Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 6 Articles
Background: Universal health coverage (UHC) assures all types of health service and protects all citizens financially in\nany conditions due to illness. Globally, the UN sustainable development goal (SDG) provides high priority for UHC as a\nhealth related goal. The National health system of Nepal has prioritized in similar way. The aim of this study is to\nexplore the challenges and opportunities on the road to UHC in Nepal.\nMethod: We used varieties of search terminologies with popular search engines like PubMed, Google, Google Scholar,\netc. to identify studies regarding Nepalâ??s progress towards UHC. Reports of original studies, policies, guidelines and\ngovernment manuals were taken from the web pages of Ministry of Health and its department/division. Searches were\ndesigned to identify the status of service coverage on UHC, financial protection on health particularly, health insurance\ncoverage with its legal status. Other associated factors related to UHC were also explored and presented in Preferred\nReporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart.\nResults: We found 14 studies that were related to legal assurance, risk pulling and financing of health service, 11 studies\nassociated to UHC service coverage status and, 7 articles linked to government stewardship, health system and\ngovernance on health care. Constitutional provision, global support, progress on the health insurance act, decentralization\nof health service to the grass root level, positive trends of increasing service coverage are seen as opportunities. However,\nexisting volunteer types of health insurance, misleading role of trade unions and high proportion of population outside\nthe country are main challenges. The political commitment under the changing political context, a sense of national\npriority and international support were identified as the facilitating factors towards UHC.\nConclusion: To achieve UHC, service and population coverage of health services has to be expanded along with financial\nprotection for marginalized communities. Government stewardship, support of stakeholders and fair contribution and\ndistribution of resources by appropriate health financing modality can speed up the path of UHC in Nepal....
Background: Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in\nundergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based\nresource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of\nnon-technical skills in undergraduate health professionals. However, there is limited literature exploring how the\ninteraction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills\nin undergraduate nursing students.\nMethods: An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the\nexperience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills.\nPurposive sampling identified participants to address the research question. Framework analysis supported by\na codebook enabled deductive and inductive data analysis.\nResults: Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the\ndifferent years interacted differently with the virtual patients. Four themes were recognised in the data: how\nthe virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter,\nchanging the way students perceive practice and potential limitations to learning.\nConclusions: Interactions with virtual patients influence learning knowledge, attitudes and practice of nontechnical\nskills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the\nprofessional role, vicarious learning and learning by making mistakes. Potential limitations to learning from\nvirtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to\nlearning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key.\nThis study demonstrates learning non-technical skills via interactions with virtual patients can change the way\nstudents perceive practice, with learning transferable to the clinical setting to support safe and competent\npatient care....
Background: Patients with giant cell arteritis (GCA) treated with tocilizumab (TCZ) every week or every other week\nand prednisone tapering achieved superior rates of sustained remission to patients treated with placebo and\nprednisone tapering in a randomised controlled trial. Health-related quality of life (HRQOL) in patients from this trial\nis now reported.\nMethods: Exploratory analyses of SF-36 PCS and MCS and domain scores, PtGA and FACIT-Fatigue were performed\nin patients treated with weekly subcutaneous TCZ 162 mg plus 26-week prednisone taper (TCZ-QW + Pred-26) or\nplacebo plus 26-week or 52-week prednisone tapers (PBO + Pred-26 or PBO + Pred-52). These analyses were\nperformed on responder and non-responder patients, including those who achieved the primary outcome and\nthose who experienced flare and received escape prednisone doses.\nResults: Baseline SF-36 PCS, MCS and domain scores were low, indicating impaired HRQOL related to GCA. At week\n52, least squares mean (LSM) changes in PCS scores improved with TCZ-QW + Pred-26 but worsened in both PBO\n+ Pred groups (p < 0.001). LSM changes in MCS scores increased with TCZ-QW+ Pred-26 versus PBO + Pred-52\n(p < 0.001). Treatment with TCZ-QW + Pred-26 resulted in significantly greater improvement in four of eight SF-36\ndomains compared with PBO + Pred-26 and six of eight domains compared with PBO + Pred-52 (p < 0.01).\nImprovement with TCZ-QW+ Pred-26 met or exceeded minimum clinically important differences (MCID) in all eight\ndomains compared with five domains with PBO + Pred-26 and none with PBO + Pred-52. Domain scores in the\nTCZ-QW + Pred-26 group at week 52 met or exceeded age- and gender-matched normative values (A/G norms).\nLSM changes from baseline in FACIT-Fatigue scores increased significantly with TCZ-QW + Pred-26, exceeding MCID\nand A/G norms (p < 0.001).\nConclusions: Patients with GCA receiving TCZ-QW + Pred-26 reported statistically significant and clinically\nmeaningful improvement in SF-36 and FACIT-Fatigue scores compared with those receiving prednisone only.\nImprovements in the TCZ-QW + Pred-26 group led to recovery of HRQOL to levels at least comparable to those of\nA/G-matched normative values at week 52 and exceeded normative values in five of eight domains....
