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Influence of polycystic ovary syndrome on the periodontal health of Indian women visiting a secondary health care centre

Varadan M, Gopalkrishna P, Bhat PV, Kamath SU, S K, K TG, et al.

Clin Oral Investig, 2019 Aug;23(8):3249-3255.
PMID: 30430337 DOI: 10.1007/s00784-018-2741-2

OBJECTIVES: Periodontal disease and polycystic ovary syndrome (PCOS) share risk factors like obesity, insulin resistance, and dyslipidemia, along with evidence of chronic inflammation in the two conditions. Evaluating the influence of PCOS on periodontal health would, therefore, identify a possible association.
MATERIALS AND METHODS: Sixty women, divided into equal groups of PCOS and healthy patients, were clinically examined for periodontal parameters like probing depth (PD), plaque index (PI), modified gingival index (mGI), and bleeding on probing (BOP). Fasting blood sugar (FBS), insulin (FI), triglycerides (TG), and free testosterone along with serum and gingival crevicular fluid (GCF) levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were the biochemical parameters evaluated.
RESULTS: Women with PCOS had statistically significant differences in mGI, PI, testosterone, FBS, and TG when compared with healthy women (p

Matched MeSH terms: Delivery of Health Care
Reorienting Health Services to People with Chronic Health Conditions: Diabetes and Stroke Services in Malaysia, Sri Lanka and Thailand

Yiengprugsawan V, Healy J, Kendig H, Neelamegam M, Karunapema P, Kasemsup V

Health Syst Reform, 2017 Jul 03;3(3):171-181.
PMID: 31157585 DOI: 10.1080/23288604.2017.1356428

This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.

Matched MeSH terms: Delivery of Health Care
Fulltext Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan

Parray AA, Dash S, Ullah MIK, Inam ZM, Kaufman S

Front Public Health, 2021;9:704811.
PMID: 34458226 DOI: 10.3389/fpubh.2021.704811

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.

Matched MeSH terms: Delivery of Health Care
Healthcare Professionals' Views for the Content of the Teddy Bear Hospital for a Child Sexual Abuse Prevention Module

Rashid AA, Cheong AT, Shamsuddin NH, Roslan D, Hisham Shunmugam R

J Child Sex Abus, 2021 02 23;30(4):442-460.
PMID: 33620024 DOI: 10.1080/10538712.2021.1890294

Worldwide studies have reported a drastic increase in child sexual abuse (CSA) involving very young children. In Malaysia, several attempts have been made to combat this problem via educational programs. Teachers have reported a lack of confidence in teaching this topic; hence a less threatening approach is needed. The Teddy Bear Hospital (TBH) is an innovation whereby the children bring their teddies while visiting the volunteers assuming healthcare practitioners' role. This execution is effective in reducing the children's anxieties about hospitalization and increasing their health knowledge. Therefore, our objective is to explore healthcare practitioners' (HCP) views for the content of TBH and its approach as a personal safety module toward preventing CSA. Eighteen in-depth-interviews were conducted. Interviews were thematically analyzed. Participants suggest the TBH method as a good approach to teaching prevention of CSA among preschoolers. Four main themes emerged from this study: (1) educating children about personal safety, (2) moral values and faith as a medium to prevent child sexual abuse, (3) addressing social media use in children, and (4) general approach to content delivery. The involvement of parents is crucial. Addressing moral values and faith and usage of social media platforms are also essential factors to look into.

Matched MeSH terms: Delivery of Health Care
The role of mental health professionals in the climate crisis: an urgent call to action

Li C, Lawrance EL, Morgan G, Brown R, Greaves N, Krzanowski J, et al.

Int Rev Psychiatry, 2022 08;34(5):563-570.
PMID: 36165755 DOI: 10.1080/09540261.2022.2097005

The climate and ecological crisis will constitute the defining public health challenge of the twenty-first century, posing an unprecedented global threat to all determinants of health, and to healthcare delivery systems. We believe that mental health professionals have a crucial role to play in responding to this crisis. Whilst responding to the mental health consequences of the climate crisis will remain a key role for us as mental health professionals, we argue that our remit goes beyond this, and should include advancing public understanding of the climate crisis, highlighting its impact on physical and mental wellbeing, and advocating for systemic changes to limit its impending harms. This paper is an urgent call to action for all mental health professionals to take up a role in the context of the climate and ecological crisis. This paper will describe the relationship between mental health and climate change, and frame it within wider systemic and conceptual frameworks. It will demonstrate that as mental health professionals we are well placed to act as leaders of change-arguing that we have a duty to do so-and suggest actions that can be implemented depending on interests, skill sets and opportunities.

