Browsing by Subject "Delivery of Health Care"
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Item Critical Interpretive Synthesis of Qualitative Data on the Health Care Ecosystem for Vulnerable Newborns in Low- to Middle-Income Countries(Elsevier, 2021-09) Ray, Hannah; Sobiech, Kathleen L.; Alexandrova, Maria; Songok, Julia Jerono; Rukunga, Janet; Bucher, Sherri; Pediatrics, School of MedicineOBJECTIVE: To critically assess and synthesize qualitative findings regarding the health care ecosystem for vulnerable (low-birth-weight or sick) neonates in low- to middle-income countries (LMICs). DATA SOURCES: Between May 4 and June 2, 2020, we searched four databases (Medline [PubMed], SCOPUS, PsycINFO, and Web of Science) for articles published from 2010 to 2020. Inclusion criteria were peer-reviewed reports of original studies focused on the health care ecosystem for vulnerable neonates in LMICs. We also searched the websites of several international development agencies and included findings from primary data collected between May and July 2019 at a tertiary hospital in Kenya. We excluded studies and reports if the focus was on healthy neonates or high-income countries and if they contained only quantitative data, were written in a language other than English, or were published before 2010. STUDY SELECTION: One of the primary authors conducted an initial review of titles and abstracts (n = 102) and excluded studies that were not consistent with the purpose of the review (n = 60). The two primary authors used a qualitative appraisal checklist to assess the validity of the remaining studies (n = 42) and reached agreement on the final 13 articles. DATA EXTRACTION: The two primary authors independently conducted open and axial coding of the data. We incorporated data from studies with different units of analysis, types of methodology, research topics, participant types, and analytical frameworks in an emergent conceptual development process according to the critical interpretive synthesis methodology. DATA SYNTHESIS: We synthesized our findings into one overarching theme, Pervasive Turbulence Is a Defining Characteristic of the Health Care Ecosystem in LMICs, and two subthemes: Pervasive Turbulence May Cause Tension Between the Setting and the Caregiver and Pervasive Turbulence May Result in a Loss of Synergy in the Caregiver-Parent Relationship. CONCLUSION: Because pervasive turbulence characterizes the health care ecosystems in LMICs, interventions are needed to support the caregiver-parent interaction to mitigate the effects of tension in the setting.Item Ethics guide for health care practitioners: working under conditions of an influenza pandemic. Plan, Prepare, Practice [Pocket version].(2009-12-01T18:49:23Z) Indiana University Center for Bioethics; Indiana State Department of HealthThe Ethics Toolkit is designed to assist health care providers in carrying out their ethical responsibilities of caring for patients and families within the clinical environment during an influenza pandemic. In particular, the Toolkit is designed to give practical input on key issues facing health care practitioners, specifically: Altered Standards of Care; Vaccine and Antiviral Provision; Triage; and Workforce Management. Other issues are discussed in the Toolkit, but receive less comprehensive attention. The input for each of these issues is based on an Ethical Framework that provides a reasoned basis for decision making. In addition to this pocket-sized version, a 16 page, full-sized, color brochure is also available. Likewise, a separate, single sheet, "Patient Guide" (page 15) is available.Item Ethics guide for health care practitioners: working under conditions of an influenza pandemic. Plan, prepare, practice.(2009-12-01T18:37:50Z) Indiana University Center for Bioethics; Indiana State Department of HealthThe Ethics Toolkit is designed to assist health care providers in carrying out their ethical responsibilities of caring for patients and families within the clinical environment during an influenza pandemic. In particular, the Toolkit is designed to give practical input on key issues facing health care practitioners, specifically: Altered Standards of Care; Vaccine and Antiviral Provision; Triage; and Workforce Management. Other issues are discussed in the Toolkit, but receive less comprehensive attention. The input for each of these issues is based on an Ethical Framework that provides a reasoned basis for decision making. In addition to this full sized, 16 page color brochure, the Toolkit is also available in a pocket-sized version. Likewise, a separate, single sheet, "Patient Guide" (page 15) is available.Item Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems(Edinburgh University Global Health Society, 2017-06) Fukuma, Shingo; Ahmed, Shahira; Goto, Rei; Inui, Thomas S.; Atun, Rifat; Fukuhara, Shunichi; Medicine, School of MedicineBACKGROUND: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. METHODS: We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture. FINDINGS: All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre-existing restricted capacity in emergency ambulance services. CONCLUSIONS: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems' strengths and vulnerabilities. Spikes in mortality rates for selected non-infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster.Item