Behaviors that undermine a culture of safety within hospitals threaten overall wellbeing\nof healthcare workers as well as patient outcomes. Existing evidence suggests negative behaviors\nadversely influence patient outcomes, employee satisfaction, retention, productivity, absenteeism,\nand employee engagement. Our objective was to examine the presence of negative behaviors within a\nhealthcare system and the influence of negative behaviors among healthcare workers on perceptions\nof patient safety culture. Using a cross-sectional design, the negative behaviors in healthcare survey\n(NBHC) and selected composites of the Agency for Healthcare Research and Quality (AHRQ) Hospital\nSurvey on Patient Safety Culture (HSOPS) were combined within an electronic survey which was\nadministered to physicians, clinical and managerial staff. Exposure to contributing factors of negative\nbehaviors was moderately correlated with elements of HSOPS, including perceptions of teamwork\nwithin units, management response to error, and overall patient safety grade. Use of aggression\nand fear of retaliation were moderately correlated with HSOPS management response to error.\nReducing healthcare worker exposure to contributing factors of negative behavior may result in\nincreased perceptions of teamwork within a hospital unit, while addressing use of staff aggression\nand fear of retaliation potentially positively influences management response to error....
There is a worldwide increase in the rate of caesarean sections. With recent\nmigration patterns and the influx of refugees into high-income countries,\nmigrants and refugees are also subjected to the increase in caesarean section\nrates. This article explores known information about the obstetrical experiences\nof refugee and displaced women. Pregnancy care varies depending on\nthe location of the displaced women. Obstetrical care in refugee centers in\nGreece is examined as an example of the overall challenges facing European\ncountries as they juggle the influx of refugees. Challenges to obstetrical care\ninclude physician shortage and the ongoing economic crisis in Greece. Refugees\nare some of the worldâ??s most vulnerable populations and overall their\nobstetrical outcomes are worse than women of the host communities. Providers\nin refugee centers must be supported and educated in best obstetrical\npractices including labor management and a judicious use of caesarean deliveries.\nIncreased outreach and training of maternal health worker can improve\nreproductive healthcare for refugees in non-camp environments....
As universities strive to raise their academic rank through the quality and quantity of scholarship in order to maintain\ntheir competitive edge and funding sources, faculty face pressure to increase number of publications and externally funded\nresearch (or project proposals). There are many challenges that make it difficult for faculty to meet a universityâ??s research\ndemand, such as increased work load in academia, teaching large-size classes of students, and other strict university deadlines\nrelated to book ordering, scheduling classes, posting grades, etc. Faculty work group conflicts, faculty incivility, and dwindling\ngrant/research funding add to faculty stress. In order to promote scholarship in academia, administrative support, collaborative\nwork environments, mentoring, and appropriate appraisal systems are needed to enable faculty to bemore productive and satisfied....
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