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Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic placed enormous pressure on healthcare systems around the world, but it also provided valuable insights for healthcare organizations during this challenging period. Objective: This study aimed to explore nurses' lived experiences of vulnerability in hospital nursing management during the COVID-19 pandemic, and reflect on the lessons learned. Methods: In this phenomenological study, 14 participants, including nurse managers at different levels and staff nurses, were selected by purposive sampling from one center university hospital. Data collection was done through in-depth individual semistructured interviews with participants and a review of weekly reports of crisis management meetings at the university hospital. Interviews were analyzed using Colaizzi's method in seven phases by MAXQDA software Version 10. Results: One overarching theme, four themes, and 15 subthemes were obtained from analyses of interviews. Four themes of "nurses' attrition," "distrust of society to the organization," "fragility in the organization's performance," and "intensified inequalities" were extracted as threats to nursing management at the hospital. Subsequently, the weekly reports of crisis management meetings at the university hospital were analyzed to extract the solutions and lessons. Conclusion: The unpreparedness of the healthcare system against a crisis can led to the loss of organizational assets, including medical staff and the credibility of the healthcare system. Limitations of the infrastructure at hospital became more obvious during the pandemic and caused serious threats to the healthcare system. Despite severe challenges along with the pandemic, it offered four valuable lessons in nursing management. [ABSTRACT FROM AUTHOR]

Rationale: Though it is crucial to contribute to patient recovery through access, diversity, continuity and regularity of outpatient care, still today most of these are deemed nonoptimal. Identifying patient profiles based on outpatient service use and quality of care indicators might help formulate more personalized interventions and reduce adverse outcomes. Aims and Objectives: This study aimed to identify profiles of individuals with mental disorders (MDs) patterned after their outpatient care use and quality of care received, and to link those profiles to individual characteristics and subsequent outcomes. Methods: A cohort of 5669 individuals with MDs was considered based on data from the 2013–2014 and 2015–2016 Canadian Community Health Survey, which were linked to administrative data from the Quebec health insurance registry. Latent class analysis generated profiles based on service use over the 12 months preceding each respondent's interview, and comparative analyses were used to associate profiles with sociodemographic and clinical characteristics, and health outcomes over the three following months. Results: Four profiles were identified. Profile 1 (P‐1) was labelled 'Low service use'; P‐2 'Moderate general practitioner (GP) care and continuity and regularity of care'; P‐3 'High GP care, continuity and regularity of care, and low psychiatrist care'; and P‐4 'High psychiatrist care and regularity of care, and low GP care'. Profiles 3 and 4 (~50% of the cohort) were provided with better care, but showed worse outcomes, mainly acute care use due to more complex conditions and unmet needs. Profiles 1 and 2 had better outcomes as they showed fewer risk factors such as being younger and having better social conditions. Conclusion: Intensity, diversity and regularity of care were higher in profiles with more complex MDs, chronic physical illnesses, and worse perceived health conditions. Adapting specific interventions for each profile, such as assertive community treatment or intensive case management for Profile 4, is recommended. [ABSTRACT FROM AUTHOR]

Introduction: This study reports our experiences with systematic retinal screening in Denmark through optometrists with access to tele-ophthalmological services before, during, and after the COVID-19 pandemic. Methods: We evaluated an optometrist-based retinal screening system with a referral option for tele-ophthalmological service by a consultant ophthalmologist within the time period of August 1, 2018 to September 30, 2023. The optometrist collected patient history, refraction, best-corrected visual acuity, intraocular pressure, basic slit-lamp examination, 4-in-1 visual field report, and retinal imaging using color fundus 45° photography. Tele-ophthalmological services were provided by consultant ophthalmologists. Within pre-defined periods of pre-COVID-19, COVID-19, and post-COVID-19, we evaluated the rate of referrals to the tele-ophthalmological service, diagnoses made, and referrals to the public healthcare system. Results: A total of 1,142,028 unique individuals, which corresponded to 19.1% of the entire population of Denmark, underwent screening by the optometrists; 50,612 (4.4%) of these individuals were referred to the tele-ophthalmological examination by consultant ophthalmologists. A referral for further ophthalmic examination, either at hospital or at an ophthalmic practice, was made for 10,300 individuals (20.4% of those referred for tele-ophthalmology, corresponding to 0.9% of the population screened). The referral rate from the screening to the tele-ophthalmological service increased from before COVID-19 (3.4%) to during COVID-19 (4.3%) and further after COVID-19 (6.4%). This increase coincided with an increasing prevalence of conditions seen in the tele-ophthalmological service. Conclusion: During a period of 5 years, 19.1% of the entire population of Denmark underwent retinal screening. This provided an adjunctive health service during a period of severe strain on the public healthcare system, while limiting the number of excessive referrals to the public healthcare system. Temporal trends illustrated an increased pattern of use of a large-scale tele-ophthalmological system. [ABSTRACT FROM AUTHOR]