Matched MeSH terms: Delivery of Health Care
Fulltext Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering

Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, et al.

JCO Glob Oncol, 2021 06;7:886-895.
PMID: 34115537 DOI: 10.1200/GO.21.00027

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.

Matched MeSH terms: Delivery of Health Care
Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes

Jamal A, Babazono A, Li Y, Yoshida S, Fujita T, Kim SA

Am J Med Qual, 2021 5 20;36(5):345-354.
PMID: 34010165 DOI: 10.1097/01.JMQ.0000735484.44163.ce

The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ22 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.

Matched MeSH terms: Delivery of Health Care
Fulltext Twenty years of traditional and complementary medicine regulation and its impact in Malaysia: achievements and policy lessons

Park JE, Yi J, Kwon O

BMC Health Serv Res, 2022 Jan 25;22(1):102.
PMID: 35078459 DOI: 10.1186/s12913-022-07497-2

BACKGROUND: Many countries are trying to integrate traditional and complementary medicine (T&CM) into their health care systems. However, it is not easy to integrate T&CM within a given health care system. This study aims to draw policy outcomes and lessons from the case of Malaysia, which has been making efforts for over 20 years to integrate various types of T&CM into the national health care system (NHS).
METHODS: Documents were searched in major databases and websites using words such as Malaysia and T&CM, and additional documents were secured using snowballing techniques. Data were classified and organized according to the World Health Organization health systems framework.
RESULTS: Malaysia has focused on managing the safety and quality of T&CM, and to that end it has been institutionalized by enacting specialized laws rather than by applying existing medical law directly. Malaysia was able to institutionalize T&CM by adopting a step-by-step approach that considered the appropriateness of administrative policies and measures.
CONCLUSIONS: Malaysia's experiences in implementing its T&CM policies will raise practical implications for countries struggling to integrate their existing T&CM into the NHS and utilize it for universal health coverage.

Matched MeSH terms: Delivery of Health Care
Fulltext EEG Channel Selection Using Multiobjective Cuckoo Search for Person Identification as Protection System in Healthcare Applications

Abdi Alkareem Alyasseri Z, Alomari OA, Al-Betar MA, Awadallah MA, Hameed Abdulkareem K, Abed Mohammed M, et al.

Comput Intell Neurosci, 2022;2022:5974634.
PMID: 35069721 DOI: 10.1155/2022/5974634

Recently, the electroencephalogram (EEG) signal presents an excellent potential for a new person identification technique. Several studies defined the EEG with unique features, universality, and natural robustness to be used as a new track to prevent spoofing attacks. The EEG signals are a visual recording of the brain's electrical activities, measured by placing electrodes (channels) in various scalp positions. However, traditional EEG-based systems lead to high complexity with many channels, and some channels have critical information for the identification system while others do not. Several studies have proposed a single objective to address the EEG channel for person identification. Unfortunately, these studies only focused on increasing the accuracy rate without balancing the accuracy and the total number of selected EEG channels. The novelty of this paper is to propose a multiobjective binary version of the cuckoo search algorithm (MOBCS-KNN) to find optimal EEG channel selections for person identification. The proposed method (MOBCS-KNN) used a weighted sum technique to implement a multiobjective approach. In addition, a KNN classifier for EEG-based biometric person identification is used. It is worth mentioning that this is the initial investigation of using a multiobjective technique with EEG channel selection problem. A standard EEG motor imagery dataset is used to evaluate the performance of the MOBCS-KNN. The experiments show that the MOBCS-KNN obtained accuracy of 93.86% using only 24 sensors with AR20 autoregressive coefficients. Another critical point is that the MOBCS-KNN finds channels not too close to each other to capture relevant information from all over the head. In conclusion, the MOBCS-KNN algorithm achieves the best results compared with metaheuristic algorithms. Finally, the recommended approach can draw future directions to be applied to different research areas.

Matched MeSH terms: Delivery of Health Care
Fulltext A study on the health economics of General Practitioners in Malaysia: Trends, challenges and moving forward

Kenny K, Omar Z, Kanavathi ES, Madhavan P

Int J Public Health Res, 2017;7(1):765-773.
MyJurnal

Health care systems play a vital role in providing health services and in optimising the population’s health of each nation. The Malaysian health care system primarily consists of the public and private health services. One of the prominent private health care services offered in the General Practitioner’s (GP) Clinic. Despite the prominent role GPs play in the health care system in this country, little is known about their practices, the issues and challenges faced by GPs in this country. The objective of this study was to describe the current GP practice operations in Malaysia in terms of its general operations, financial expenditure and revenue, market competitiveness and laboratory services offered by the clinics.

