Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, ...Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.展开更多
Multi-criteria decision making(MCDM)is a technique used to achieve better outcomes for some complex business-related problems,whereby the selection of the best alternative can be made in as many cases as possible.This...Multi-criteria decision making(MCDM)is a technique used to achieve better outcomes for some complex business-related problems,whereby the selection of the best alternative can be made in as many cases as possible.This paper proposes a model,the multi-criteria decision support method,that allows both service providers and consumers to maximize their profits while preserving the best matching process for resource allocation and task scheduling.The increasing number of service providers with different service provision capabilities creates an issue for consumers seeking to select the best service provider.Each consumer seeks a service provider based on various preferences,such as price,service quality,and time to complete the tasks.In the literature,the problem is viewed from different perspectives,such as investigating how to enhance task scheduling and the resource allocation process,improve consumers’trust,and deal with network problems.This paper offers a novel model that considers the preferences of both service providers and consumers to find the best available service provider for each consumer.First,the model adopts the best-worst method(BWM)to gather and prioritize tasks based on consumers’and service providers’preferences.Then,the model calculates and matches similarities between the sets of tasks from the consumer’s side with the sets of tasks from the provider’s side to select the best service provider for each consumer using the two proposed algorithms.The complexity of the two algorithms is found to be O(n3).展开更多
Background: Knowledge decay can be present in a lot of different careers but it is especially important when affecting the anesthesia provider. Knowledge decay can lead to skill decay. Therefore, it leads to worse pat...Background: Knowledge decay can be present in a lot of different careers but it is especially important when affecting the anesthesia provider. Knowledge decay can lead to skill decay. Therefore, it leads to worse patient outcomes. It is important to know how knowledge decay occurs and to know how to prevent it. Purpose: The purpose of this review was to explore the contributing factors of knowledge decay while also examining how different learning activities can be used to prevent it from occurring. Methods: A systematic literature search was performed in PubMed, Cochrane databases, and Embase. The American Association of Nurse Anesthesiology website was also examined. Findings: Knowledge decay usually occurs when either the anesthesia provider is in a new area of practice or when the provider has had a significant amount of time pass since the latest implementation of an anesthesia skill. The type of activity shown to best combat knowledge decay is the use of a simulation-based learning activity. Classroom learning can also help combat knowledge decay, but not to the same extent. Conclusions: The most significant way to prevent knowledge decay in the anesthesia provider is to implement simulation-based learning activities, as well as keep anesthesia providers comfortable with the skills that they practice.展开更多
Background: Healthcare Providers’ knowledge and practice of postpartum hemorrhage (PPH) management are essential to reduce maternal morbidity and mortality. PPH is a public health problem due to the high maternal mor...Background: Healthcare Providers’ knowledge and practice of postpartum hemorrhage (PPH) management are essential to reduce maternal morbidity and mortality. PPH is a public health problem due to the high maternal mortality (MM) associated with it worldwide (25%). Improving the quality of PPH management is a major challenge in low-income countries where, despite the progress made in its management, PPH remains a major contributor to maternal morbidity and mortality. Objective: We will evaluate the level of knowledge and practices of providers in the PPH management in Kinshasa in the Democratic Republic of the Congo (DRC). Methods: This study will be descriptive and cross-sectional. The minimum sample size will be 86. Our study population will consist of delivery room care providers. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparisons of means between groups will be made using Student’s t-test and Pearson’s chi-square test. The test will be statistically significant for a p value 0.05. Data will be collected and processed anonymously and confidentially. Conclusion: Improving quality of care must be a priority in obstetrics. This evaluation requires us to determine the level of knowledge and practices of providers in the PPH management in Kinshasa.展开更多
Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph ...Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.展开更多
Both conflict and asymmetric information exist betweenthe telecom operators and the service provider,and result in illegal behaviors of the service provider.The relationship between the telecom operators andthe servic...Both conflict and asymmetric information exist betweenthe telecom operators and the service provider,and result in illegal behaviors of the service provider.The relationship between the telecom operators andthe service provider is classical multi-task principalagentrelationship. The multi-task incentive for theservice provider is considered in the design of theprincipal-agent incentive contract, and it is necessaryto add the multi-task incentive to the serviceproviders through the analysis of the risk costs andthe agency costs of this problem.展开更多
