Healthcare Facilities and Medical Tourism Across the World: A Bibliometric Analysis

This study aimed to review the literature on healthcare facilities and medical tourism from a range of nations that have established medical tourism sectors and assess the effect of healthcare facilities on medical tourism. A bibliometric study of the Scopus database was carried out by using the search terms '(Facility AND of AND healthcare) AND TITLE-ABS-KEY (health AND tourism) AND medical tourism' for the years 2012-2022. A qualitative evaluation of the literature was then performed to find and locate 92 articles. VOSviewer and NVivo 12 Plus were employed for data analysis. The findings indicated that the following trending subject keywords were used during the period in question: health (rate 1.97), medicine (rate 1.91), tourism (rate 1.70), care (rate 0.83), facilities (rate 0.64) and healthcare (rate 0.61). Furthermore, this research identified four distinct clusters: i) medical tourism, ii) healthcare quality, iii) healthcare system and iv) health services. The study found that healthcare facilities, as actors that have a role in the development of medical tourism, have not been sufficiently explored, even though there is evidence that they play a role in the growth of the sector. This result is in line with Heung's argument, which makes the same point.

Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

Navigating Challenges in Biomedical Waste Management in India: A Narrative Review

Biomedical waste management (BMWM) in India poses significant challenges that demand thorough examination and strategic interventions. As the country's healthcare sector expands rapidly, proper management of biomedical waste becomes increasingly critical to safeguarding public health and environmental integrity. Biomedical waste, encompassing industrial waste, hospital waste, and waste from other healthcare facilities, poses a heightened risk of infection and injury compared to any other form of waste. A lack of understanding regarding safe medical waste disposal practices can be hazardous to one's health as well as the environment. To improve waste management practices in the country, we can suggest effective strategies and recommendations by developing a deeper understanding of the current situation. To manage medical waste effectively, healthcare professionals must be knowledgeable about and have experience with this process. This evaluation study provides a comprehensive overview of current BMWM methods in India, shedding light on the benefits, drawbacks, challenges, and areas for improvement in the healthcare waste management system. Several important facets of BMWM were highlighted by the literature research, including waste segregation, treatment techniques, and disposal options, as well as compliance and regulatory frameworks.

Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan

Background

Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system.

Aim

To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016.

Methods

A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables.

Results

Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas.

Conclusion

IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.

Assessment of Patient Matters in Healthcare Facilities

BACKGROUND AND OBJECTIVES

Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities.

MATERIALS AND METHODS

We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile.

RESULTS

We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures.

CONCLUSIONS

Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.

Utilisation of partogram at a district in the North West Province, South Africa

Background

The partogram or partograph is a tool used to monitor the progress of labour and serves as a diagnostic tool for labour-related abnormalities such as prolonged labour, cephalopelvic disproportion (CPD) and obstructed labour. Appropriate utilisation of the partogram aids health caregivers with early diagnosis and facilitates clinical judgement and interventions to prevent complications of abnormal labour. The partogram is thus a mandatory tool to be utilised to monitor the progress of labour for intrapartum care in South Africa.

Aim

This study aimed to assess and describe the utilisation of the partogram in a district of the North West Province.

Setting

The study was conducted in the private rooms of facilities rendering maternity services in the district.

Methods

A quantitative cross-sectional descriptive design was employed. A purposive sampling was used to select healthcare facilities, and simple random sampling was employed to select plotted partograms. Data were collected using a checklist and analysed using Statistical Package for Social Sciences software version 22.

Results

A total of 279 partograms were analysed. The average partogram utilisation was 20% correct and 80% substandard or not recorded. All files had partogram documents included.

Conclusion

A large percentage (80%) of the partograms were not completed according to the World Health Organization (WHO) standards. There was a concern about high proportions of unrecorded parameters such as monitoring of foetal and maternal conditions, and the progress of labour.

Contribution

The findings and recommendations of the study could improve partogram utilisation in maternity care.

A survey of screening and support systems for socially high-risk pregnancies at obstetric facilities in Japan

AIM

To clarify the state of screening and support systems for socially high-risk pregnant women at obstetric facilities across Japan and identify the characteristics of facilities related to the implementation of screening.

METHODS

This cross-sectional study used a self-administered questionnaire. Participants were managers of hospitals, clinics, and midwifery birth centers handling deliveries in 47 prefectures across Japan. The questionnaire comprised items regarding the characteristics of participants and their facilities, service provision related to socially high-risk women available at the facility, the number of specified pregnant women (tokutei ninpu) per year, methods of screening, and support systems within the obstetric facilities. Descriptive statistics and multivariate logistic regression analysis were performed using IBM-SPSS version 24 for the association between facility characteristics and screening practices for socially high-risk pregnant women.

RESULTS

Valid responses were received from 716 of 2512 obstetric facilities. Rates of specified expectant mothers per annual number of deliveries were identified as follows: perinatal medical centers (2.7%), general hospitals (1.6%), obstetrics and gynecology hospitals (1.0%), and clinics (0.8%). A total of 426 facilities (60.6%) reported screening all expectant mothers to identify socially high-risk pregnant women. Multiple logistic regression analysis revealed that facility characteristics and service/care provision related to screening practices included availability of in-hospital midwife-led care and in-hospital midwifery clinics (adjusted odds ratio 1.61; 95% CI [1.30, 1.47]), one-on-one care by midwife (1.73; 95% CI [1.15, 2.59]), multidisciplinary meetings within the facility (1.70; 95% CI [1.14, 2.56]), follow-up support systems after discharge (1.90; 95% CI [1.17, 3.09]), and participation in the regional council for children in need of protection (2.33; 95% CI [1.13, 4.81]).

CONCLUSIONS

Approximately 60% of surveyed obstetric facilities screen for socially high-risk women. Increasing service provision at facilities may be necessary to implement screening.

Accessible art in healthcare facilities: exploring perspectives of healthcare art for visually impaired people

Introduction

Art in healthcare facilities shows promising results in improving patients' health and well-being and, as such, meets the WHO's definition of health technology. Yet, it remains unclear if healthcare art equally benefits all users. Given the growing number of visually impaired people (VIP), it is valuable to determine whether healthcare art is accessible to VIP and to explore strategies for improving it.

Methods

This study employed a mixed methodology, which included (1) secondary research of 25 cases of healthcare art programmes to identify the presence of accessible art in healthcare facilities and the practices that influence it; (2) review of thirty-one Health Building Notes and four supplementary British guidelines on healthcare art to discover if the accessibility of art is required and identify which recommendations influence it; and (3) interview surveys of healthcare art practitioners from three London NHS Trusts to identify opportunities to increase arts accessibility.

Results and discussion

The evidence showed that healthcare art programmes were mostly inaccessible to VIP. Most healthcare art programmes did not involve VIP in the commissioning process and, thus, lacked procedures that could facilitate accessibility. There were not enough recommendations in the healthcare facility guidelines to support the accessibility of arts for VIP. The recommendations on artwork in healthcare facility guidelines could increase accessibility if particular conditions were met. Interviews with NHS trusts in London revealed numerous opportunities to improve arts accessibility for healthcare art programmes.

Fair Healthcare Practices in Orthopedics Assessed with a New Framework

Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.

Situational Analysis of Healthcare Delivery and User Perspectives of Mobile Diagnostics (mDiagnostics) in Chennai, Tamil Nadu, India: A Mixed-Method Study

Introduction Situational analysis of exciting infrastructure including mobile health services is crucial for comprehensive healthcare delivery. The concept of mDiagnostics has gained traction as it addresses the challenges of accessibility, affordability, and availability of healthcare services in remote regions. Purpose The study was to do a situational analysis of the availability of medical diagnostic facilities and identify the challenges and barriers faced in the implementation and utilisation of mDiagnostics. Material and methods The present study was a mixed mixed-method study conducted in rural and urban areas of Chennai, Tamil Nadu, India. A total of 1,489 households were included. Situational analysis of existing healthcare facilities and the availability of Ayushman Bharat Health Account (ABHA) numbers for study participants in both urban and rural areas was assessed. In-depth interviews on user perspective, affordability, awareness of existing health services, and perception of the utility of mobile lab services and focus group discussions with healthcare professionals, community members, and key stakeholders were carried out. Thematic analysis for qualitative data, proportion, and means were calculated for the quantitative component. Result Out of 1,489 households included, 711 were from rural areas, and 778 were from urban areas. The distance traveled from their residence to both the lab and health facility was less than 5 km in urban areas, while it is more than 5 km in rural areas. The mean expenditure in availing healthcare services is above five thousand rupees per annum in nearly half of the rural households (46%) and 60% of urban. The analyses of interviews explored the availability, acceptability, and affordability under seven thematic areas for situational analysis of healthcare facilities, and a focused group discussion was held to explore the community member's barrier to healthcare services. Conclusion The study reveals a comprehensive understanding of healthcare delivery access disparities between rural and urban areas in Tamil Nadu. The findings highlighted the potential benefits of mobile lab initiatives in improving healthcare access and early disease detection in underserved rural communities.