Matched MeSH terms: Delivery of Health Care
Overview of situational awareness in healthcare and the need for early exposure

Zairul-Nizam ZF, Ibrahim NA

Med J Malaysia, 2022 Nov;77(6):750-754.
PMID: 36448395

Medicine and healthcare can rightly be considered as High Reliability Organization (HRO) when it strives to promote and maintain reproducible and safe outcomes for all patients. Situational awareness (SA) as a concept meant to augment patient safety has often been discussed in the literature, but our own local contribution to this important discussion is decidedly deficient. Being initially implemented in the aviation industry, this concept has been extended to be a crucial element in high-demand activities, including healthcare. As such, extensive exposure is given early on during the training of medical personnel in many countries. We believe that our own medical students and other healthcare candidates in training should be similarly exposed to this concept as it can have a tremendous impact on patient well-being and safety. This paper attempts to provide a short overview of the SA in healthcare and how we can similarly promote its inclusion in our training programmes.

Matched MeSH terms: Delivery of Health Care
Fulltext Impact of COVID-19 Pandemic on Healthcare Utilization among Patients with Type 2 Diabetes Mellitus: A Systematic Review

Amsah N, Md Isa Z, Ahmad N, Abdul Manaf MR

Int J Environ Res Public Health, 2023 Mar 04;20(5).
PMID: 36901588 DOI: 10.3390/ijerph20054577

As the COVID-19 pandemic continues, healthcare services have been grossly overwhelmed by the pandemic. Due to this circumstance, routine care for individuals with type 2 diabetes mellitus (T2DM) has been temporarily disrupted. The purpose of this systematic review was to summarize the evidence regarding the impact of the COVID-19 pandemic on healthcare utilization among patients with T2DM. A systematic search was conducted in the Web of Science, Scopus, and PubMed databases. The process of identifying the final articles followed the PRISMA guidelines. The inclusion criteria were articles published between 2020 and 2022, written in English, and studies focusing on the research question. Any proceedings and books were excluded. A total of fourteen articles relevant to the research question were extracted. Following that, the included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT) and the Joanna Briggs Institute Critical Appraisal Tool to assess the quality of the studies. The findings were further classified into three themes: reduced healthcare utilization among T2DM patients in routine healthcare services, a surge of telemedicine usage, and delay in the delivery of healthcare services. The key messages include demands for monitoring the long-term effects of the missed care and that better preparedness is crucial for any pandemic in the future. A tight diagnostic workup at the community level and regular follow-ups are crucial in managing the impact of the pandemic among T2DM patients. Telemedicine should be on the agenda of the health system to maintain and complement healthcare services. Future research is warranted to determine effective strategies to deal with the impact of the pandemic on healthcare utilization and delivery among T2DM patients. A clear policy is essential and should be established.

Matched MeSH terms: Delivery of Health Care
Fulltext Secured and Privacy-Preserving Multi-Authority Access Control System for Cloud-Based Healthcare Data Sharing

Gupta R, Kanungo P, Dagdee N, Madhu G, Sahoo KS, Jhanjhi NZ, et al.

Sensors (Basel), 2023 Feb 27;23(5).
PMID: 36904822 DOI: 10.3390/s23052617

With continuous advancements in Internet technology and the increased use of cryptographic techniques, the cloud has become the obvious choice for data sharing. Generally, the data are outsourced to cloud storage servers in encrypted form. Access control methods can be used on encrypted outsourced data to facilitate and regulate access. Multi-authority attribute-based encryption is a propitious technique to control who can access encrypted data in inter-domain applications such as sharing data between organizations, sharing data in healthcare, etc. The data owner may require the flexibility to share the data with known and unknown users. The known or closed-domain users may be internal employees of the organization, and unknown or open-domain users may be outside agencies, third-party users, etc. In the case of closed-domain users, the data owner becomes the key issuing authority, and in the case of open-domain users, various established attribute authorities perform the task of key issuance. Privacy preservation is also a crucial requirement in cloud-based data-sharing systems. This work proposes the SP-MAACS scheme, a secure and privacy-preserving multi-authority access control system for cloud-based healthcare data sharing. Both open and closed domain users are considered, and policy privacy is ensured by only disclosing the names of policy attributes. The values of the attributes are kept hidden. Characteristic comparison with similar existing schemes shows that our scheme simultaneously provides features such as multi-authority setting, expressive and flexible access policy structure, privacy preservation, and scalability. The performance analysis carried out by us shows that the decryption cost is reasonable enough. Furthermore, the scheme is demonstrated to be adaptively secure under the standard model.