Introduction. The article presents a comparison of simulation models for financing an inpatient emergency department and a therapeutic department using the example of an emergency therapeutic flow of patients.The objective was to analyze the economic aspects in an inpatient emergency department for the treatment of emergency therapeutic conditions such as hypertension.Methods and materials. Based on a retrospective analysis of the flow of incoming patients for emergency and urgent indications, a simulation model of the load and economic calculations of the work of the inpatient emergency department was developed.Results. According to the results of the study, it was revealed that with a three-fold increase in the flow of patients entering the department, the inpatient emergency department copes with this flow more effectively in comparison with the therapeutic one. Despite this funding, the medical institution receives significantly less.Conclusion. Based on the study, the need to create a special tariff plan for the work of such units as the inpatient emergency department was identified, because the capacity in this department is many times greater.

Abstract Introduction This study reports our experiences with systematic retinal screening in Denmark through optometrists with access to tele-ophthalmological services before, during, and after the COVID-19 pandemic. Methods We evaluated an optometrist-based retinal screening system with a referral option for tele-ophthalmological service by a consultant ophthalmologist within the time period of August 1, 2018 to September 30, 2023. The optometrist collected patient history, refraction, best-corrected visual acuity, intraocular pressure, basic slit-lamp examination, 4-in-1 visual field report, and retinal imaging using color fundus 45° photography. Tele-ophthalmological services were provided by consultant ophthalmologists. Within pre-defined periods of pre-COVID-19, COVID-19, and post-COVID-19, we evaluated the rate of referrals to the tele-ophthalmological service, diagnoses made, and referrals to the public healthcare system. Results A total of 1,142,028 unique individuals, which corresponded to 19.1% of the entire population of Denmark, underwent screening by the optometrists; 50,612 (4.4%) of these individuals were referred to the tele-ophthalmological examination by consultant ophthalmologists. A referral for further ophthalmic examination, either at hospital or at an ophthalmic practice, was made for 10,300 individuals (20.4% of those referred for tele-ophthalmology, corresponding to 0.9% of the population screened). The referral rate from the screening to the tele-ophthalmological service increased from before COVID-19 (3.4%) to during COVID-19 (4.3%) and further after COVID-19 (6.4%). This increase coincided with an increasing prevalence of conditions seen in the tele-ophthalmological service. Conclusion During a period of 5 years, 19.1% of the entire population of Denmark underwent retinal screening. This provided an adjunctive health service during a period of severe strain on the public healthcare system, while limiting the number of excessive referrals to the public healthcare system. Temporal trends illustrated an increased pattern of use of a large-scale tele-ophthalmological system.

Background. The severe course of parenteral viral hepatitis and their further chronicity are associated with the presence of immunodeficiency disorders, frequency of which increases significantly in harsh climate. The article discusses the spread of parenteral viral hepatitis in the Arctic zone of the Republic of Sakha (Yakutia) and the issues of organizing medical care for patients with chronic viral hepatitis at the regional level.The aim of the study. To analyze the incidence rates of parenteral viral hepatitis in the Arctic regions of Yakutia in order to improve the health care system using the example of remote areas of hard access.Methods. The work uses materials from official statistics of the territorial department of Rospotrebnadzor for the Republic of Sakha (Yakutia) for 2000–2022 and information from the “Chronic viral hepatitis in the Republic of Sakha (Yakutia)” register. Results. In the Arctic regions of Yakutia, problems are observed in chronic forms of viral hepatitis B, C and D, as well as in their outcomes, such as cirrhosis and liver cancer, leading to early disability and mortality. In the general structure, hepatitis B infection prevails, which indicates the presence of family foci of infection. All this requires a complex of not only therapeutic, but also advanced anti-epidemiological measures.Conclusion. The difficult epidemiological situation regarding parenteral viral hepatitis, caused by extreme natural and climatic conditions, genetic characteristics of the indigenous population and the lack of medical institutions specializing in the treatment of chronic viral hepatitis, dictates the need to strengthen systematic on-site monitoring studies and telemedicine consultations in the Arctic zone of Yakutia. Thanks to this, residents of hard-to-reach areas of the Arctic zone of the Republic of Sakha (Yakutia) will be able to receive targeted subsidized care for the treatment of chronic hepatitis without traveling to Yakutsk.

Background Students of medical universities, future employees, will have an impact on the shaping healthcare system. It is important to know and understand their opinions on the factors affecting working conditions and, consequently, changes necessary to improve effectiveness of health care. Students’ expectations can contribute to the changing working conditions for graduates and bring added value to health system redefinition. Material and Methods The study used factor analysis to check whether its use was justified. Reliability analysis was performed and structure indicators were determined for each question. The anonymous survey was conducted from September 2017 until March 2018; 1205 students were randomly selected for the sample. Results Eighty percent of the students declared interest in healthcare changes, >50% reported that the main factors influencing the work were competencies, financing, medical equipment and organization. Over 90% of the respondents indicated too long wait times for an appointment with a specialist and admission to hospital as the reason for the low efficiency of healthcare, whereas >80% of the survey participants considered insufficient funding to be a barrier. The need for changing the financing scheme was underlined by >90% of the students, and of health priorities by about 80%. Approximately 71% of the respondents were in favour of limiting the role of government in decision-making processes and introducing changes into the education system. Conclusions Students’ views on organizational and financial factors of working conditions can contribute to improvement in systemic solutions at both micro and macro levels. Limiting the role of politicians in planning and implementing reforms can motivate employees to be more creative and decisive. Analysis of opinions can bring added value to health policy and systemic changes and should be extended by further research results after the COVID-19 pandemic. Students’ interest in healthcare reform encourages reflection on enriching education with managerial skills. Med Pr Work Health Saf. 2024;75(4):321–332

OBJECTIVES: This study aimed to assess the associations of pre-pandemic perceived work stressors and work satisfaction among nurses, including nurse assistants, with burnout profiles and their transitions in response to the pandemic. METHODS: Three hundred and thirty-seven nurses working in an Italian University hospital participated in a longitudinal study including a survey in August 2019 investigating perceived work stressors (assessed using the HSE Indicator Tool), work satisfaction (Work Satisfaction Scale), and burnout (Maslach Burnout Inventory), and a second survey in December 2020 assessing burnout. Using latent transition analysis, we identified burnout profiles and then estimated the associations between work stressors and satisfaction on profiles and transitions. RESULTS: We identified three pre-pandemic profiles, namely engaged (67%), ineffective (15%), and burnout (18%); and three pandemic profiles, namely engaged (37%), exhausted (51%), and severe burnout (12%). The severe burnout profile consisted of 70% nurses classified in the burnout profile before the pandemic. Overall, work stressors and satisfaction were associated with both pre-pandemic and pandemic burnout profiles. Among nurses not in the burnout profile prior to COVID-19, pre-pandemic hostile relationships increased [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05–1.34] and work satisfaction decreased (OR 0.82, 95% CI 0.68–0.98) the probability to transition to exhausted. Moreover, work satisfaction (OR 0.54, 95% CI 0.32–0.91) and participation in work organization (OR 0.69, 95% CI 0.51–0.93) protected from transitioning to severe burnout. The association between peer support and the transition to exhausted needs further investigation. CONCLUSIONS: Pre-pandemic work stressors and satisfaction were associated with pandemic burnout and burnout transitions. To enhance preparedness for future crises, healthcare managers should carefully assess and tackle work-related constraints affecting nurses.

The study investigates the direct influence of Institutional Pressures (IP) and Dynamic Managerial Capability (DMC) on digital readiness (DR), and the subsequent impact on strategic renewal (SR) within private hospitals in Indonesia. Utilizing a quantitative approach and a cross-sectional research design, 231 valid responses were analyzed using smart partial least squares (PLS) for structural equation modeling (SEM). The findings reveal that institutional pressure directly affects digital readiness, emphasizing the critical role of DMC in mediating the relationship between institutional pressure and digital readiness. Furthermore, the study highlights the strong connection between digital readiness and strategic renewal, underscoring the organization’s capability for digital transformation. The originality of this study lies in its exploration of the interplay between institutional pressures, dynamic managerial capabilities (DMC), and digital readiness (DR) in shaping strategic renewal within private hospitals in Indonesia. By examining how institutional pressures influence DR and the mediating role of DMC, this research uniquely contributes to the understanding of digital transformation challenges in healthcare, offering valuable insights for organizations seeking to enhance their strategic responses in facing digital disruptions.

Purpose: The aim of the article is to draw the relationship between organizational agility and the innovation process in healthcare organizations and to examine the mediating role of job satisfaction in this relationship. Methodology: The quantitative study was conducted on a research sample determined using the convenience sampling method, consisting of 470 nurses managers working in healthcare organizations in Turkey. For statistical analysis of the data, we used the PLS-SEM approach to analyse the data, testing the hypotheses of current study. Findings: Nursing managers play an important role in the mechanism of shaping an innovative work environment based on organizational agility. Organizational agility contributes to innovation in healthcare organizations. Job satisfaction is one of the factors influencing this relationship, therefore organizations should strive to increase it. Research limitations: The survey was limited to health care nursing managers in Turkey. Although the number of responses is high (n = 470), limiting the sample to a specific geographical region may hinder generalisations. Therefore, future research could include nurse managers from other countries. Practical implications: The empirical results of the current study confirm the research model developed. The results provide guidance for healthcare managers. Through to this study, attention has been drawn to the need to develop all determinants of organizational agility and employee satisfaction in order to foster innovation in healthcare organizations. Originality/value: Nursing managers should develop the competences and knowledge necessary for organizational agility. Proper formulation of challenges and tasks (for managers and for nurses’ teams), in line with Expectation States Theory (EST), will increase job satisfaction and have a positive impact on the innovation process. [ABSTRACT FROM AUTHOR]

This study systematically investigated the extent and application of sustainability practices in the healthcare system by thoroughly examining existing research conducted on healthcare-related issues within the framework of sustainability. The review primarily focuses on three key conceptual aspects: the social, economic, and ecological dimensions of sustainability. PLS-SEM (partial least squares structural equation modeling) and MGA (multigroup analysis) for private and state healthcare organizations were applied in the study. The results show that there exists a robust positive relationship between the environmental dimension and the social dimension of health organizations' outcomes, and the environmental dimension of the sustainability of healthcare organizations achieves a positive relationship with the economic dimension, while this relatedness is absent in the case of private healthcare organizations, for two perspectives: internal processes and learning. Moreover, the social dimension is identified as a factor that strengthens the impact of the environmental dimension on the economic dimension of health organizations' outcomes. The results can be used in the development of policies and regulations, and for defining the strategies of healthcare organizations. [ABSTRACT FROM AUTHOR]

Copyright of Social Sciences Studies is the property of Social Sciences Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Social Sciences Research / Sosyal Bilimler Arastirmalari Dergisi is the property of ODU Journal of Social Sciences Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundA total of 7,307 Ukrainian refugees moved to Antwerp, Belgium, during the study period (01 April 2022 to 31 December 2022). The city’s administration set up three care centers where these people were introduced to the Belgian primary care system, a medical file was created, and acute/preventive/chronic care was delivered. This community case study analyzes the organization and contents of care and reflects upon its meaning for the mainstream healthcare system.MethodsThis is an observational study using routine electronic medical record data to measure the uptake of care. For a sample of 200 subjects, a retrospective chart review was conducted.ParticipantsAll refugees with a medical file at one of the three participating care centers were included.Main outcomesFor the observational study, 2,261 patients were reached (30% of the potential users), and 6,450 contacts were studied. The nurses (including midwives) conducted 4,929 out of 6,450 (76%) of all consultations, while the general practitioners (GPs) conducted 1,521 out of 6,450 (24%). Of the nurse consultations, 955 (19%) were followed by another nurse consultation and 866 (18%) by a GP consultation. In the structured case reviews, most contacts were concerned with acute problems (609 out of 1,074, 57%). The most prevalent reasons for encounters and diagnoses were typical primary care issues. The nurses were able to manage half of the cases independently (327, 55%), referred 37% (217) of cases to the GP, and consulted a GP (live, by telephone, or a dedicated app) for 8% (48) of cases. GPs mostly prescribed drugs, referred to a medical specialist, and advised over-the-counter drugs, while nurses more often advised over-the-counter drugs (mostly paracetamol, nose sprays, and anti-inflammatory drugs), provided non-medical advice, or ordered laboratory tests.DiscussionThe medical care points delivered mostly typical acute primary care in this first phase, with a key role for nurses. The care points did not sufficiently take up chronic diseases and mental health problems. These results will inform policymakers on the use of primary care centers for newly arriving patients in times of a large influx. A nurse-first model seems feasible and efficient, but evaluation of safety and quality of care is needed. Once the acute phase of this crisis fades away, questions about the comprehensiveness, continuity, and integration of care for migrants remain relevant.

Background Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic.Methods To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and real-life initiatives; (2) RPM; and (3) care integration.Results 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring (TM) devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives.Conclusion RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.

Introduction. The relevance of conducting this study is determined by the necessity to create organizational conditions and optimize the clinical-diagnostic aspect of medical care for patients with traumatic brain injury (TBI) and acute stroke. This aims to improve patients' quality of life by enhancing the effectiveness of medical care provision in Ukraine. This improvement is based on identifying the causes and analyzing deficiencies in medical care for these conditions. The aim of the research is to investigate the specificity of deficiencies in providing medical care to patients with isolated traumatic brain injury and acute hemorrhagic stroke due to the rupture of cerebral arterial aneurysms based on a retrospective analysis of medical documentation, as well as the results of patient treatment in cases of discrepancies between clinical and forensic diagnoses concerning the primary, concomitant diseases, and their complications. Materials and methods. Clinical assessment of the results of providing care to patients with traumatic brain injury and stroke was conducted through a retrospective analysis of medical documentation of patients who were hospitalized with these pathologies. The applied methods include clinical and laboratory investigations of homeostasis and metabolism parameters, and instrumental techniques. Results. In the identified influence of the timing of the operation (within the first few days) and the breakthrough of blood in the subarachnoid space of the brain, including with intracranial hemorrhage as a result of a re-rupture of a cerebral arterial aneurysm, on the risk of lethal outcomes of surgical treatment, a rationale for searching ways to optimize therapeutic tactics in this category of patients was provided. This includes identifying defects and shortcomings in the organizational aspect of medical care. Conclusions. Based on the analysis and identification of the most informative factors influencing the results of surgical treatment of cerebral aneurysms, a prediction system has been developed that allows calculating the probability of its outcome. The application of the forecast is advisable to consider in the prevention and timely detection of possible deficiencies in providing medical care to patients with stroke.

The article presents a review in the form of theoretical knowledge and critical understanding of cognitive premises, value formations and ideas about law, conceptualized in the chapter "Ethical and legal foundations of medical triage standards in the Russian military medical service" in the book "Lack of resources in an unfavorable environment: an ethical study principles of medical triage and procedures for providing medical care", published in 2023 by the Springer publishing house (Switzerland). The authors note that the reviewed chapter of the monograph is of theoretical, empirical and practical interest for researchers in healthcare organization, including in conditions of armed (military conflicts), philosophers, lawyers, as well as medical and legal students. This interest is due to the fact that the author of the chapter under review successfully managed to describe, justify and reveal the substantive characteristics of the ethical and legal foundations of medical triage in the activities of the Russian military medical service. Cognitive, legal, informational, value and prognostic aspects are the obvious advantages of the chapter under review, which will contribute to its popularization among readers.

Introduction and aimsThe organization of healthcare pathways for neurodevelopmental disorders (NDD) relies on different levels of expertise depending on the complexity of these disorders. NDDs affect between 8% and 15% of children. Historically, national recommendations and healthcare planning measures were initially devoted to autism spectrum disorders and were gradually extended to Attention deficit hyperactivity disorder (ADHD) and specific learning and development disorders. Private doctors play an increasing role in these pathways at different levels of care due to difficulties in organization, particularly in the health and social sector. The aim of this work was to evaluate the contribution of second-line private doctors in the diagnosis and care of children affected by NDD.MethodsA first series of surveys in 2016 evaluated the level of commitment of primary care pediatricians; this online national survey was repeated in 2023 among 1,430 members of the French Association of Ambulatory Pediatrics (Association Française de Pédiatrie Ambulatoire: AFPA) to assess their training, current and future involvement, and activity in NDD care. Analysis was performed by the main author using Epi-Info software.ResultsThe study identified in 2023 214 second-line private doctors (14% of all pediatricians in activity), of which 185 agreed to appear in a directory published the same year by the AFPA to facilitate referrals from other professionals. Sex ratio of responders is usual for paediatricians: 79.5%/20.5% (F/M), with a distribution among ages showing a slight increase of the age range between age 51–60 (30.5%). Our data indicate that in France in 2022, second-line private doctors made 48%–53% of NDD diagnoses, 24%–26.4% of follow-up consultations and declare to be accountable for 21% of initial prescriptions for Methylphenidate. Among these second-line doctors, 40% had completed a post-university degree on NDD, 74.3% had completed professional development training (PDT) and 85.2% had completed either or both types of training. Most doctors participating in the survey wanted to improve their level of practice, suggesting that in five years, the number of second-line private doctors will increase by 20% to 244 despite 24 planned retirements within the same period. This data probably underestimates the role of private doctors in NDD diagnosis, follow-up, and initial Methylphenidate prescriptions given the unfavourable working conditions (no financial compensation for long appointments, difficulty accessing paramedical and psychological assessments).ConclusionsOur data confirms that diagnosis and care coordination in the various presentations of NDD may rely on different types of practices and specializations: medical and social professionals, mental health professionals, but also a growing body of medical doctors involved in developmental and behavioural pediatrics. This data and reflection will be helpful for organizing healthcare in France or in other countries. Main study limitation relies in the self-declaration of MD's involvement in NDD and could not evaluate the activity of employed MD's from the social and medico social sector, nor be based on the national databases for prescription. It remains however the first attempt of characterization of medical activity at the national level in France for NDD.

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years. Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17‑18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied. Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012). Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

The COVID-19 pandemic had a serious impact on global health and showed that the current state of most health systems in the world was not ready for such an emergency. During the pandemic, the provision of specialized planned medical care to patients with chronic diseases was suspended, and therefore telemedicine technologies for remote monitoring of patients began to be actively used in many countries of the world. In the Russian Federation, leading experts have issued organizational and methodological recommendations for the management of patients with diabetes and other chronic diseases during the COVID-19 pandemic. The measures taken by the government to provide medicines and prevent COVID-19 infection have allowed many patients with diabetes to observe a self-isolation regime. Meanwhile, there are data on the negative impact of self-isolation on the general condition of patients for various reasons: a decrease in the level of self-control and physical activity, a reduction in the volume of planned specialized medical care. Telemedicine technologies in the Russian Federation have been successfully used for remote monitoring of patients with mild and moderate severity of COVID-19. Currently, the widespread use of telemedicine and modern digital technologies, which proved their effectiveness during the pandemic in the treatment and control of diabetes, has not yet reached an optimal level. This review examines the possibilities of using telemedicine technologies for patients with diabetes, analyzes the experience of foreign countries and the Russian Federation in managing patients with diabetes during a pandemic, and analyzes the effectiveness of management measures to provide medical care to patients with diabetes.