Pattern of Road Traffic Injuries and Their Pre-hospitalization Factors Reported at a Public Tertiary Healthcare Facility and Rural Private Healthcare Facility in Rajasthan, India

OBJECTIVE

We aimed to report the pattern of road traffic injuries (RTIs) and pre-hospitalization factors of road traffic injuries among the accident victims reported at an urban and a rural healthcare facility in the Jaipur district, Rajasthan.

METHODS

This cross-sectional study was conducted in a tertiary-level, urban public healthcare facility in Jaipur city and a secondary-level, rural private facility in nearby Chomu town. The study participants were all those who encountered road traffic injury and visited any of these healthcare facilities to seek care. The study tool included information on demographics, type of road user, vehicles, accidents, roads, environment, and other pre-hospitalization factors. Data collectors were nurses trained to collect data using the tablet-based application. Data were analyzed using proportions/percentages. Bivariate analysis was done to assess the significance of differences between categories of factors and between rural and urban facilities.

RESULTS

Among 4,642 cases, 93.8% were enrolled in the urban facility, and the remaining were enrolled in the rural facility. Predominantly, males (83.9%) and young adults 18-34 years (58.9%) were reported in both study facilities. Among the accident victims reported at the urban facility, major groups were educated up to the primary level (25.1%) or graduate level (21.9%). About 60% of them were drivers. Most of these injuries occurred on urban roads (50.2%) or two-lane roads (42%). About three-fourths of the injured were using two-wheeler geared vehicles, and 46.7% were overtaking or turning the vehicle when the accident happened. The majority of cases (61.6%) did not require hospitalization. Among the rural facility participants, 27.2% were graduates, and 24.7% were below primary education. Most of these injuries happened on the national highway (35.8%) or rural roads (33.3%). Most of them used two-wheeler geared (80.1%) at the time of the accident. Most were injured while doing normal straight driving (80.5%). Most participants (80.1%) in the rural facility did not follow the traffic rules, and 43.9% required hospitalization.

CONCLUSION

Young males were the most affected age group by road traffic injuries. Differential patterns of road traffic injuries and pre-hospital factors were observed in urban and rural areas.

Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability

Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.

The Benefits of Molnupiravir Treatment in Healthcare Facilities Patients with COVID-19

Background

Molnupiravir (MOL) is an oral antiviral medication that has recently been treated for COVID-19.

Objectively

We perform a prospective and observational study to elucidate the efficacy and safety of MOL in healthcare patients with COVID-19.

Materials and Methods

A observational, non-randomized study of patients diagnosed with COVID-19 in 46 healthcare facilities and treated with MOL started within 5 days after the onset of signs or symptoms. We recorded data for all patients, including demographic data, clinical features, and symptoms. Treatment response was classified into cure, stable, hospitalization and death. Multivariate analysis was performed with stepwise logistic regression for hospitalization and death risk factors.

Results

In total, 856 patients were diagnosed as having COVID-19 and treated with MOL during the study period. Of those, 496 patients (57.9%) were cured, 256 patients (29.9%) in stable condition, 104 patients (12.2%) hospitalized, and 22 patients (2.6%) died, respectively. There was significant effectiveness (87.8%) in COVID-19 patients using MOL. Multivariate analysis was performed to confirm the risk factors for hospitalization and death and included elder age (>80 years old) (odds ratio (OR) 2.2, 95% confidence interval (CI): 1.1-6.9), old cerebrovascular accident (CVA) (OR=4.1, 95% CI: 1.3-9.9), the presence of diabetes mellitus (DM) (OR=2.6, 95% CI: 1.2-9.1) and chronic respiratory diseases (OR=2.4, 95% (CI): 1.3-8.1).

Limitations

This is an observational study, neither randomized study nor control group study.

Conclusion

Initial treatment with MOL has the treatment benefits and is well tolerated for patients with COVID-19 in healthcare facilities. Older age, old CVA, DM, and chronic respiratory diseases were independent risk factors for hospitalization and mortality. The results demonstrate there are important clinical benefits of MOL beyond the reduction in hospitalization or death for these patients with more comorbidities in Taiwan.