Matched MeSH terms: Delivery of Health Care
Fulltext Perception of integrating complementary and alternative medicine practice in patient's treatment among the healthcare practitioners: a systematic review

Aizuddin AN, Zamzuri M'IA, Mansor J, Nurumal SR, Yunus SZSA, Razak MAA, et al.

Pan Afr Med J, 2022;43:19.
PMID: 36451723 DOI: 10.11604/pamj.2022.43.19.31133

There is a growing trend in complementary and alternative medicine (CAM) usage among the population with medical conditions. However, there is hesitancy for medical practitioners to integrate its application with the current treatment modality, despite governance by the authority. Hence, our objective is to systematically evaluate the healthcare perception towards integrating CAM in their practices. We systematically searched three large and renowned databases i.e., Scopus, Web of Science and PubMed, regarding "Perception on Integrating CAM Usage in Patient's Treatment among Healthcare Practitioners" from 2016 until 2020. At least two independent reviewers comprehensively screened and extracted the data from the accepted articles. A total of 15 studies were included in the final qualitative synthesis following a strict and rigorous assessment checked using MMAT 2018 checklist. The studies included providing the richness of information due to the qualitative nature of the study design. There were three main domains extracted i.e. knowledge, attitude, and perspective of the healthcare practitioner towards CAM integration. Limited knowledge of CAM among healthcare providers may be the possible main reason for non-supportive attitude and negative perspective on CAM. However, those who showed an inclination towards CAM were found to be more open and ready to learn about CAM if it provides benefits to the patients. There is a heterogeneity of perception towards CAM integration from healthcare providers' point of view. A proactive and systematic CAM literacy awareness program may help to improve their understanding and possibly gain more trust in its application.

Matched MeSH terms: Delivery of Health Care
Fulltext COVID-19 Vehicle Based on an Efficient Mutual Authentication Scheme for 5G-Enabled Vehicular Fog Computing

Al-Shareeda MA, Manickam S

Int J Environ Res Public Health, 2022 Nov 24;19(23).
PMID: 36497709 DOI: 10.3390/ijerph192315618

The COVID-19 pandemic is currently having disastrous effects on every part of human life everywhere in the world. There have been terrible losses for the entire human race in all nations and areas. It is crucial to take good precautions and prevent COVID-19 because of its high infectiousness and fatality rate. One of the key spreading routes has been identified to be transportation systems. Therefore, improving infection tracking and healthcare monitoring for high-mobility transportation systems is impractical for pandemic control. In order to enhance driving enjoyment and road safety, 5G-enabled vehicular fog computing may gather and interpret pertinent vehicle data, which open the door to non-contact autonomous healthcare monitoring. Due to the urgent need to contain the automotive pandemic, this paper proposes a COVID-19 vehicle based on an efficient mutual authentication scheme for 5G-enabled vehicular fog computing. The proposed scheme consists of two different aspects of the special flag, SF = 0 and SF = 1, denoting normal and COVID-19 vehicles, respectively. The proposed scheme satisfies privacy and security requirements as well as achieves COVID-19 and healthcare solutions. Finally, the performance evaluation section shows that the proposed scheme is more efficient in terms of communication and computation costs as compared to most recent related works.

Matched MeSH terms: Delivery of Health Care
Fulltext Knowledge sharing behaviour among head nurses in online health communities: The moderating role of knowledge self-efficacy

Shehab S, Al-Bsheish M, Meri A, Dauwed M, Aldhmadi BK, Kareem HM, et al.