This paper examines the perception of adolescents on the attitudes of providers on their access and use of reproductive health services (ARHS) in Delta State, Nigeria, with a view of assessing the impact of providers...This paper examines the perception of adolescents on the attitudes of providers on their access and use of reproductive health services (ARHS) in Delta State, Nigeria, with a view of assessing the impact of providers’ attitude on the use of adolescents’ reproductive health services in Delta State. The study adopted a survey design to collect primary data using questionnaires and focus group discussions (FGDs) from adolescents in a sample of schools. A sample size of 1500 respondents was taken from 12 schools in six Local Government Areas in three Senatorial Districts in Delta State, Nigeria. The locations of the schools were such that six each were in rural and urban communities respectively. The result from the study was that unfriendly attitudes of providers which keep adolescents waiting, inadequate duration of consultations, judgmental attitudes of some providers, lack of satisfactory services provision and lack of confidentiality will put off adolescents from accessing and using adolescents’ reproductive health services irrespective of their sex, age, class, religion, residence, ethnic group, parents’ education or income levels. The paper concludes that medical personnel take all these issues very seriously when dealing with adolescents to enhance access and use adolescents’ reproductive health services in Delta State and indeed Nigeria.展开更多
<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;"></span> <span style="font-family:Verdana;"...<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;"></span> <span style="font-family:Verdana;">Tuberculosis is one of the leading causes of mortalities attributable to an infectious disease. In a private sector-driven health system such as Nigeria, the private health providers are very important stakeholders in tuberculosis diagnosis and management. Unfortunately, there are few data on the level of contribution of these private health providers to the case finding and notification of tuberculosis in Nigeria. Consequently, this study assessed the contribution of the private providers to the diagnosis and treatment of tuberculosis under the Global Fund Private Public Mix New Funding Model (2<sup></sup></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup>nd</sup></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> phase) grant (GF PPM NFM2) in the four implementing states of south west Nigeria. <b></b></span><b><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">This is a retrospective, cross-sectional analysis of the NFM2 programme implementation data collected between January 1, 2019 and December 31, 2020. Data was extracted from the routine registers such as the presumptive TB registers;treatment register of the private health facilities engaged for PPM activities between 2019 and 2020. The data was entered and analyzed using Microsoft excel package. The variables were summarized using appropriate charts and table. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">Concerning the percentage contribution of the Global Fund Private Public Mix (GF PPM) grant to the total state TB case notification, majority of the implementing states show some progressive rise in the contribution of GF PPM to State TB case notification as the grant implementation progressed. Furthermore, at the initial period of the grant implementation, the health facilities seemed to have generate</span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">d</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> majority of the cases. However, as the grant implementation progressed, the PPMVs were responsible for the diagnosis of majority of the cases. <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">As the grant progressed, there was a progressive increase in the number of presumptive TB cases as well as in the number of notified cases of tuberculosis attributable to private provider engagement.</span></span></span>展开更多
Objective:To assess healthcare workers’knowledge of novel coronavirus disease 2019(COVID-19)in the early phase of the outbreak in Indonesia.Methods:A cross-sectional survey was conducted in 12 hospitals in Indonesia ...Objective:To assess healthcare workers’knowledge of novel coronavirus disease 2019(COVID-19)in the early phase of the outbreak in Indonesia.Methods:A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25,2020.Healthcare workers’knowledge on COVID-19 was assessed,and demographic data,workplace characteristics,and medical professional characteristics as well as the current local situation of COVID-19 were collected.To characterize determinants associated with knowledge,a logistic regression analysis was employed.Results:Out of 288 healthcare workers who completed the interview-assisted questionnaire,149(51.7%)respondents had a good knowledge.Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors:adjusted odds ratio(aO R):0.38;95%CI:0.20-0.72 and aO R:0.31;95%CI:0.13-0.73,respectively.Compared to healthcare workers who had medical practice experience less than 5 years,those who had worked for more than 10 years had lower knowledge(a OR:0.43;95%CI:0.20-0.90).Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room(aO R:14.33;95%CI:3.67-55.88).Conclusions:The knowledge of COVID-19 among surveyed healthcare workers was relatively low.The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.展开更多
Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through...Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts.The interviews were conducted face-to-face,and MAXQDA software version 10 was used to organize the data and thematic analysis.Results:The participants included 5 medical emergency technicians,5 physicians,2 Red Crescent technicians,and 8 nurses.The main influential factors of healthcare providers’resilience were limited relief infrastructure,supportive empowerment,organizational capitals,and contradictory consequences.Other important factors were resource limitation,confusion and uncertainty,empowerment training,comprehensive support,human and value capital,social capital,physical capital,suffering,disability,calm,and excellence.Conclusion:Improving healthcare providers’resilience can be achieved by reducing uncertainty,providing the physical,economic,and human resources,strengthening motivation and comprehensive supports.It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters.Moreover,researchers should study each dimension to provide profound knowledge regarding resilience in disasters.展开更多
Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions...Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions. Design: The 2010 Minnesota Adult Tobacco Survey (MATS) is a random digit dial telephone survey with 7057 Minnesota adults. Both landline and mobile telephone samples were included. These samples were combined and weighted to represent the population of adults in Minnesota. Results: Among adult Minnesotans, 16.1% were current smokers, 80.9% reported seeing a health care provider in the past 12 months and 80.2% of those adults were asked if they smoke. Among smokers who saw any provider in the past 12 months, 94.4% reported they were asked about smoking and 71.8% were advised not to smoke. In contrast, 43.9% of smokers received referrals from a health care provider and among those, 37.5% were recommended medications and 24.8% were referred to a quit smoking program. Conclusion: Given the large body of evidence supporting cessation interventions by health care providers, the increase in use of electronic medical records and the availability and success of evidence-based cessation programs, efforts to improve rates of identifying and treating each tobacco user are needed. Further research is needed to explore how cessation intervention responsibilities can be shared among the clinical team and integrated into ongoing clinical care.展开更多
Studies investigating the relationship between size and performance of water service providers are abundant. Yet, this relationship has not been fully addressed in Palestinian water sector, particularly, after the iss...Studies investigating the relationship between size and performance of water service providers are abundant. Yet, this relationship has not been fully addressed in Palestinian water sector, particularly, after the issuance of water law 2014 which calls for merging water providers into large regional utilities. This research evaluates the significant effect of the size of Palestinian water service providers on non-revenue water, staff productivity, collection efficiency, average consumption, average price, operating and maintenance cost, working ratio, and gross profit. The multivariate analysis shows that there are significant differences in working ratio, non-revenue water, staff productivity, average price, and gross profit based on the size. On the other side, no significant differences have been found in average daily consumption, operating and maintenance cost per unit, and collection efficiency based on those providers’ size. The small service providers perform better in non-revenue water, staff productivity, and collection efficiency;wherein, large service providers are more profitable than small service providers. Implications of these findings by conducting further studies will add the value for better merging of the Palestinian water providers and the reforming process.展开更多
A hybrid intelligent approach is proposed to help the decision maker to select the appropriate third-party reverse logistics provider. The following process is included: firstly,the evaluation team is established to d...A hybrid intelligent approach is proposed to help the decision maker to select the appropriate third-party reverse logistics provider. The following process is included: firstly,the evaluation team is established to determine the selection criteria and evaluate them by triangular fuzzy numbers; secondly,calculate the weight of criteria by the proposed hybrid algorithm integrating particle swarm optimization( PSO) and simulated annealing( SA); then, the performance evaluation for each supplier is predicted by the proposed self-feedback neural network( SFBNN) based on the historical data. A numerical example is also presented to interpret the methodology above.展开更多
The Metro Ethernet Forum(MEF) put forward the concept of Carrier Ethernet(CE) to improve Ethernet technology and make it a transmission convergence layer solution for Next Generation Network(NGN).Provider Backbone Tra...The Metro Ethernet Forum(MEF) put forward the concept of Carrier Ethernet(CE) to improve Ethernet technology and make it a transmission convergence layer solution for Next Generation Network(NGN).Provider Backbone Transport(PBT) is the result of the enhancement and improvement of the early Ethernet technologies and it is the new version of CE implementation technology and standard which is promising.Through studying the PBT-related technologies,PBT network structure,PBT advantages as the transmission convergence layer solution and its trend of future development,it is concluded that PBT can be used as the preferred technology of the transmission convergence layer in the NGN,though there are some problems to be solved for PBT.展开更多