The impact of transparency constraints on the efficiency of the Russian healthcare system: systematic literature review

There is an ongoing debate among researchers and policy-makers on how to make transparency a powerful tool of healthcare systems. This study addresses how the availability and accessibility of information about medical services to the general population affects healthcare outcomes in Russia. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines. Transparency indicators of health facilities used in the world's most efficient healthcare systems are also reviewed. Although the increase of transparency in the Russian healthcare system is considered as a tool for improving its efficiency, very little has been done to improve the actual level of transparency. The existing institutional specifics of the Russian healthcare system impose serious restrictions on acceptable levels of transparency. In the reviewed empirical Russian studies, transparency is often viewed simplistically as either information available on the websites of medical organizations or issues related to the amount of accessible indicators of compulsory medical statistical reporting. The novelty of this study consists in (a) reviewing the most recent studies on the topic and (b) including studies in Russian in the analysis. We elaborate on general and specific policy implications for improving transparency-driven outcomes in the Russian healthcare system.

Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time

OBJECTIVE

To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic.

METHODS

Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time.

RESULTS

Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83-4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time.

CONCLUSION

Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.

Use of an E2SFCA method to assess healthcare resources in Jordan during COVID-19 pandemic

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pandemic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, analyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources.

Study on value-based design of healthcare facilities: Based on review of the literature in the USA and Japan

With limited medical resources, it is of great significance for countries all over the world to explore architectural design methods to enhance the value of medical facilities. Therefore, it is very necessary to carry out an extensive international comparison. In order to grasp the research trend of healthcare facilities in the world, this paper conducts co-occurrence analysis, cluster analysis, and trend analysis of the keywords of 334 English articles and 153 Japanese articles related to healthcare facilities published in important academic journals in the USA and Japan in the past 15 years. We not only compare the similarities and differences in healthcare facility research between the USA and Japan, but also explore the reasons for these differences. It is found that by introducing three kinds of value variables, such as time, space, and behavior, we can not only well explain the difference in the solution of healthcare facilities in the USA and Japan to reduce medical costs but also provide new ideas for architectural design to enhance the value of hospitals. Based on the above analysis, a conceptual framework of value-based design of healthcare facilities that combines the advantages of the USA and Japan is proposed in this paper.

Analyzing Healthcare Facility Resilience: Scientometric Review and Knowledge Map

In contemporary “high-risk” society, unexpected disasters (epidemics and extreme weather) and chronic pressures (aging problems) put tremendous pressure on healthcare facilities. Enhancing the healthcare facilities' resilience ability to resist, absorb, and respond to disaster disruptions is urgent. This study presents a scientometric review for healthcare facility resilience research. A total of 374 relevant articles published between 2000 and 2020, collected from Web of Science (WoS) core collection database, Scopus database and MEDLINE database were reviewed and analyzed. The results indicated that research on resilience in healthcare facilities went through three development periods, and the research involved countries or institutions that are relatively scattered. The studies have been focused on the subject categories of engineering, public, environmental, and occupational health. The keywords of “resilience,” “hospital,” “disaster,” “healthcare,” and “healthcare facility” had the most frequency. Furthermore, based on the literature co-citation networks and content analysis, the detected seven co-citation clusters were grouped into four knowledge domains: climate change impact, strengthening resilience in response to war and epidemic, resilience assessment of healthcare facility, and the applications of information system. Moreover, the timeline view of literature reflected the evolution of each domain. Finally, a knowledge map for resilience of healthcare facilities was put forward, in which critical research contents, current knowledge gaps, and future research work were discussed. This contribution will promote researchers and practitioners to detect the hot topics, fill the knowledge gaps, and extend the body of research on resilience of healthcare facilities.

Using Low-Cost Sensors to Assess Fine Particulate Matter Infiltration (PM2.5) during a Wildfire Smoke Episode at a Large Inpatient Healthcare Facility

Wildfire smoke exposure is associated with a range of acute health outcomes, which can be more severe in individuals with underlying health conditions. Currently, there is limited information on the susceptibility of healthcare facilities to smoke infiltration. As part of a larger study to address this gap, a rehabilitation facility in Vancouver, Canada was outfitted with one outdoor and seven indoor low-cost fine particulate matter (PM_2.5) sensors in Air Quality Eggs (EGG) during the summer of 2020. Raw measurements were calibrated using temperature, relative humidity, and dew point derived from the EGG data. The infiltration coefficient was quantified using a distributed lag model. Indoor concentrations during the smoke episode were elevated throughout the building, though non-uniformly. After censoring indoor-only peaks, the average infiltration coefficient (range) during typical days was 0.32 (0.22–0.39), compared with 0.37 (0.31–0.47) during the smoke episode, a 19% increase on average. Indoor PM_2.5 concentrations quickly reflected outdoor conditions during and after the smoke episode. It is unclear whether these results will be generalizable to other years due to COVID-related changes to building operations, but some of the safety protocols may offer valuable lessons for future wildfire seasons. For example, points of building entry and exit were reduced from eight to two during the pandemic, which likely helped to protect the building from wildfire smoke infiltration. Overall, these results demonstrate the utility of indoor low-cost sensors in understanding the impacts of extreme smoke events on facilities where highly susceptible individuals are present. Furthermore, they highlight the need to employ interventions that enhance indoor air quality in such facilities during smoke events.

An audit of Zimbabwean public sector diagnostic ultrasound services

Introduction

the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services.

Methods

utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province.

Results

of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service.

Conclusion

in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.

Systematic Analysis of Literature on the Marketing of Healthcare Systems. Challenges for Russian and Romanian Healthcare Systems

This paper aims at finding the most dominant ideas about the marketing of healthcare systems highlighted in the mainstream literature, with a focus on Russia and Romania. To reach this goal, a systematic analysis of literature was conducted and various competitive advantages and disadvantages of the medical models that require special attention from the governments are considered. In this respect we examined 106 papers published during 2006 to 2020 found on four scientific databases. They were selected using inclusion and exclusion criteria according to PRISMA methodology. The main findings of the research consist of the opportunity to use marketing tools in order to improve the quality of healthcare systems in the named countries. Thus, using market orientation, the managers of healthcare systems could stimulate the innovation, the efficiency of funds allocation and the quality of medical services. The results will lead to a better quality of population life and to an increasing of life expectancy. As this paper reviews some articles from Russian literature, it can add a new perspective to the topic. These outcomes have implications for government, business environment, and academia, which should cooperate in order to develop the healthcare system using marketing strategies.

[COVID-19 control in Niger: an assessment of infection prevention and control practices at healthcare facilities in the city of Niamey]

Niger has been facing the coronavirus disease 2019 (COVID-19) pandemic since 19^th March 2020. In this article we report an assessment of infection prevention and control (IPC) practices at healthcare facilities in the city of Niamey in Niger and propose solutions. This assessment focused on the 12 themes contained in the World Health Organization IPC assessment framework for healthcare facilities. The assessment was conducted in 83 public and private healthcare facilities, which represent 60% of healthcare facilities in the city of Niamey. At the level of tertiary healthcare facilities, the overall IPC score was 75% which represents a moderate level of compliance with recommended IPC practices. At the level of private healthcare facilities, the overall score was 53%; also, a moderate level of performance. Finally, the overall IPC score was 45% at primary public healthcare facilities; which shows a very low level of adherence to IPC recommendations. IPC practices in public and private healthcare facilities in Niamey remain a challenge for healthcare authorities. Developing a tailored restorative plan would be helpful in meeting this challenge.

Evaluation and Planning for a 250 Bedded COVID-19 Healthcare Infrastructure in City of Gurgaon, India

The novel corona virus has reached the pandemic levels since March 2020. This has exerted tremendous pressure on existing infrastructure. Amenities related to quarantine and isolation are new norms in healthcare set-ups all over the world. The present study helps to understand the guidelines needed to change the current available infrastructural resources of essential departments in addition to forecasting and organizing the infrastructure required to cater the special needs of the COVID-19 patients without compromising the smooth functioning of the healthcare facility and not risking the safety of the health care professionals delivering it.

Using a mHealth system to recall and refer existing clients and refer community members with health concerns to primary healthcare facilities in South Africa: a feasibility study

Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa.

Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa.

Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal.

Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system.

Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions.

When It Is Not Measured, How Then Will It Be Planned for? WaSH a Critical Indicator for Universal Health Coverage in Kenya

The quality and safety of healthcare facility (HCF) services are critical to achieving universal health coverage (UHC) and yet the WHO/UNICEF joint monitoring program for water supply, sanitation and hygiene report indicates that only 51% and 23% of HCF in Sub-Saharan Africa have basic access to water and sanitation, respectively. Global commitments on improving access to water, sanitation, hygiene, waste management and environmental cleaning (WaSH) in HCF as part of implementing UHC have surged since 2015. Guided by political ecology of health theory, we explored the country level commitment to ensuring access to WaSH in HCFs as part of piloting UHC in Kisumu, Kenya. Through content analysis, 17 relevant policy documents were systematically reviewed using NVIVO. None of the national documents mentioned all the component of WaSH in healthcare facilities. Furthermore, these WaSH components are not measured as part of the universal health coverage pilot. Comprehensively incorporating WaSH measurement and monitoring in HCFs in the context of UHC policies creates a foundation for achieving SDG 6.

[From insertion to inclusion]

The integration of a person with a disability is challenging on a legal, financial and managerial level. Many doubts and fears persist, preventing disabled employees from becoming fully integrated. It is essential to work on deconstructing prejudices and improving managers' training.

A Decision-Making Algorithm for Rearchitecting of Healthcare Facilities to Minimize Nosocomial Infections Risks

Most of the healthcare facilities (HFs) have to face the nosocomial infections (NIs), which increase the rates of morbidity, mortality, and financial burden on the HFs and the patients. The control of the NIs is a global issue and requires additional effort. Because the pathogenic microbes can be transmitted among all the HF departments, the layout and design of the HFs (or the department configuration) is considered to play a significant role in control of the NIs. A few of the departments transmit the microbes more than other departments, called ‘cause’, while some other departments are more infected than others, called ‘effect’. Here, the researchers have stated that both the cause and effect departments are risky. This research tried to propose a comprehensive mathematical algorithm for choosing the high-risk department(s) by applying the NI and the managerial criteria to minimize NIs through rearchitecting of the HFs. To develop the algorithm, the researchers applied the multiple criteria decision-making (MCDM) methods. They used Decision-Making Trial and Evaluation Laboratory (DEMATEL) and modified weighted sum method (WSM) methods, and their hybrid, along with a modified nominal group technique (NGT) for data collection. The proposed algorithm was later validated by implementation in a HF as a case study. Based on all results of the algorithm, the high-risk departments in the HF were identified and proposed to be eliminated from the HF in such a way that the facility would retain its functionality. The algorithm was seen to be valid, and the feasibility of the algorithm was approved by the top managers of the HF after the algorithm was implemented in the case study. In conclusion, the proposed algorithm was seen to be an effective solution for minimizing the NIs risk in every HF by eliminating the high-risk departments, which could simplify the HF manager’s decisions.

[Reconstructing the relationship in health facilities]

Health facilities are today subjected to a drive for profitability, efficiency and performance which go against caregivers' core values of providing help and support. To maintain the necessary focus on care and its difficulties, health managers must favour and reinforce relations between colleagues, and involve teams in the decisions and projects concerning their care activity. Working on the relationship is an essential part of this approach.

[Not Available]

TOWARDS A NEW CERTIFICATION OF HEALTHCARE FACILITIES FOR 2020.: The accreditation process, now a certification process for healthcare facilities, has constantly evolved since 1999 in order to improve the quality and safety of care provided to patients. In order to meet demographic, epidemiological and social challenges, it needs to be revised again. The French National Health Authority board has fixed three main objectives for the 2020 version: to medicalise certification, simplify it and adapt it to hospital groups in the public and private sector.

[The challenges of sustainable development in healthcare facilities]

Healthcare and medical-social facilities have a major responsibility within society, that of the quality of care, but also that of developing a system of sustainable and socially-responsible health. This system must meet the three pillars which constitute such an approach: economic, social and environmental sustainability. Innovation remains central to the sustainable evolution of practices and the first results are now visible.

[The role of caregivers in environmental health in hospital]

Environmental health is part of the daily practice of caregivers in a health facility. It is particularly evident in the waste and water quality management systems. It is resulting in changes to roles and practices, particularly for nurse hygienists.

Controlling infectious disease outbreaks in low-income and middle-income countries

When an infectious disease outbreak is detected or suspected, a healthcare facility’s infection control personnel should be notified and an outbreak control team formed that is pertinent to the size and severity of the outbreak and healthcare facility. Management of an infectious disease outbreak in a middle- or low-income country is challenging. Cost-effective recommendations that are easy to carry out and that have been stratified according to the type of infection and prevention and control intervention used are provided in this paper and constitute basic practices.

The Impact of Environmental Design on Teamwork and Communication in Healthcare Facilities: A Systematic Literature Review

The purpose of this systematic review is to investigate the current knowledge about the impact of healthcare facility design on teamwork and communication by exploring the relevant literature. Teamwork and communication are behavioral factors that are impacted by physical design. However, the effects of environmental factors on teamwork and communication have not been investigated extensively in healthcare design literature. There are no published systematic reviews on the current topic. Searches were conducted in PubMed and Google Scholar databases in addition to targeted design journals including Health Environmental Research & Design, Environment and Behavior, Environmental Psychology, and Applied Ergonomics. Inclusion criteria were (a) full-text English language articles related to teamwork and communication and (b) involving any healthcare built environment and space design published in peer-reviewed journals between 1984 and 2017. Studies were extracted using defined inclusion and exclusion criteria. In the first phase, 26 of the 195 articles most relevant to teamwork and 19 studies of the 147 were identified and reviewed to understand the impact of communication in healthcare facilities. The literature regarding the impact of built environment on teamwork and communication were reviewed and explored in detail. Eighteen studies were selected and succinctly summarized as the final product of this review. Environmental design, which involves nurses, support staff, and physicians, is one of the critical factors that promotes the efficiency of teamwork and collaborative communication. Layout design, visibility, and accessibility levels are the most cited aspects of design which can affect the level of communication and teamwork in healthcare facilities.