PLoS One, 2023;18(1):e0278721.
PMID: 36656899 DOI: 10.1371/journal.pone.0278721

BACKGROUND: Head nurses are vital in understanding and encouraging knowledge sharing among their followers. However, few empirical studies have highlighted their contribution to knowledge-sharing behaviour in Online Health Communities (OHCs). In addition, scant literature has examined the moderating role of knowledge self-efficacy in this regard.
PURPOSES: This study examines the moderating role of self-efficacy between the association of four selected individual factors of head nurses (i.e., Trust, Reciprocity, Reputation, and Ability to Share) and their knowledge-sharing behaviour in OHCs in Jordan.
METHOD: The data were obtained by using a self-reported survey from 283 head nurses in 22 private hospitals in Jordan. A moderation regression analysis using a structural equation modelling approach (i.e. Smart PLS-SEM, Version 3) was utilised to evaluate the study's measurement and structural model.
RESULTS: Knowledge self-efficacy moderates the relationship between the three individual factors (i.e., Trust, Reciprocity, and Reputation) and knowledge-sharing behaviours. However, self-efficacy did not moderate the relationship between the ability to share and knowledge-sharing behaviours.
IMPLICATIONS: This study contributes to understanding the moderating role of knowledge self-efficacy among head nurses in online healthcare communities. Moreover, this study provides guidelines for head nurses to become active members in knowledge sharing in OHCs. The findings of this study offer a basis for further research on knowledge sharing in the healthcare sector.

Matched MeSH terms: Delivery of Health Care
Engaging community pharmacists in tuberculosis-directly observed treatment: a mixed-methods study

Wong YJ, Thum CC, Ng KY, Lee SWH

Prim Health Care Res Dev, 2023 Mar 22;24:e21.
PMID: 36946302 DOI: 10.1017/S1463423623000105

AIM: This study aimed to evaluate the feasibility of implementing community pharmacy-based tuberculosis-directly observed treatment (TB-DOT) in Malaysia.
BACKGROUND: Tuberculosis (TB) eradication is one of the top priorities in the public health agenda in Malaysia. While public-private mix (PPM) initiatives have been launched, community pharmacists remain undervalued assets in TB management.
METHODS: A two-phase mixed-methods study targeting community pharmacists was conducted in Malaysia between March and October 2021. The first phase was an online self-administered survey developed according to the Consolidated Framework for Implementation Research (CFIR). The second phase was a semi-structured interview to allow deeper understanding on the quantitative results. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using thematic analysis with a semi-inductive approach. The data were triangulated to enhance comprehensiveness and credibility of the findings.
FINDINGS: The survey was completed by 388 community pharmacists, and 23 pharmacists participated in the interview. Most community pharmacists indicated their willingness to serve as TB-DOT supervisors (70.1%). Qualitative results supported the findings. Community pharmacy-based TB-DOT service was perceived as an avenue to improve TB management and outcomes and to enhance the professional role of pharmacists in TB service at primary care settings. This was also perceived as a feasible intervention with the potential to strengthen the National TB Control programme. This initiative needs be reinforced with adequate support from the public healthcare sector for a strong partnership in ensuring success.

Matched MeSH terms: Delivery of Health Care
Fulltext An Industrial IoT-Based Blockchain-Enabled Secure Searchable Encryption Approach for Healthcare Systems Using Neural Network

Ali A, Almaiah MA, Hajjej F, Pasha MF, Fang OH, Khan R, et al.

Sensors (Basel), 2022 Jan 12;22(2).
PMID: 35062530 DOI: 10.3390/s22020572

The IoT refers to the interconnection of things to the physical network that is embedded with software, sensors, and other devices to exchange information from one device to the other. The interconnection of devices means there is the possibility of challenges such as security, trustworthiness, reliability, confidentiality, and so on. To address these issues, we have proposed a novel group theory (GT)-based binary spring search (BSS) algorithm which consists of a hybrid deep neural network approach. The proposed approach effectively detects the intrusion within the IoT network. Initially, the privacy-preserving technology was implemented using a blockchain-based methodology. Security of patient health records (PHR) is the most critical aspect of cryptography over the Internet due to its value and importance, preferably in the Internet of Medical Things (IoMT). Search keywords access mechanism is one of the typical approaches used to access PHR from a database, but it is susceptible to various security vulnerabilities. Although blockchain-enabled healthcare systems provide security, it may lead to some loopholes in the existing state of the art. In literature, blockchain-enabled frameworks have been presented to resolve those issues. However, these methods have primarily focused on data storage and blockchain is used as a database. In this paper, blockchain as a distributed database is proposed with a homomorphic encryption technique to ensure a secure search and keywords-based access to the database. Additionally, the proposed approach provides a secure key revocation mechanism and updates various policies accordingly. As a result, a secure patient healthcare data access scheme is devised, which integrates blockchain and trust chain to fulfill the efficiency and security issues in the current schemes for sharing both types of digital healthcare data. Hence, our proposed approach provides more security, efficiency, and transparency with cost-effectiveness. We performed our simulations based on the blockchain-based tool Hyperledger Fabric and OrigionLab for analysis and evaluation. We compared our proposed results with the benchmark models, respectively. Our comparative analysis justifies that our proposed framework provides better security and searchable mechanism for the healthcare system.

