Displaying publications 461 - 480 of 607 in total

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  1. Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM
    BMC Health Serv Res, 2017 Jan 13;17(1):35.
    PMID: 28086871 DOI: 10.1186/s12913-016-1963-8
    BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.

    METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.

    RESULTS: Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.

    CONCLUSION: Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.

    TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016).
    Matched MeSH terms: Delivery of Health Care, Integrated/organization & administration*
  2. Webb AH
    N Z Med J, 1973 Nov 14;78(502):412-4.
    PMID: 4129253
    Matched MeSH terms: Delivery of Health Care*
  3. Hyder AA, Merritt M, Ali J, Tran NT, Subramaniam K, Akhtar T
    Bull World Health Organ, 2008 Aug;86(8):606-11.
    PMID: 18797618
    Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.
    Matched MeSH terms: Delivery of Health Care/ethics*
  4. Abdul Karim R, Zakaria NF, Zulkifley MA, Mustafa MM, Sagap I, Md Latar NH
    Biomed Eng Online, 2013;12:21.
    PMID: 23496940 DOI: 10.1186/1475-925X-12-21
    Telepointer is a powerful tool in the telemedicine system that enhances the effectiveness of long-distance communication. Telepointer has been tested in telemedicine, and has potential to a big influence in improving quality of health care, especially in the rural area. A telepointer system works by sending additional information in the form of gesture that can convey more accurate instruction or information. It leads to more effective communication, precise diagnosis, and better decision by means of discussion and consultation between the expert and the junior clinicians. However, there is no review paper yet on the state of the art of the telepointer in telemedicine. This paper is intended to give the readers an overview of recent advancement of telepointer technology as a support tool in telemedicine. There are four most popular modes of telepointer system, namely cursor, hand, laser and sketching pointer. The result shows that telepointer technology has a huge potential for wider acceptance in real life applications, there are needs for more improvement in the real time positioning accuracy. More results from actual test (real patient) need to be reported. We believe that by addressing these two issues, telepointer technology will be embraced widely by researchers and practitioners.
    Matched MeSH terms: Delivery of Health Care
  5. Yip CH, Anderson BO
    Expert Rev Anticancer Ther, 2007 Aug;7(8):1095-104.
    PMID: 18028018
    Breast cancer is an increasingly urgent problem in low- and mid-level resource countries of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care to patients when diagnostic and/or treatment resources are lacking. For this reason, it is important to identify which resources commonly applied in resource-abundant countries most effectively fill the healthcare needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made in order to maximize improvement in outcome. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for countries with limited resources (low- and middle-income countries) to improve breast health outcomes. The BHGI serves as a program for international guideline development and as a hub for linkage among clinicians, governmental health agencies and advocacy groups to translate guidelines into policy and practice. The BHGI collaborated with 12 national and international health organizations, cancer societies and nongovernmental organizations to host two BHGI international summits. The evidence-based BHGI Guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast healthcare. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in healthcare delivery, based upon outcomes, cost, cost-effectiveness and use of healthcare services.
    Matched MeSH terms: Delivery of Health Care
  6. Lee TW, Chan SC, Chua WT, Harbinder K, Khoo YL, Ow Yeang YL, et al.
    Med J Malaysia, 2004 Aug;59(3):317-22.
    PMID: 15727376 MyJurnal
    An audit on diabetic management was done in seven Perak general practice (GP) clinics in December 2001. The results showed inadequacies in nine out of eleven criteria assessed. Remedial measures were implemented. A second audit in March 2003, at the completion of the audit cycle, showed improvements in all the criteria used. All clinics established a diabetic register compared to 28.6% in the first audit and 57.1% of the clinics set up a reminder mechanism compared to 0% in the first audit. In the process of care, recording of weight, height, blood pressure; feet examination, fundoscopy, blood sugar monitoring and urine for albumin improved at the end of the audit cycle. In the only outcome criteria, the blood sugar control improved from 21.8% to 31.3%.
    Matched MeSH terms: Delivery of Health Care
  7. Mohd-Tahir NA, Paraidathathu T, Li SC
    SAGE Open Med, 2015;3:2050312115596864.
    PMID: 26770795 DOI: 10.1177/2050312115596864
    Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients' demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.
    Matched MeSH terms: Delivery of Health Care
  8. Goh AY, Lum LC, Chan PW
    J Trop Pediatr, 1999 Dec;45(6):362-4.
    PMID: 10667007
    Paediatric intensive care in Malaysia is a developing subspecialty with an increasing number of specialists with a paediatric background being involved in the care of critically ill children. A part prospective and part retrospective review of 118 consecutive non-neonatal ventilated patients in University Hospital, Kuala Lumpur was carried out from 1 June 1995 to 31 December 1996 to study the clinical epidemiology and outcome in our paediatric intensive case unit (PICU). The mean age of the patients was 33.9 +/- 6.0 months (median 16 months). The main mode of admission was emergency (96.6 per cent) with an overall mortality rate of 42 per cent (50/118). The mean paediatric risk of mortality (PRISM) score was 20 +/- 0.98 SEM, with 53 per cent of patients having a score of over 30 per cent. Multiorgan dysfunction (MODS) was identified in 71 per cent of patients. Admission efficiency (mortality risk > 1 per cent) was 97 per cent. Standardized mortality rate using PRISM was an acceptable 1.06. The main diagnostic categories were respiratory (32 per cent), neurology (22 per cent), haematology-oncology (18 per cent); the aetiology of dysfunction was mainly infective. Non-survivors were older (29.5 vs. 13.8 months, p < 0.0001), had more severe illness (mean PRISM score 30 vs. 14, p < 0.0001), were more likely to develop MODS (96 vs. 53 per cent, p < 0.0001) and required more intervention and monitoring. Paediatric intensive care in Malaysia differs widely from that in developed countries in patient characteristics, severity of illness, and care modalities provided.
    Matched MeSH terms: Delivery of Health Care
  9. Abidi SS
    PMID: 10724989
    The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.
    Matched MeSH terms: Delivery of Health Care
  10. Reprowatch, 1999 May;19(3-4):4.
    PMID: 12322208
    Matched MeSH terms: Delivery of Health Care
  11. Chaing HS, Merino-chavez G, Yang LL, Wang FN, Hafez ES
    Adv Contracept Deliv Syst, 1994;10(3-4):355-63.
    PMID: 12287843
    Matched MeSH terms: Delivery of Health Care
  12. Chan Onn Fong, Kim KW, Ness GD
    PMID: 12338570
    PIP:
    Results are presented of research undertaken in the Republic of Korea and Malaysia to determine how far integration affects the performance of family planning and allied programs and to identify organizational determinants of clinic level interactive linkages. The report discusses the background of the research, provides overviews of the country programs, outlines research methodologies and procedures, and presents findings. 41 clinics with high, medium, and low performance ratings in Korea and 17 main health centers, 31 sub-health centers, and 49 midwife stations in Malaysia, (some of them intensive input demonstration areas) were assessed on performance, interaction measures, and organizational determinants. The overall finding was that integration affects program performance, but the direction of the impact depends on how the integrated programs are organized. In Malaysia, where the program is specifically organized to integrate family planning with maternal and child health, the integration appears to have increased service delivery and resulted in larger numbers of family planning acceptors. No spill-over was found from the inputs of the 2 components to each other. The overall positive impact and lack of service reduction due to integration appears to result from specific planning for a limited degree of integration. In Korea, a mild negative relationship was found between clinic level performance in the family planning and community development, or Saemaul Undong (SU) components. In the field SU was observed to be more favored and powerful, and was not fully integrated with family planning. The major conclusion of the study was that integration works best when family planning is linked to similar services, and does not work as well with services that are different in character or in degree of government support.
    Matched MeSH terms: Delivery of Health Care
  13. Osteria TS
    PMID: 12269204
    "This paper examines recent trends in urbanization in four selected ASEAN countries--Indonesia, Malaysia, the Philippines and Thailand--giving particular attention to the scale and pace of urbanization, the unique features of urban communities, and the health changes and adjustments that accompany urban development in these countries."
    Matched MeSH terms: Delivery of Health Care
  14. Malaysia. High Court
    Annu Rev Popul Law, 1987;14:39.
    PMID: 12346715
    The defendant, an obstetrician and gynaecologist, was accused of voluntarily causing a woman to miscarry, such miscarriage having been performed without good faith and an intention to save the woman's life. The Court upheld the conviction of the defendant, rejecting his argument, supported by an expert witness, that he had performed the abortion in order to avoid the possibility of pulmonary embolism, which might result because the woman had enlarged varicose veins. It held that the argument was not reasonable under the current law and that procuring an abortion was a serious matter to be done only as a last resort to save the life of a woman or to save her from becoming a mental "wreck."
    Matched MeSH terms: Delivery of Health Care
  15. Bul Keluarga, 1979 Jul-Aug;97:4-5, 8.
    PMID: 12261448
    PIP: On August 15, 1978, the integrated parasite control/family planning program was launched by the National Family Planning Board in the Tanjong Malim Estate in Kuala Lumpur (the estate is a rubber oil palm plantation) to enhance the health status of the estate workers and their families. Personal hygiene, good toilet habits, and washing fruits and vegetables before eating were emphasized. Pre- and post-surveys of worm infestation of the estate population revealed that treatment with drugs dramatically reduced the rate of intestinal helminthiasis infection among the population. To sustain the prevention or total eradication of the disease, an ongoing educational program was initiated and included the following features: 1) increasing knowledge of the community as to how intestinal helminthiasis is transmitted, and ways of limiting transmission; 2) providing safe and sanitary toilet facilities for young children, and; 3) periodic deworming of susceptible population every 3 months. The estate members are also encouraged to plant vegetables in their backyard. The National Family Planning Board also helped the estate members organize different functional groups, such as Mothers' Group. This multifaceted approach to family planning appears to have an encouraging future, particularly in family development.
    Matched MeSH terms: Delivery of Health Care
  16. Palafox B, Seguin ML, McKee M, Dans AL, Yusoff K, Candari CJ, et al.
    BMJ Open, 2018 07 30;8(7):e024000.
    PMID: 30061449 DOI: 10.1136/bmjopen-2018-024000
    INTRODUCTION: Hypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients' sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts.

    METHODS AND ANALYSIS: The study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24-30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20-25 participants per community 12-18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers).

    ETHICS AND DISSEMINATION: Ethical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and 'digital stories' coproduced with research participants.

    Matched MeSH terms: Delivery of Health Care
  17. Natalia Che Ishak, Hayati Kadir Shahar, Rosliza Abdul Manaf
    MyJurnal
    Introduction: HIV-related stigma refers to prejudice, negative attitudes and abuse directed at people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. This study was designed to examine drivers of HIV-related stigma among healthcare workers in health clinics in Hulu Langat, Selangor. Methods: This is a sin-gle-blinded, cluster randomised controlled trial (parallel groups). A total of 158 participants from the intervention group and 158 participants from the control group were randomised via balloting process at the cluster (clinic) level. A comprehensive self-administered questionnaire based on the stigma index tool was used. Data were analysed using IBM SPSS version 25 involving descriptive and bivariate analyses. The baseline results were analysed using the chi-square test and Mann-Whitney U test. Results: The response rate for the intervention group was 83.5% and 81.6% for the control group (82.3% combined response rate). Majority of the respondent’s age between 30 – 39 years old, female, nurses, have experience working with PLHIV and worked for 0 – 9 years in the healthcare setting. Comparison of total infection concern score (p = 0.001) and total willingness to treat key populations (KPs) score (p = 0.025) between intervention and control group at baseline were significant. However, comparison of total opinion/perception about PLHIV score, total knowledge about HIV score, total intention to stigmatise score and total health facility policies and guidelines score between intervention and control group at baseline showed no significant dif-ference. Conclusion: The significant difference between groups on certain scores above might be due to different job category between the two groups thus influence how willing they are in treating PLHIV. These findings may assist stigma reduction intervention programmes targeting healthcare providers in Hulu Langat, Selangor and ensure quality care for PLHIV.
    Matched MeSH terms: Delivery of Health Care
  18. Waqas A, Teoh SH, Lapão LV, Messina LA, Correia JC
    J Med Internet Res, 2020 10 02;22(10):e18835.
    PMID: 33006571 DOI: 10.2196/18835
    BACKGROUND: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning.

    OBJECTIVE: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required.

    METHODS: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field.

    RESULTS: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics.

    CONCLUSIONS: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era.

    Matched MeSH terms: Delivery of Health Care
  19. Munusamy T, Karuppiah R, Bahuri NFA, Sockalingam S, Cham CY, Waran V
    World Neurosurg, 2021 01;145:e53-e60.
    PMID: 32956888 DOI: 10.1016/j.wneu.2020.09.076
    OBJECTIVE: The coronavirus disease 2019 pandemic poses major risks to health care workers in neurocritical care. Recommendations are in place to limit medical personnel attending to the neurosurgical patient as a protective measure and to conserve personal protective equipment. However, the complexity of the neurosurgical patient proves to be a challenge and an opportunity for innovation. The goal of our study was to determine if telemedicine delivered through smart glasses was feasible and effective in an alternative method of conducting ward round on neurocritical care patients during the pandemic.

    METHODS: A random pair of neurosurgery resident and specialist conducted consecutive virtual and physical ward rounds on neurocritical patients. A virtual ward round was first conducted remotely by a specialist who received real-time audiovisual information from a resident wearing smart glasses integrated with telemedicine. Subsequently, a physical ward round was performed together by the resident and specialist on the same patient. The management plans of both ward rounds were compared, and the intrarater reliability was measured. On study completion a qualitative survey was performed.

    RESULTS: Ten paired ward rounds were performed on 103 neurocritical care patients with excellent overall intrarater reliability. Nine out of 10 showed good to excellent internal consistency, and 1 showed acceptable internal consistency. Qualitative analysis indicated wide user acceptance and high satisfaction rate with the alternative method.

    CONCLUSIONS: Virtual ward rounds using telemedicine via smart glasses on neurosurgical patients in critical care were feasible, effective, and widely accepted as an alternative to physical ward rounds during the coronavirus disease 2019 pandemic.

    Matched MeSH terms: Delivery of Health Care
  20. Shrestha N, Shad MY, Ulvi O, Khan MH, Karamehic-Muratovic A, Nguyen UDT, et al.
    One Health, 2020 Dec 20;11:100180.
    PMID: 33072836 DOI: 10.1016/j.onehlt.2020.100180
    Globalization has altered the way we live and earn a livelihood. Consequently, trade and travel have been recognized as significant determinants of the spread of disease. Additionally, the rise in urbanization and the closer integration of the world economy have facilitated global interconnectedness. Therefore, globalization has emerged as an essential mechanism of disease transmission. This paper aims to examine the potential impact of COVID-19 on globalization and global health in terms of mobility, trade, travel, and countries most impacted. The effect of globalization were operationalized in terms of mobility, economy, and healthcare systems. The mobility of individuals and its magnitude was assessed using airline and seaport trade data and travel information. The economic impact was measured based on the workforce, event cancellations, food and agriculture, academic institutions, and supply chain. The healthcare capacity was assessed by considering healthcare system indicators and preparedness of countries. Utilizing a technique for order of preference by similarity to ideal solution (TOPSIS), we calculated a pandemic vulnerability index (PVI) by creating a quantitative measure of the potential global health. The pandemic has placed an unprecedented burden on the world economy, healthcare, and globalization through travel, events cancellation, employment workforce, food chain, academia, and healthcare capacity. Based on PVI results, certain countries were more vulnerable than others. In Africa, more vulnerable countries included South Africa and Egypt; in Europe, they were Russia, Germany, and Italy; in Asia and Oceania, they were India, Iran, Pakistan, Saudi Arabia, and Turkey; and for the Americas, they were Brazil, USA, Chile, Mexico, and Peru. The impact on mobility, economy, and healthcare systems has only started to manifest. The findings of this study may help in the planning and implementation of strategies at the country level to help ease this emerging burden.
    Matched MeSH terms: Delivery of Health Care
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