Background: Organizational climate is a set of characteristics which describes an organization, distinguishes it from other organizations, and influences the behavior of people in the organization. Organizational health is also the ability of the organization to maintain survival and compromise with the environment and improve the status of the organization. Therefore, the current research was conducted to determine the predictability of organizational health regarding Kermanshah University of Medical Sciences through organizational climate dimensions. Methods: The current cross-sectional study was conducted in 2019. The statistical population of this descriptive correlational research included all the employees (n = 1337) of the eight deputies and the management of Kermanshah University of Medical Sciences, 299 of whom were selected as the research sample by stratified random sampling method using Cochran’s formula. Data were collected by two standard questionnaires, Organizational Climate Questionnaire by Halpin and Croft (1963) and Organizational Health Questionnaire by Hoy and Fedman (1987). Data were analyzed by SPSS 22 and Smart PLS 3 software using Pearson correlation coefficient test and regression analysis. Results: The mean score of organizational climate (101.9 ± 13.006) of Kermanshah University of Medical Sciences was at a moderate to high level, and the mean score of organizational health (131.4 ± 18.51) was at a normal level. The results of the correlation test showed that all the components of organizational climate, except team work spirit, had a positive and significant correlation with organizational health (r = 0.56 and p < 0.01). In addition, the results of the regression analysis showed that organizational climate predicted and explained 0.56 of the variance created in organizational health (p < 0.05). Conclusion: The results indicated a positive and significant relationship between organizational climate and organizational health of Kermanshah University of Medical Sciences. Therefore, improving the positive organizational climate dimensions will promote organizational health.

Objectives: Corruption means abusing the position and power delegated for personal gain, which undermines the performance of the organization and the quality of services provided to patients. The aim of this study was to identify and extract internal and external anti-corruption strategies in healthcare organizations. Information sources and selected methods for study: This scoping review was performed on the published documents (57 items) until September 5, 2020. Search was conducted in English databases including PubMed, Web of Sciences and Scopus and also in Persian ones including SID and Magiran. There was also a manual search for anti-corruption strategies in relevant international organizations. Qualitative data were analyzed thematically using MaxQDA 10 software. Results: 57 studies and reports were selected to find strategies to fight corruption. The three main areas of solutions were identified as executive, legislative and judiciary powers. 16 strategies were extracted in the fields of executive (7 cases), legislative (5 cases) and judiciary (4 cases). Solutions regarding the Ministry of Health were categorized into 6 building blocks of health systems, including leadership / governance, service delivery, financing, health workforce, medical products, vaccines, technology, and the health information system. Conclusion: Fighting corruption in healthcare organizations requires using a set of intra-sectoral and extra-sectoral solutions, and in this regard, policy-makers need to design and implement practical strategies based on the evidence presented in areas prone to corruption.

Copyright of Management international / International Management / Gestiòn Internacional is the property of Management International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study systematically investigated the extent and application of sustainability practices in the healthcare system by thoroughly examining existing research conducted on healthcare-related issues within the framework of sustainability. The review primarily focuses on three key conceptual aspects: the social, economic, and ecological dimensions of sustainability. PLS-SEM (partial least squares structural equation modeling) and MGA (multigroup analysis) for private and state healthcare organizations were applied in the study. The results show that there exists a robust positive relationship between the environmental dimension and the social dimension of health organizations’ outcomes, and the environmental dimension of the sustainability of healthcare organizations achieves a positive relationship with the economic dimension, while this relatedness is absent in the case of private healthcare organizations, for two perspectives: internal processes and learning. Moreover, the social dimension is identified as a factor that strengthens the impact of the environmental dimension on the economic dimension of health organizations’ outcomes. The results can be used in the development of policies and regulations, and for defining the strategies of healthcare organizations.

The managers of healthcare organizations need the information to confront COVID-19. The aim of this research is to analyze the role of the management accounting system of Iranian healthcare organizations in the management of COVID-19 including diagnosis, prevention, and treatment via a survey on multi-level management. The statistical population consisted of all the managers working in the upper, middle, and operational sections at the medical academies and governmental hospitals in Iran who are somehow involved in COVID-19. The results of the paper indicated all levels of management utilized the information of the management accounting system for performance evaluation of COVID-19 management. In addition, our findings showed that operational managers made little use of information to control patterns and qualitative features in confronting COVID-19. While the upper and middle managers utilized this information significantly. Considering the research's result and the role of directing management accountants, they should provide the necessary information for each management level to try harder to confront COVID-19. [ABSTRACT FROM AUTHOR]

Introduction. This article presents the experience of five years of using simulation modeling to optimize work in the field of healthcare organization. Works are considered on the example of organizing the process of a three-level system for organizing emergency medical care in the regions, and examples of the practical application of computer modeling to improve the work of an inpatient emergency department are presented.The objective was to study various methods and approaches to the implementation of simulation modeling used in practice in the healthcare system. Consider the possibilities of simulation modeling on the FlexsimHC platform.Methods and materials. The analysis of methods and software used to create a simulation model in the healthcare sector was carried out. The main possibilities of using process modeling on the FlexsimHC platform were considered on the example of designing work inside and outside the hospital.Results. After a series of experiments in the virtual space, the data obtained were put into practice. On the example of the completed project of the simulation model of the region, a real way to optimize the emergency medical care in the region was proposed. Experiments were also carried out on models of an inpatient emergency department, the results of which revealed ways to optimize the workflow aimed at reducing the duration of stay inside the department, at an adequate distribution of patient flows, allowing timely implementation of all necessary medical and diagnostic measures without additional burden on medical personnel.Conclusion. Simulation modeling is the key to solving the logical problems of modern planning, allowing to reduce the risks of logistics errors in real time.

There are three areas of harmony in human life that are related to each other: "work environment", "love-to be loved-sexual area" and "social environment". Incompatibility and dissatisfaction in one area can also affect other areas. Therefore, the aim of this study is to examine the relationship between job satisfaction, life satisfaction, communication, and sexual satisfaction of healthcare employees. The data collected by questionnaires from 394 employees working in university hospitals in Turkey were analysed using SPSS and AMOS programs. The findings show that there is a positive relationship between the job and life satisfaction of employees of healthcare organizations. Additionally, the findings revealed that communication skills and sexual satisfaction have a mediating role between job satisfaction and life satisfaction of employees in healthcare organizations. Life satisfaction, sexual satisfaction, and relationships are some of the factors that should be considered by healthcare organizations. It would be beneficial to employees and the public if health policy makers implemented programmes to enhance job satisfaction. [ABSTRACT FROM AUTHOR]

Home mechanical ventilation (HMV) is an effective treatment for patients with chronic hypercapnic respiratory failure caused by restrictive or obstructive pulmonary disorders. Traditionally, HMV is initiated in the hospital, nowadays usually on a pulmonary ward. The success of HMV, and especially non-invasive home mechanical ventilation (NIV), has led to a steep and ongoing increase in the incidence and prevalence of HMV, in particular for patients with COPD or obesity hypoventilation syndrome. Consequently, the number of available hospital beds to accommodate these patients has become insufficient, and models of care that minimize the use of (acute) hospital beds need to be developed. At present, the practices for initiation of NIV vary widely, reflecting the limited research on which to base model-of-care decisions, local health system features, funding models, and historical practices. Hence, the opportunity to establish outpatient and home initiation may differ between countries, regions, and even HMV centres. In this narrative review, we will describe the evidence regarding the feasibility, effectiveness, safety, and cost savings of outpatient and home initiation of NIV. In addition, the benefits and challenges of both initiation strategies will be discussed. Finally, patient selection and execution of both approaches will be examined. [ABSTRACT FROM AUTHOR]

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These recommendations were approved at the meeting of the Samara regional branch of the Society of Transplantologists, protocol № 6, 2022. They contain recommendations for the actions of health authorities at the beginning of multiorgan transplantation programs.

Abstract Background Multiple attempts aimed at highlighting the relationship between big data analytics and benefits for healthcare organizations have been raised in the literature. The big data impact on health organization management is still not clear due to the relationship’s multi-disciplinary nature. This study aims to answer three research questions: a) What is the state of art of big data analytics adopted by healthcare organizations? b) What about the benefits for both health managers and healthcare organizations? c) What about future directions on big data analytics research in healthcare? Methods Through a systematic literature review the impact of big data analytics on healthcare management has been examined. The study aims to map extant literature and present a framework for future scholars to further build on, and executives to be guided by. Results The positive relationship between big data analytics and healthcare organization management has emerged. To find out common elements in the studies reviewed, 16 studies have been selected and clustered into 4 research areas: 1) Potentialities of big data analytics. 2) Resource management. 3) Big data analytics and management of health surveillance systems. 4) Big data analytics and technology for healthcare organization. Conclusions In conclusion is identified how the big data analytics solutions are considered a milestone for managerial studies applied to healthcare organizations, although scientific research needs to investigate standardization and integration of the devices as well as the protocol in data analysis to improve the performance of the healthcare organization.

Abstract Background Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the COVID-19 pandemic focusing mainly on technology implementations. Methods This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The literature search was conducted in Science Direct, IEEE XPLORE, Scopus, and Web of Science databases from January 2020 until July 2021, with an English language restriction. A quality assessment was based on the Critical Appraisal Skills Programs checklist. Results The included studies focused on the implementation of technology for telehealth, multidisciplinary approach, service satisfaction, guidelines, and medical training. They provided illustrative insight into the strategy of telehealth in different medical specialties, such as pediatric gastroenterology, oncology, ophthalmology, and laryngology. Nonsurgical specialties had the greatest number of telehealth visits. Clinicians showed positive attitudes toward the implementation of video telehealth visits; patients report high levels of satisfaction with this care and strong interest in continuing this modality as a significant portion of clinical practice. Conclusions This systematic review provided an illustrative insight into the strategy of telehealth for different purposes. According to our findings, telehealth may be used in different medical area with a clear strategy of intervention according to patients’ and doctors’ needs.