Measuring research mistrust in adolescents and adults: Validity and reliability of an adapted version of the Group-Based Medical Mistrust Scale(PLOS, 2021-01-22) Knopf, Amelia S.; Krombach, Peter; Katz, Amy J.; Baker, Rebecca; Zimet, Gregory; School of NursingMistrust of health care providers among persons of color is a significant barrier to engaging them in research studies. Underrepresentation of persons of color is particularly problematic when the health problem under study disproportionately affects minoritized communities. The purpose of this study was to test the validity and reliability of an abbreviated and adapted version of the Group Based Medical Mistrust Scale. The GBMMS is a 12-item scale with three subscales that assess suspicion, experiences of discrimination, and lack of support in the health care setting. To adapt for use in the research setting, we shortened the scale to six items, and replaced "health care workers" and "health care" with "medical researchers" and "medical research," respectively. Using panelists from a market research firm, we recruited and enrolled a racially and ethnically diverse sample of American adults (N = 365) and adolescents aged 14-17 (N = 250). We administered the adapted scale in a web-based survey. We used Cronbach's alpha to evaluate measure internal reliability of the scale and external factor analysis to evaluate the relationships between the revised scale items. Five of the six items loaded onto a single factor, with (α = 0.917) for adolescents and (α = 0.912) for adults. Mean scores for each item ranged from 2.5-2.9, and the mean summary score (range 6-25) was 13.3 for adults and 13.1 for adolescents. Among adults, Black respondents had significantly higher mean summary scores compared to whites and those in other racia/ethnic groups (p<0.001). There was a trend toward significance for Black adolescents as compared to white respondents and those in other racial/ethnic groups (p = 0.09). This five-item modified version of the GBMMS is reliable and valid for measuring research mistrust with American adults and adolescents of diverse racial and ethnic identities.Item Patient guide: Questions and answers about Altered Standards of Care. Plan, prepare, practice.(2009-12-01T18:57:14Z) Indiana State Department of Health; Indiana University Center for BioethicsThis patient guide address the following questions: What is an influenza (flu) pandemic? What are Altered Standards of Care? Will vaccines ("flu shot") and antiviral medicines work? and How will my family and I get vaccines and antiviral medicine? In addition to this patient guide, see the related: "Ethics guide for health care practitioners: working under conditions of an influenza pandemic. Plan, Prepare, Practice."Item Prerequisites to Implementing a Pharmacogenomics Program in a Large Healthcare System(Nature Publishing Group, 2014-09) Levy, KD; Decker, BS; Carpenter, JS; Flockhart, DA; Dexter, PR; Desta, Z; Skaar, Todd C.; Department of Medicine, Division of Clinical Pharmacology, IU School of MedicineItem Sustainable mobile information infrastructures in low resource settings(IOS, 2010) Braa, Kristin; Purkayastha, SaptarshiDeveloping countries represent the fastest growing mobile markets in the world. For people with no computing access, a mobile will be their first computing device. Mobile technologies offer a significant potential to strengthen health systems in developing countries with respect to community based monitoring, reporting, feedback to service providers, and strengthening communication and coordination between different health functionaries, medical officers and the community. However, there are various challenges in realizing this potential including technological such as lack of power, social, institutional and use issues. In this paper a case study from India on mobile health implementation and use will be reported. An underlying principle guiding this paper is to see mobile technology not as a "stand alone device" but potentially an integral component of an integrated mobile supported health information infrastructure.Item Using National Measures of Patients' Perceptions of Health Care to Design and Debrief Clinical Simulations(Wolters Kluwer, 2017-01) Eisert, Shelly L.; Bartlett Ellis, Rebecca J.; Geers, Jennifer W.; Werskey, Karen L.; School of NursingThis article describes an innovative approach to using national measures of patients' perspectives of quality health care. Nurses from a regional simulation consortium designed and executed a simulation using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to prepare nurses to improve care and, in turn, enhance patients' perceptions of care. The consortium is currently revising the reporting mechanism to collect data about specific learning objectives based on national quality indicator benchmarks, specifically HCAHPS. This revision reflects the changing needs of health care to include quality metrics in simulation.Item What is conscience and why is respect for it so important?(The final version is available from www.springerlink.com., 2008) Sulmasy, Daniel P.The literature on conscience in medicine has paid little attention to what is meant by the word 'conscience.' This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one's ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed.