DESIGNS: Retrospective cross-sectional study.
SETTING: PMCare claims database from January 2016 to August 2019.
PARTICIPANTS: A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs.
MAIN OUTCOME MEASURES: The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges.
RESULTS: The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively.
CONCLUSION: Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.
PATIENTS AND METHODS: This longitudinal quasi-experimental study with pre- and post-intervention design involved 96 infants born between 28 and 37 weeks of gestation for three months, and was carried out at a neonatal intensive care unit in Malaysia. The experimental group received a structured education program and careful monitoring of their kangaroo care practices, while the control group received routine care without a structured education program. The institutional review board approved the study design and registered at ClinicalTrials.gov (NCT04926402).
RESULTS: The kangaroo care hours performed by mothers at baseline in the experimental and control group was 4.12 and 0.55 hours per week, respectively. At three months post-discharge, the experimental group had significantly higher weight gain, higher breastfeeding rates and shorter lengths of hospitalization than the control group.
CONCLUSION: A locally contextualized and structured kangaroo care education program is effective in the performance of kangaroo care. One hour per day of kangaroo care is positively associated with an extended period of breastfeeding, improved weight gain and shorter hospitalization of premature infants.
PATIENTS AND METHODS: This study employed a mixed method explanatory sequential approach. We surveyed 262 health workers and interviewed 12 health workers. Descriptive statistical (frequency distributions and summary measures) analysis was performed to assess the distributions of variables using SPSS. We used thematic analysis for the qualitative data analysis.
RESULTS: We discovered a good level of open disclosure practice, open disclosure system, attitude toward open disclosure and process, open disclosure according to the level of harm resulting from PSIs in the quantitative phase. The qualitative phase revealed that most participants were confused about the difference between incident reporting and incident disclosure. Furthermore, the quantitative and qualitative analyses revealed that major errors or adverse events should be disclosed. The contradictory findings may be due to a lack of awareness of incident disclosure. The important factors in disclosing the incident are effective communication, type of incident, and patient and family characteristics.
CONCLUSION: Open disclosure is novel for Indonesian health professionals. A good open disclosure system in hospitals could address several issues such as lack of knowledge, lack of policy support, lack of training, and lack of policy. To limit the negative implications of disclosing situations, the government should develop supportive policies at the national level and organize many initiatives at the hospital level.
PURPOSE: This study explored the enabling factors for the effective implementation of the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) program in the Ministry of Health (MOH) hospitals in Madinah, Saudi Arabia.
METHODS: This qualitative study involved 22 professionals from five CBAHI-accredited MOH hospitals in Madinah, Saudi Arabia. A purposive sampling technique was applied, and data were collected through in-depth, semi-structured interviews. A thematic analysis approach was applied to the interview transcripts.
RESULTS: Four themes and 11 subthemes emerged. The emerging themes included the development of human capital, resolving quality management issues, ensuring the availability of resources, and strategizing CBAHI-specific solutions.
CONCLUSION: The current study fills this knowledge gap by identifying the factors leading to the effective implementation of the CBAHI accreditation program in the MOH hospitals. Only the effective execution of the CBAHI will increase healthcare quality and, as a result, justify the significant resources and efforts invested in these programs. Future research should replicate similar study in other governments or private hospitals.
METHODS: A questionnaire survey was employed for a convenience sample of 400 nurses at Malacca General Hospital in Malaysia who voluntarily participated in this cross-sectional study. The Statistical Package for the Social Sciences (SPSS) was used to treat and analyze the data. Descriptive statistics were generated, and Post Hoc analyses and ANOVA tests were conducted.
RESULTS: Findings indicated that working hours duration was significantly associated with nurses' anxiety (F (4, 394) = 10.362, p <0.001), depression (F (4, 395) = 23.041, p< 0.001), fatigue (F (4, 395) = 24.232, p< 0.001), sleepiness (F (4, 395) = 4.324, p < 0.002), quality of nursing care (F (4, 395) = 16.21, p <0.001) and intention leave their job, (F (4, 395) = 50.29, p <0.001). The results also revealed that working more than 14 hours was negatively associated with their perceived quality of nursing care and positively associated with their perceived ill-being and intention to leave.
CONCLUSION: Shift length is an important issue, and nursing managers must consider shift length as it can adversely correlate with the nurses' perceptions of work and life.
PURPOSE: This study aims to investigate the roles of vitamin A and E levels in CSOM patients with Cholesteatoma.
PATIENTS AND METHODS: The study was conducted between July and December 2020, and the method used was an analytical observational approach with a case-control design. The sample population comprised 60 CSOM patients divided into 2 groups. These included those with and without cholesteatoma.
RESULTS: The results showed that there was no significant difference between these two groups in terms of the impact of vitamin A and E levels (respectively, p = 0.626, p = 0.864).
CONCLUSION: Considering these results, it was discovered that vitamins A and E levels do not influence the occurrence of CSOM with or without cholesteatoma.
METHODS: A cross-sectional study was conducted between April and May 2023 to assess PharmD students' perceptions, concerns, and experiences regarding the integration of ChatGPT into clinical pharmacy education. The study utilized a convenient sampling method through online platforms and involved a questionnaire with sections on demographics, perceived benefits, concerns, and experience with ChatGPT. Statistical analysis was performed using SPSS, including descriptive and inferential analyses.
RESULTS: The findings of the study involving 211 PharmD students revealed that the majority of participants were male (77.3%), and had prior experience with artificial intelligence (68.2%). Over two-thirds were aware of ChatGPT. Most students (n= 139, 65.9%) perceived potential benefits in using ChatGPT for various clinical tasks, with concerns including over-reliance, accuracy, and ethical considerations. Adoption of ChatGPT in clinical training varied, with some students not using it at all, while others utilized it for tasks like evaluating drug-drug interactions and developing care plans. Previous users tended to have higher perceived benefits and lower concerns, but the differences were not statistically significant.
CONCLUSION: Utilizing ChatGPT in clinical training offers opportunities, but students' lack of trust in it for clinical decisions highlights the need for collaborative human-ChatGPT decision-making. It should complement healthcare professionals' expertise and be used strategically to compensate for human limitations. Further research is essential to optimize ChatGPT's effective integration.
METHODS: A cross-sectional survey was carried out in Yemen from December 2022 to March 2023 to investigate public perception and knowledge of mpox. Individuals were approached through social media platforms using a convenient sampling approach. Linear regression was used to determine the association between participants' knowledge (dependent variable) and explanatory variables.
RESULTS: A total of 853 individuals consented to take part in the study. A significant proportion of respondents had a low knowledge level (N=572, 67.06%). Most participants knew about the nature of the diseases (75%, n=641), transmission mode (78.1%, n=668), hand sanitizer preventive measures, and skin- related symptoms. However, only 20.8% (n= 178) knew that diarrhea is not a symptom, and 25.4% (n= 217) knew antibiotics are unnecessary for mpox management. A proportion of 57.7% (n=492) of the participants feared human mpox, and 47.7% (n= 407) thought it was a conspiracy. Most participants had a good perception of local and international health authorities controlling the disease. Age, education level, having a health-related certificate, and receiving a 2-dose vaccination for COVID-19 had statistically significant associations with mpox knowledge level (P < 0.05). Social media platforms were the most often used information source about mpox (78.3%, n= 668), followed by articles (41.1%, n=351).
CONCLUSION: The study reveals a low public knowledge about mpox in Yemen, emphasizing the need for targeted educational campaigns, especially via social media, to strengthen public health measures and disease control. Addressing Knowledge gaps and correcting misconceptions is crucial for improving preparedness and response to the disease.
OBJECTIVE: To assess students' knowledge and attitudes about risks and prevention of consanguineous marriage.
METHODS: Demographic details of the participants and data on knowledge and attitudes concerning the risks and prevention of consanguineous marriage were obtained using an online self-administered questionnaire. The factors associated with good knowledge and attitude toward consanguineous marriage were investigated by logistic regression analysis.
RESULTS: A total of 667 participants enrolled in the study. The average knowledge score about consanguineous marriage risk and prevention was 78.6% with a 95% confidence interval (CI) [77.3, 79.8], and the average attitude was 79.7% with a 95% confidence interval (CI) [79, 80.6]. A better knowledge score was observed in older participants (OR 1.01; 95% CI 1.004-1.024), females (OR 1.69; 95% CI 1.48-1.94), participants with parental history of consanguinity (OR 1.33; 95% CI 1.17-1.52), participants with family history of consanguineous marriage (OR 5.18; 95% CI 2.19-7.10), and participants with family history of inherited disease (OR 1.52; 95% CI 1.25-1.86).
CONCLUSION: In general, the overall level of knowledge and attitudes toward consanguineous marriage risk and prevention was good among university students. To efficiently control and manage the adverse health impacts associated with consanguineous marriage, there is an urgent need to develop and implement evidence-based counseling and screening programs for consanguineous marriage that would significantly reduce the number of at-risk marriages.
METHODS: We conducted a data mining study on TCM symptom of spastic CP children aged 4-14 years old treated at Xi'an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, from October 2021 to March 2023. The medical records of all eligible and complete spastic CP patients were extracted, processed for data cleansing, transformed, and subsequently analyzed to discern distinctive TCM symptom. K-Means Clustering Analysis and Association Rule Analysis were used for data mining.
RESULTS: Core symptoms identified for spastic CP encompassed "Motor Dysfunction", "Impaired Speech", "Delayed Development", "Limb Stiffness", "Rigidity in the limbs", "Intellectual Impairment", "Timidity and susceptibility to startle responses", "Muscle Wasting", and "Pale or Dull Complexion". Among the top-ranking associations of symptom, patterns emerge wherein "Motor dysfunction" intertwine with "Impaired speech", "Motor dysfunction" coexist with "Delayed development", and "Impaired speech" are accompanied by "Delayed development".
CONCLUSION: This study identified the core symptom of spastic CP and tentatively suggests that the clinical manifestations of spastic CP are essentially consistent with the TCM pattern "liver exuberance and spleen weakness". This finding has facilitated the preliminary establishment of correlations between TCM pattern differentiation and the disease in medicine. It is anticipated that this correlation will bring tangible benefits to a larger number of children with spastic CP.
PURPOSE: To our knowledge, little is known about stress, adversity quotient, and health behaviors of university students in Thailand. Therefore, the aims of this study were to determine the relationships among socioeconomic factors, stress, and adversity quotient influencing university students' health behavior during the COVID-19 crisis.
PATIENTS AND METHODS: We conducted a cross-sectional predictive study; it was included 416 undergraduate students ≥18 years of age at a university in Thailand. We used descriptive statistics, chi-squared test, and stepwise multiple linear regression for data analysis.
RESULTS: The results indicated that most participants were women (71.90%), and the highest proportion of students were enrolled in College of Politics and Governance (25.24%). Most of the students had a high stress level (M = 3.54, SD = 0.53), high adversity quotient (M = 3.77, SD = 0.63), and good health behavior (M = 3.06, SD = 0.53). Adversity quotient, stress, and current faculty/college were significant predictors of health behaviors of undergrad students (total variance: 37.2%).
CONCLUSION: Total adversity quotient was the strongest predictor of health behavior, followed by stress and current faculty/colleges. On the basis of our results, we suggested that faculty members, caretakers, and interdisciplinary care teams should consider adversity quotient and stress in developing activities to encourage and promote students' physical and mental health behaviors, particularly during the COVID-19.
METHODS: A scoping review was conducted using pre-defined search terms in three scientific databases, including Google Scholar, ScienceDirect, and PubMed. A multi-stage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. Review articles, meta-analysis studies, and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form.
RESULTS: Of the initially identified 681 studies, 17 studies with 136,026 patients were included in the review. Of these, 16 were randomized controlled trials, while the remaining study was a retrospective cohort study. The majority of pharmacist-led interventions were face-to-face counseling sessions (n=8), followed by remote- or telephone-based interventions (n=5) and multi-faceted interventions (n=4). The majority of the studies (n=7) used self-reported adherence measures and pharmacy refill records (n=8) to measure the rate of adherence to prescribed medications. Eleven of the included studies reported a statistically significant (P<0.05) impact on medication adherence. Overall, twelve studies assessed the effect of the interventions on the clinical outcome measures; of these, only four studies were associated with significant impact.
CONCLUSION: Pharmacist-led interventions were associated with improved patients' adherence to their medications but were less likely to be consistently associated with the attainment of clinical outcomes. Face-to-face counseling was the most commonly used intervention; while, the multi-faceted interventions were more likely to be effective in improving the overall outcome measures. The rigorous design of targeted interventions with more frequent follow-ups, careful consideration of the involved medications, and patients' characteristics could increase the effectiveness of these interventions.
METHODS: A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05.
RESULTS: The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035).
CONCLUSION: Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions.
IMPLICATIONS FOR PRACTICE: Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.