The provision of high-quality medical care has become a key challenge in many countries. At the same time, there is a growing awareness that the early detection of chronic diseases can reduce mortality rates. Therefor...The provision of high-quality medical care has become a key challenge in many countries. At the same time, there is a growing awareness that the early detection of chronic diseases can reduce mortality rates. Therefore, it is important to identify service needs which influence to participate in health screening. To date, little research has been conducted into the perspectives of service providers on this topic. In this preliminary study, we aimed to explore the perspectives of service providers who work in a community-based setting in order to identify perceived barriers to chronic disease screening and incentives which can increase participation rates. In-depth interviews were conducted with 10 experienced health service providers from October 2017 to December 2017. Interviewees included physicians and community health representatives who had been working in a community-based health screening service for at least 3 years. The study identified several aspects of health screening services for chronic diseases that are in need of improvement, including a shortage of appropriate health service providers, inadequate attendance promoting measures, a lack of continually accessible and affordable medical services, healthcare professionals who possess inadequate communication skills, and rural-urban health care disparities. Service providers believe that current services do not fulfill community needs. Older adults who live in rural areas experience especially significant screening-related health disparities, which are mainly affected by structural service barriers. To improve the quality of medical services, healthcare screening services should be evaluated according to the perspectives of both participants and service providers.展开更多
In a cloud computing environment, users using the pay-as-you-go billing model can relinquish their services at any point in time and pay accordingly. From the perspective of the Cloud Service Providers (CSPs), this is...In a cloud computing environment, users using the pay-as-you-go billing model can relinquish their services at any point in time and pay accordingly. From the perspective of the Cloud Service Providers (CSPs), this is not beneficial as they may lose the opportunity to earn from the relinquished resources. Therefore, this paper tackles the resource assignment problem while considering users relinquishment and its impact on the net profit of CSPs. As a solution, we first compare different ways to predict user behavior (i.e. how likely a user will leave the system before its scheduled end time) and deduce a better prediction technique based on linear regression. Then, based on the RACE (Relinquishment-Aware Cloud Economics) model proposed in [1], we develop a relinquishment-aware resource optimization model to estimate the amount of resources to assign on the basis of predicted user behavior. Simulations performed with CloudSim show that cloud service providers can gain more by estimating the amount of resources using better prediction techniques rather than blindly assigning resources to users. They also show that the proposed prediction-based resource assignment scheme typically generates more profit for a lower or similar utilization.展开更多
Injection is said to be safe when causing no harm to the recipient, and it does not expose provider to avoidable risk and does not result in any waste that is dangerous for other people. Purpose: The study was carried...Injection is said to be safe when causing no harm to the recipient, and it does not expose provider to avoidable risk and does not result in any waste that is dangerous for other people. Purpose: The study was carried out to determine the perspectives of the Saudi health care providers on the safe use and disposal of injection. Methods: Prospective cross sectional survey was used, structured interviews were carried out by the use of pretested questionnaire to elicit general opinions on injection practices skills, and disposal processes in different health settings in Taif Area. Results: Females were dominant injection providers 82.3%. About 80% of providers tend to discard single use injection at once after administration and 84% tend to safely dispose them. Hygienic measures were well maintained. Increased used pattern of injection was observed 46%. Providers were well satisfied by the measures adopted to curb after using hazards. High rate of injection sticks 74.3% was observed. Conclusion: Although some measures of safe disposal were maintained by Saudi injections’ providers, still some regulation efforts should be done to curb spreading out of infection due to mal use and disposal of injection.展开更多
Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) an...Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.展开更多
Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (...Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.展开更多
文摘Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.
文摘Multi-criteria decision making(MCDM)is a technique used to achieve better outcomes for some complex business-related problems,whereby the selection of the best alternative can be made in as many cases as possible.This paper proposes a model,the multi-criteria decision support method,that allows both service providers and consumers to maximize their profits while preserving the best matching process for resource allocation and task scheduling.The increasing number of service providers with different service provision capabilities creates an issue for consumers seeking to select the best service provider.Each consumer seeks a service provider based on various preferences,such as price,service quality,and time to complete the tasks.In the literature,the problem is viewed from different perspectives,such as investigating how to enhance task scheduling and the resource allocation process,improve consumers’trust,and deal with network problems.This paper offers a novel model that considers the preferences of both service providers and consumers to find the best available service provider for each consumer.First,the model adopts the best-worst method(BWM)to gather and prioritize tasks based on consumers’and service providers’preferences.Then,the model calculates and matches similarities between the sets of tasks from the consumer’s side with the sets of tasks from the provider’s side to select the best service provider for each consumer using the two proposed algorithms.The complexity of the two algorithms is found to be O(n3).