Matched MeSH terms: Delivery of Health Care
Fulltext Data envelopment analysis for ambulance services of different service providers in urban and rural areas in Ministry of Health Malaysia

Mohd Hassan NZA, Bahari MS, Aminuddin F, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Mohd Hanafiah AN, et al.

Front Public Health, 2022;10:959812.
PMID: 36684911 DOI: 10.3389/fpubh.2022.959812

INTRODUCTION: Ambulance services are pivotal in any country's healthcare system. An efficient ambulance service not only decreases patient mortality rate but also allows resource prioritization for better outputs. This study aims to measure the efficiency of ambulance services provided by health facilities in the Ministry of Health (MOH), Malaysia.
METHODS: This cross-sectional study analyzed the efficiency of 76 Decision-Making Units (DMUs) or health facilities, consisting of 62 health clinics and 14 hospitals. Data Envelopment Analysis (DEA) was used for computing efficiency scores while adopting the Variable Return to Scale (VRS) approach. The analysis was based on input orientation. The input was the cost of ambulance services, while the output for this analysis was the distance coverage (in km), the number of patients transferred, and hours of usage (in hours). Subsequent analysis was conducted to test the Overall Technical Efficiency (OTE), the Pure Technical Efficiency (PTE), the Scale Efficiency (SE), and the Return to Scale with the type of health facilities and geographical areas using a Mann-Whitney U-test and a chi-square test.
RESULTS: The mean scores of OTE, PTE, and SE were 0.508 (±0.207), 0.721 (±0.185), and 0.700 (±0.200), respectively. Approximately, 14.47% of the total health facilities were PTE. The results showed a significant difference in OTE and SE between ambulance services in hospitals and health clinics (p < 0.05), but no significant difference in PTE between hospitals and clinics (p>0.05). There was no significant difference in efficiency scores between urban and rural health facilities in terms of ambulance services except for OTE (p < 0.05).
DISCUSSION: The ambulance services provided in healthcare facilities in the MOH Malaysia operate at 72.1% PTE. The difference in OTE between hospitals and health clinics' ambulance services was mainly due to the operating size rather than PTE. This study will be beneficial in providing a guide to the policymakers in improving ambulance services through the readjustment of health resources and improvement in the outputs.

Matched MeSH terms: Delivery of Health Care
Haemophilia care in Asia: Learning from clinical practice in some Asian countries

Angchaisuksiri P, Amurao-Abiera M, Chou SC, Chewcharat P, Chozie NA, Gomez R, et al.

Haemophilia, 2024 May;30(3):609-616.
PMID: 38523289 DOI: 10.1111/hae.14998

BACKGROUND: The healthcare systems in Asia vary greatly due to the socio-economic and cultural diversities which impact haemophilia management.
METHODS: An advisory board meeting was conducted with experts in haemophilia care from Asia to understand the heterogeneity in clinical practices and care provision in the region.
FINDINGS: The overall prevalence of haemophilia in Asia ranges between 3 and 8.58/100,000 patients. Haemophilia A was more prevalent as compared to haemophilia B with a ratio of around 5:1. There is under-diagnosis in the region due to lack of diagnosis, registries and/or lack of appropriate facilities in suburban areas. Most patients are referred to the haematologists by their families or primary care physicians, while some are identified during bleeding episodes. Genetic testing faces obstacles like resource constraints, services available at limited centres and unwillingness of patients to participate. Prophylaxis is offered for people with haemophilia (PWH) with a severe bleeding phenotype. Recombinant factors are approved in most countries across the region and are the preferred therapy. The challenges highlighted for not receiving a high standard of care include patients' reluctance to use an intravenous treatment, poor patient compliance due to frequency of infusions, budget constraints and lack of funding, insurance, availability and accessibility of factor concentrates. Prevalence of neutralizing antibodies ranged from 5% to 20% in the region. Use of immune tolerance induction and bypassing agents to treat inhibitors depends on their cost and availability.
CONCLUSION: Haemophilia care in Asia has evolved to a great extent. However, some challenges remain for which a strategic approach along with multi-stakeholder involvement are needed.

Matched MeSH terms: Delivery of Health Care

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