Paul Barach
- Department of Anaesthesia, Children's Research Center of Michigan, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA; University of Queensland, Brisbane, Queensland, Australia
| | - André A J Van Zundert
- University of Queensland, Brisbane, Queensland, Australia; Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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Capolongo S, Barach P, Brambilla A, Gola M, Signorelli C. The challenges in training and education of hospital designers and planners. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The designed hospital environment is one of the most complex endeavors of work and there is a growing need of specialization. Scientific, technological and research developments and innovation along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach to the design and management of hospitals. Therefore, it is likely that the current professions will be replaced and flanked by more specialized ones.
Objectives
The scope of the paper is to display an overview of the current educational courses of the emerging Hospital Planner, referring to the worldwide available training courses (BSc, MSc, specialization and PhD courses) related to healthcare design. The focus relates to the fields of Medicine and Nursing sciences, Architecture and Engineering.
Results
A preliminary investigation has been conducted of websites and snowballing technique. The search was limited to active training programs and courses. Currently several institutions offer BSc, MSc courses and PhD programs in Healthcare Design, Environmental and Building Hygiene and Public Health. As well, there are several professional postgraduate courses either in classroom or using hybrid programs including webinars. Clemson University, USA and Ontario College of Art and Design University, Canada, offer a full MSc degree in Architecture and Health. In addition, there are several joint degree programs such as physician-engineer, physician-architect, nurse-architect or engineer.
Conclusions
From the preliminary study emerged a considerable number of international experiences addressing the topic of Hospital Planner training. Further in-depth investigations will examine the topic through questionnaires and interviews of the course organization, students' experiences, outcomes and professional careers, fields of interest and collaborations with other institutions.
Key messages
Hospital environments are the most complex field of work and require many years of specialization and multidisciplinarity and influence the quality of patient outcomes. The academic stream of the built environment is evolving toward proving specific multidisciplinary courses and hands-on experiences to support a degree in hospital planning, design and management.
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Affiliation(s)
- S Capolongo
- Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy
| | - P Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, USA
| | - A Brambilla
- Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy
| | - M Gola
- Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy
| | - C Signorelli
- Biomedical, Biotechnological, and Translational Sciences, Università Vita-Salute San Raffaele, Milan, Italy
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Gola M, Brambilla A, Barach P, Signorelli C, Capolongo S. Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare. Ann Ig 2020; 32:549-566. [PMID: 32744586 DOI: 10.7416/ai.2020.2375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles. OBJECTIVES To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences. RESULTS The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online. CONCLUSIONS A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.
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Affiliation(s)
- M Gola
- Department of Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy - Design & Health LAB, Politecnico di Milano, Milan, Italy
| | - A Brambilla
- Department of Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy - Design & Health LAB, Politecnico di Milano, Milan, Italy
| | - P Barach
- Jefferson College of Population Health, Philadelphia, PA, USA- Wayne State University, Detroit, MI, USA - Sigmund Freud University, Vienna, Austria
| | - C Signorelli
- University Vita-Salute San Raffaele, Milan, Italy
| | - S Capolongo
- Department of Architecture, Built environment and Construction engineering, Politecnico di Milano, Milan, Italy - Design & Health LAB, Politecnico di Milano, Milan, Italy
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Capolongo S, Gola M, Brambilla A, Morganti A, Mosca EI, Barach P. COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals. Acta Biomed 2020; 91:50-60. [PMID: 32701917 PMCID: PMC8023092 DOI: 10.23750/abm.v91i9-s.10117] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals. METHODS The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020. RESULTS In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation. CONCLUSIONS Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed to validate the strategies empirically.
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Affiliation(s)
- Stefano Capolongo
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Marco Gola
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Andrea Brambilla
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Alessandro Morganti
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Erica Isa Mosca
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America; Jefferson College of Population Health, Philadelphia, PA, United States of America; Sigmund Freud University, Wien, Austria.
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Bruce CR, Harrison P, Nisar T, Giammattei C, Tan NM, Bliven C, Shallcross J, Khleif A, Tran N, Kelkar S, Tobias N, Chavez AE, Rivera D, Leong A, Romano A, Desai SN, Sol JR, Gutierrez K, Rappel C, Haas E, Zheng F, Park KJ, Jones S, Barach P, Schwartz R. Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study. JMIR Mhealth Uhealth 2020; 8:e19333. [PMID: 32589161 PMCID: PMC7381069 DOI: 10.2196/19333] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies. Objective This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction). Methods We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities. Results The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment. Conclusions A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.
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Affiliation(s)
- Courtenay R Bruce
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | | | - Neema M Tan
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | | | | | - Aroub Khleif
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Nhan Tran
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Sayali Kelkar
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Noreen Tobias
- Information Technology Portfolio Management Office, Houston, TX, United States
| | - Ana E Chavez
- Cardiovascular Surgery Associates, Houston Methodist Hospital, Houston, TX, United States
| | - Dana Rivera
- Houston Methodist Orthopedic and Sports Medicine - The Woodlands, Houston Methodist The Woodlands, The Woodlands, TX, United States
| | - Angela Leong
- Clinical Design and Planning, Houston Methodist Hospital System, Houston, TX, United States
| | - Angela Romano
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - S Nicholas Desai
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Josh R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
| | - Kayla Gutierrez
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | | | - Eric Haas
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Feibi Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Kwan J Park
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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