文摘Background: Knowledge decay can be present in a lot of different careers but it is especially important when affecting the anesthesia provider. Knowledge decay can lead to skill decay. Therefore, it leads to worse patient outcomes. It is important to know how knowledge decay occurs and to know how to prevent it. Purpose: The purpose of this review was to explore the contributing factors of knowledge decay while also examining how different learning activities can be used to prevent it from occurring. Methods: A systematic literature search was performed in PubMed, Cochrane databases, and Embase. The American Association of Nurse Anesthesiology website was also examined. Findings: Knowledge decay usually occurs when either the anesthesia provider is in a new area of practice or when the provider has had a significant amount of time pass since the latest implementation of an anesthesia skill. The type of activity shown to best combat knowledge decay is the use of a simulation-based learning activity. Classroom learning can also help combat knowledge decay, but not to the same extent. Conclusions: The most significant way to prevent knowledge decay in the anesthesia provider is to implement simulation-based learning activities, as well as keep anesthesia providers comfortable with the skills that they practice.
文摘Background: Healthcare Providers’ knowledge and practice of postpartum hemorrhage (PPH) management are essential to reduce maternal morbidity and mortality. PPH is a public health problem due to the high maternal mortality (MM) associated with it worldwide (25%). Improving the quality of PPH management is a major challenge in low-income countries where, despite the progress made in its management, PPH remains a major contributor to maternal morbidity and mortality. Objective: We will evaluate the level of knowledge and practices of providers in the PPH management in Kinshasa in the Democratic Republic of the Congo (DRC). Methods: This study will be descriptive and cross-sectional. The minimum sample size will be 86. Our study population will consist of delivery room care providers. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparisons of means between groups will be made using Student’s t-test and Pearson’s chi-square test. The test will be statistically significant for a p value 0.05. Data will be collected and processed anonymously and confidentially. Conclusion: Improving quality of care must be a priority in obstetrics. This evaluation requires us to determine the level of knowledge and practices of providers in the PPH management in Kinshasa.
文摘Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.
文摘Both conflict and asymmetric information exist betweenthe telecom operators and the service provider,and result in illegal behaviors of the service provider.The relationship between the telecom operators andthe service provider is classical multi-task principalagentrelationship. The multi-task incentive for theservice provider is considered in the design of theprincipal-agent incentive contract, and it is necessaryto add the multi-task incentive to the serviceproviders through the analysis of the risk costs andthe agency costs of this problem.
文摘This paper examines the perception of adolescents on the attitudes of providers on their access and use of reproductive health services (ARHS) in Delta State, Nigeria, with a view of assessing the impact of providers’ attitude on the use of adolescents’ reproductive health services in Delta State. The study adopted a survey design to collect primary data using questionnaires and focus group discussions (FGDs) from adolescents in a sample of schools. A sample size of 1500 respondents was taken from 12 schools in six Local Government Areas in three Senatorial Districts in Delta State, Nigeria. The locations of the schools were such that six each were in rural and urban communities respectively. The result from the study was that unfriendly attitudes of providers which keep adolescents waiting, inadequate duration of consultations, judgmental attitudes of some providers, lack of satisfactory services provision and lack of confidentiality will put off adolescents from accessing and using adolescents’ reproductive health services irrespective of their sex, age, class, religion, residence, ethnic group, parents’ education or income levels. The paper concludes that medical personnel take all these issues very seriously when dealing with adolescents to enhance access and use adolescents’ reproductive health services in Delta State and indeed Nigeria.