Epidemiology and outcome of elderly admitted to the ward for sepsis

BACKGROUND

The elderly represent a significant cohort of patients presenting at the emergency department, especially in the developed countries. They are characterized by impaired physical condition, comorbidities, and little immune system resources and make frequent use of the healthcare system and its facilities. This study aimed to describe the features and prognostic factors of sepsis in elderly patients (>60 years old) admitted to an internal medicine ward.

MATERIAL AND METHODS

Two hundred eighty eight consecutively patients aged >60 years who were admitted with sepsis during a two-year-period were retrospectively included in the study. Clinical and laboratory parameters at presentation were analyzed. Causes of sepsis and biochemical markers were compared between the healthcare facility-naïve and the healthcare facility-exposed groups. The effect of comorbidities and previous exposure to the healthcare system on clinical course and outcome of the patients was analyzed.

RESULTS

Among the comorbidities that were recorded and included in the analysis, the presence of chronic and acute renal impairment and neurologic disabilities were associated with a worse outcome of sepsis in the elderly. In the same cohort, a previous contact with the healthcare system was found to affect the duration of hospital stay, but not the outcome per se. Sepsis-related markers, such as inflammatory markers were not found to be associated with clinical progression and outcome.

CONCLUSIONS

Timely diagnosis and accurate evaluation of the severity of sepsis is required to ensure a better outcome for the patients. Sensitive markers and accurate prognostic models are constantly pursued. The impact of living characteristics of the modern aging society is additionally addressed and their effect on sepsis outcome assessed. Hippokratia 2016, 20(4): 274-278.

Healthcare Waste Generation and Management in Public Healthcare Facilities in Adama, Ethiopia

BACKGROUND

Over the past few years there has been rising production of hazardous byproducts, including dioxins, furans, and mercury from indiscriminate handling and treatment of healthcare waste. This situation is worse in developing countries where there is a serious lack of reliable data on factors such as generation and characteristics of healthcare waste.

OBJECTIVES

To investigate healthcare waste generation and current management practices of public healthcare facilities in Adama, Ethiopia.

METHODS

All departments and sections in studied healthcare facilities (one referral hospital and four health centers) were examined for the characterization and determination of healthcare waste generation based on World Health Organization (WHO) guidelines. Wastes were collected and measured daily for seven consecutive days. Plastic buckets and bags of different colors were used for different types of wastes. Plastic bags were removed every morning and their weights were measured every day at 8 am using a scale.

RESULTS

The average daily generation of healthcare waste from studied health centers ranged from 0.02 to 0.03 kg/patient/day, and the average daily waste generation of Adama referral hospital was 1.23 kg/bed/day. The healthcare waste generation rate was statistically different across the health service delivery sectors (p < 0.001). The proportion of hazardous healthcare waste generated in Adama referral hospital and health centers was 34.9% and 75%, respectively. There was no segregation of healthcare waste by type at the point of generation or pre-treatment of infectious waste in the studied healthcare facilities. Open pit burning and single chamber incinerators were the most utilized final treatment methods. Furthermore, there was a low level of awareness about safe healthcare waste management.

CONCLUSIONS

The overall findings of this study indicate that the proportion of hazardous healthcare waste generated from the studied healthcare facilities was above the threshold set by the WHO. There is a lack of proper waste management systems in all public healthcare facilities in Adama, Ethiopia. Awareness raising activities on proper healthcare waste management should be undertaken targeting all healthcare workers.

Quality of diagnosis and monitoring of tuberculosis in Northern Ethiopia: medical records-based retrospective study

OBJECTIVES

To determine quality of diagnosis and monitoring of treatment response of patients with smear-negative pulmonary tuberculosis (TB) compared with smear-positive cases in Ethiopia.

METHODS

A retrospective analysis of medical records of newly diagnosed pulmonary TB cases that were registered for taking anti-TB medication and had completed treatment between 2010 and 2012. We evaluated the percentage of cases that were managed according to the International Standards of Tuberculosis Care (ISTC) and compared smear-negative with smear-positive cases.