文摘<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;"></span> <span style="font-family:Verdana;">Tuberculosis is one of the leading causes of mortalities attributable to an infectious disease. In a private sector-driven health system such as Nigeria, the private health providers are very important stakeholders in tuberculosis diagnosis and management. Unfortunately, there are few data on the level of contribution of these private health providers to the case finding and notification of tuberculosis in Nigeria. Consequently, this study assessed the contribution of the private providers to the diagnosis and treatment of tuberculosis under the Global Fund Private Public Mix New Funding Model (2<sup></sup></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup>nd</sup></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> phase) grant (GF PPM NFM2) in the four implementing states of south west Nigeria. <b></b></span><b><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">This is a retrospective, cross-sectional analysis of the NFM2 programme implementation data collected between January 1, 2019 and December 31, 2020. Data was extracted from the routine registers such as the presumptive TB registers;treatment register of the private health facilities engaged for PPM activities between 2019 and 2020. The data was entered and analyzed using Microsoft excel package. The variables were summarized using appropriate charts and table. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">Concerning the percentage contribution of the Global Fund Private Public Mix (GF PPM) grant to the total state TB case notification, majority of the implementing states show some progressive rise in the contribution of GF PPM to State TB case notification as the grant implementation progressed. Furthermore, at the initial period of the grant implementation, the health facilities seemed to have generate</span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">d</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> majority of the cases. However, as the grant implementation progressed, the PPMVs were responsible for the diagnosis of majority of the cases. <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">As the grant progressed, there was a progressive increase in the number of presumptive TB cases as well as in the number of notified cases of tuberculosis attributable to private provider engagement.</span></span></span>
文摘Objective:To assess healthcare workers’knowledge of novel coronavirus disease 2019(COVID-19)in the early phase of the outbreak in Indonesia.Methods:A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25,2020.Healthcare workers’knowledge on COVID-19 was assessed,and demographic data,workplace characteristics,and medical professional characteristics as well as the current local situation of COVID-19 were collected.To characterize determinants associated with knowledge,a logistic regression analysis was employed.Results:Out of 288 healthcare workers who completed the interview-assisted questionnaire,149(51.7%)respondents had a good knowledge.Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors:adjusted odds ratio(aO R):0.38;95%CI:0.20-0.72 and aO R:0.31;95%CI:0.13-0.73,respectively.Compared to healthcare workers who had medical practice experience less than 5 years,those who had worked for more than 10 years had lower knowledge(a OR:0.43;95%CI:0.20-0.90).Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room(aO R:14.33;95%CI:3.67-55.88).Conclusions:The knowledge of COVID-19 among surveyed healthcare workers was relatively low.The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.
基金financially supported by Iran University of Medical Sciences,Tehran,Iran.
文摘Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts.The interviews were conducted face-to-face,and MAXQDA software version 10 was used to organize the data and thematic analysis.Results:The participants included 5 medical emergency technicians,5 physicians,2 Red Crescent technicians,and 8 nurses.The main influential factors of healthcare providers’resilience were limited relief infrastructure,supportive empowerment,organizational capitals,and contradictory consequences.Other important factors were resource limitation,confusion and uncertainty,empowerment training,comprehensive support,human and value capital,social capital,physical capital,suffering,disability,calm,and excellence.Conclusion:Improving healthcare providers’resilience can be achieved by reducing uncertainty,providing the physical,economic,and human resources,strengthening motivation and comprehensive supports.It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters.Moreover,researchers should study each dimension to provide profound knowledge regarding resilience in disasters.
文摘Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions. Design: The 2010 Minnesota Adult Tobacco Survey (MATS) is a random digit dial telephone survey with 7057 Minnesota adults. Both landline and mobile telephone samples were included. These samples were combined and weighted to represent the population of adults in Minnesota. Results: Among adult Minnesotans, 16.1% were current smokers, 80.9% reported seeing a health care provider in the past 12 months and 80.2% of those adults were asked if they smoke. Among smokers who saw any provider in the past 12 months, 94.4% reported they were asked about smoking and 71.8% were advised not to smoke. In contrast, 43.9% of smokers received referrals from a health care provider and among those, 37.5% were recommended medications and 24.8% were referred to a quit smoking program. Conclusion: Given the large body of evidence supporting cessation interventions by health care providers, the increase in use of electronic medical records and the availability and success of evidence-based cessation programs, efforts to improve rates of identifying and treating each tobacco user are needed. Further research is needed to explore how cessation intervention responsibilities can be shared among the clinical team and integrated into ongoing clinical care.
文摘Studies investigating the relationship between size and performance of water service providers are abundant. Yet, this relationship has not been fully addressed in Palestinian water sector, particularly, after the issuance of water law 2014 which calls for merging water providers into large regional utilities. This research evaluates the significant effect of the size of Palestinian water service providers on non-revenue water, staff productivity, collection efficiency, average consumption, average price, operating and maintenance cost, working ratio, and gross profit. The multivariate analysis shows that there are significant differences in working ratio, non-revenue water, staff productivity, average price, and gross profit based on the size. On the other side, no significant differences have been found in average daily consumption, operating and maintenance cost per unit, and collection efficiency based on those providers’ size. The small service providers perform better in non-revenue water, staff productivity, and collection efficiency;wherein, large service providers are more profitable than small service providers. Implications of these findings by conducting further studies will add the value for better merging of the Palestinian water providers and the reforming process.
基金Project of the Shanghai Committee of Science and Technology,China(No.12DZ1510000)
文摘A hybrid intelligent approach is proposed to help the decision maker to select the appropriate third-party reverse logistics provider. The following process is included: firstly,the evaluation team is established to determine the selection criteria and evaluate them by triangular fuzzy numbers; secondly,calculate the weight of criteria by the proposed hybrid algorithm integrating particle swarm optimization( PSO) and simulated annealing( SA); then, the performance evaluation for each supplier is predicted by the proposed self-feedback neural network( SFBNN) based on the historical data. A numerical example is also presented to interpret the methodology above.
文摘The Metro Ethernet Forum(MEF) put forward the concept of Carrier Ethernet(CE) to improve Ethernet technology and make it a transmission convergence layer solution for Next Generation Network(NGN).Provider Backbone Transport(PBT) is the result of the enhancement and improvement of the early Ethernet technologies and it is the new version of CE implementation technology and standard which is promising.Through studying the PBT-related technologies,PBT network structure,PBT advantages as the transmission convergence layer solution and its trend of future development,it is concluded that PBT can be used as the preferred technology of the transmission convergence layer in the NGN,though there are some problems to be solved for PBT.
文摘The provision of high-quality medical care has become a key challenge in many countries. At the same time, there is a growing awareness that the early detection of chronic diseases can reduce mortality rates. Therefore, it is important to identify service needs which influence to participate in health screening. To date, little research has been conducted into the perspectives of service providers on this topic. In this preliminary study, we aimed to explore the perspectives of service providers who work in a community-based setting in order to identify perceived barriers to chronic disease screening and incentives which can increase participation rates. In-depth interviews were conducted with 10 experienced health service providers from October 2017 to December 2017. Interviewees included physicians and community health representatives who had been working in a community-based health screening service for at least 3 years. The study identified several aspects of health screening services for chronic diseases that are in need of improvement, including a shortage of appropriate health service providers, inadequate attendance promoting measures, a lack of continually accessible and affordable medical services, healthcare professionals who possess inadequate communication skills, and rural-urban health care disparities. Service providers believe that current services do not fulfill community needs. Older adults who live in rural areas experience especially significant screening-related health disparities, which are mainly affected by structural service barriers. To improve the quality of medical services, healthcare screening services should be evaluated according to the perspectives of both participants and service providers.
文摘In a cloud computing environment, users using the pay-as-you-go billing model can relinquish their services at any point in time and pay accordingly. From the perspective of the Cloud Service Providers (CSPs), this is not beneficial as they may lose the opportunity to earn from the relinquished resources. Therefore, this paper tackles the resource assignment problem while considering users relinquishment and its impact on the net profit of CSPs. As a solution, we first compare different ways to predict user behavior (i.e. how likely a user will leave the system before its scheduled end time) and deduce a better prediction technique based on linear regression. Then, based on the RACE (Relinquishment-Aware Cloud Economics) model proposed in [1], we develop a relinquishment-aware resource optimization model to estimate the amount of resources to assign on the basis of predicted user behavior. Simulations performed with CloudSim show that cloud service providers can gain more by estimating the amount of resources using better prediction techniques rather than blindly assigning resources to users. They also show that the proposed prediction-based resource assignment scheme typically generates more profit for a lower or similar utilization.
文摘Injection is said to be safe when causing no harm to the recipient, and it does not expose provider to avoidable risk and does not result in any waste that is dangerous for other people. Purpose: The study was carried out to determine the perspectives of the Saudi health care providers on the safe use and disposal of injection. Methods: Prospective cross sectional survey was used, structured interviews were carried out by the use of pretested questionnaire to elicit general opinions on injection practices skills, and disposal processes in different health settings in Taif Area. Results: Females were dominant injection providers 82.3%. About 80% of providers tend to discard single use injection at once after administration and 84% tend to safely dispose them. Hygienic measures were well maintained. Increased used pattern of injection was observed 46%. Providers were well satisfied by the measures adopted to curb after using hazards. High rate of injection sticks 74.3% was observed. Conclusion: Although some measures of safe disposal were maintained by Saudi injections’ providers, still some regulation efforts should be done to curb spreading out of infection due to mal use and disposal of injection.
文摘Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.
文摘Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.