RESULTS

We analysed 1168 cases of which 742 (64%) were sputum smear-negative cases. Chest radiography examination at diagnosis and microbiological testing at the end of the intensive phase of treatment was performed in a smaller proportion than in smear-positive TB cases (70% vs. 79%, P value <0.001) and (70% vs. 95%, P value <0.001), respectively.

CONCLUSIONS

Clinical actions recommended in the ISTC are of greatest importance in minimising pitfalls in care of smear-negative TB yet were performed less often in smear-negative than smear-positive TB cases.

Olanzapine long-acting injection: insights from an early case series in the UK

OBJECTIVE

Olanzapine long-acting injection depot (OLAI) has been licensed in the UK since 2008. As a result of the recognition during clinical trials that in 0.07% of injections there may be inadvertent intravenous administration leading to post-injection delirium/sedation syndrome (PDSS), the licence mandates a 3 h observation after each injection and accompaniment of the patient to their final destination. The administration of OLAI may thus necessitate organization of local service provisions. We report on how a single healthcare facility in Northern Ireland has treated three initial patients and present a brief case series on these patients and their clinical outcomes.

METHODS

In the first three patients with schizophrenia to receive OLAI, the clinical notes were retrospectively examined to provide clinical data.

RESULTS

All three patients had acceptable clinical outcomes showing sustained clinical improvement and have continued on OLAI for over 1 year. Observation has been undertaken within an existing daycare unit staffed by nursing staff and occupational therapists for 3 h after each injection. No issues have emerged from the use of this service that has also provided educational and psycho-educational programmes for the patients. No cases of post-injection delirium/sedation syndrome were reported. There have been no additional cost implications.

CONCLUSIONS

In patients for whom OLAI may be clinically indicated, the utilization of an existing service to provide the 3 h of observation after each injection may represent a solution with a cost-neutral outcome.

Recommendations and requirements for soap and hand rub dispensers in healthcare facilities

Hand hygiene is one of the most important measures to prevent transmission of infectious agents and plays a major role in prevention of infection in any type of healthcare setting. While requirements for the efficacy of hand disinfectants are defined in European testing norms such as the EN 1500 for hygienic hand disinfection or EN 12791 for surgical hand preparation, no specific recommendations for hand rub dispensers and liquid soap dispensers have been given yet. Therefore, the intention of the present recommendation on soap and hand rub dispensers in healthcare facilities is to close this gap and to enhance future improvement of dispenser functionality and design. Regardless of manufacture and design of a hand rub or liquid soap dispensers the following requirements shall be met in healthcare facilities:

Triggering the dispenser must be possible without using hands. Sensor- or elbow-operated dispensers both fulfill this requirement. Dispensers must be only refillable in a modality where the content, be it a hand rub or liquid soap, cannot be contaminated. This is achieved best by using replaceable cartridge systems. Refilling through “top-up” must not be possible. The disperser should allow usage of different types of cartridges made by different manufacturers. Dispensers must be operated and maintained such that a microbial contamination of the pump nozzle may easily be avoided. It must be possible to identify the products used in a dispenser easily and without any manipulation. Identifying the type of product, be it a hand rub or a liquid soap, as well as reading the product's name and critical manufacturers' warnings must be possible at any time. The disperser must allow identification of the level of the used product without any further manipulation at any time. The design of the dispenser must allow easy cleaning and disinfection the outside and inside of the dispenser. The manufacturer of the dispenser must provide the user with information on applicable chemicals and cleaning products. It must be possible to reprocess the dispenser and all of its permanent parts by applying machine based thermal disinfection at an A₀-value of minimum 60 (e.g. 80°C/1 minute). Automatically portioning dispensers shall not fail during 200 hubs. The maximal allowed failure rate shall not exceed 1% (2 out of 200 consecutive hubs). A dispenser used for alcohol based hand rubs must allow keeping the alcohol concentration constant over a time period of 3 months. The maximum acceptable decrease in the concentration of the alcohol shall not exceed 5%. Liquid soap and hand rub dispensers with single-use pumps, ideally already mounted on the cartridge and to be discharged with the empty cartridge, are preferable. If pumps are used on the next consecutive cartridge, the manufacturer must provide the user with a detailed introduction for cleansing and reprocessing before further use. Because of forensic reasons it is recommended to place a good readable sign on the dispenser indicating e.g. “Apply alcohol based hand rubs only on the hand! Do not drink, avoid spraying into the eye or application on mucous membranes”. It is regarded as an additional benefit, if the dispenser is able to document the consumption of hand rub or the frequency of hubs either mechanically or electronically.