The commentary critically analyzes the strategy proposed by the authors of the article for performing osteosynthesis and describes the system of care for patients with fractures in Moscow. Operating rooms are divided into planned and emergency. And they, in turn, are divided into conventional and hybrid, in which it is simultaneously possible to perform endoscopic, endovascular, and open surgery. Surgeries are performed in order of priority. Highest priority: extra-focal fixation of limb bones and/or pelvis with ex-fix devices; surgery on extremities with impaired blood supply in the distal parts; decompressive fasciotomies with simultaneous external fixation of fragments in ex-fix devices with suspected formation of compartment syndrome; surgeries performed in patients with severe combined or multiple trauma. High priority: open fractures of type 3A and 3B according to the Gustillo classification, requiring primary surgical treatment of wounds and external fixation; closed unstable fractures.

Abstract Introduction Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders. Methods This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians’ work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic. Conclusions We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

Objective: description of the current problems concerning the development and conducting of a protocol of clinical approbation (CA) of methods of prevention, diagnosis, treatment and rehabilitation to optimize the implementation of innovative medical technologies in practical health care through CA.Material and methods. The review of the legislative framework governing CA and analysis of the proceedings of CA issues strategic session were carried out, management decisions to improve the effectiveness of CA were proposed. Analysis of legal acts stipulating the notion and status of CA was performed. The study included orders of the Ministry of Health of the Russian Federation, which established regulations on the organization of CA, the CA protocol templates, etc. Methodological materials, review articles on the organization of health care in the Russian Federation selected from various open sources were studied. The basis for making management decisions on improving the quality of CA procedure was formed by the participants of the CA issues strategic session which had been initiated by the Center for Healthcare Quality Assessment and Control.Results. Based on the results of the strategic session and the analysis of legal acts, current issues related to CA regulation, such as lack of СА coordination and research publications, poor methodological quality of clinical and economic evaluations within CA, promotion of innovation through CA were identified. The developed managerial decisions on improvement of CA and promotion of innovations in practical health care were presented.Conclusion. Current legal acts regulating CA activities should be updated with a view to establishing a transparent system of clinical and economic evaluations of new and innovative methods for making an informed decision to include them in clinical guidelines and routine clinical practice. It is proposed to legally assign the functions of CA coordinator to the federal medical development organizations. Regarding the promotion of innovative technologies in practical health care, it is advisable to create a system for the introduction of innovations, including taking into account conducting CA.

In this paper, this study proposed a fuzzy mixed goal programming model addressing health care organization's resource allocation problem in a fuzzy environment. Compared to other deterministic techniques, the formulation can effectively handle the vagueness and imprecision in the statement of the objectives and ensure that the more importance of a fuzzy goal, the higher achievement degree it can obtain. Further, the formulation can easily be extended to other service organizations when the decision variables are vague and decision makers need to determine a desired achievement degree and preemptive priority for each of the fuzzy goals based on the relative importance of the goals. An example case with realistic data from the Turkeys health care organization structure showed the effectiveness and flexibility of our model to handle real world problems. With more information about the service structure and behaviors of healthcare organization, the system can set clear priority values as fuzzy weight (or importance) in future studies. [ABSTRACT FROM AUTHOR]

Introduction: Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders. Methods: This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results: We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic. Conclusions: We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors. [ABSTRACT FROM AUTHOR]

Background: Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. Methods: To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and real-life initiatives; (2) RPM; and (3) care integration. Results: 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring (TM) devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. Conclusion: RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements. [ABSTRACT FROM AUTHOR]

Accreditation of hospitals is considered one of the most relevant mechanisms to achieve improvement in the quality and safety of healthcare (8). Worldwide, accreditation is gaining popularity as an effective mechanism for external assessment of healthcare quality. It is considered a method to address the issue of healthcare quality and safety. Accreditation is the independent and systematic assessment of a hospital against defined standards and recognition of a certain level of achievements of those standards by an external body. It is a process of certifying the credibility of an organization. In healthcare, accreditation recognizes and certifies the capability of a healthcare organization in delivering an acceptable standard of healthcare services, which is based upon excellent and safe practices. In this study, healthcare professionals' attitude toward quality accreditation is examined to know about their accountability. Total of 604 healthcare professionals such as; consultant physicians/surgeons, duty doctors, nursing staff, paramedical staff/allied healthcare staff, hospital administrators/managers, others (housekeeping in-charge/blue collar employees and healthcare academicians from public, private and run by Trust located in the North and Central India were randomly chosen. Through the application of factor analysis two components are explored, i.e., service quality and adaptability. One way of ANOVA was applied and found that a difference among the categories of healthcare professionals is observed for these components. [ABSTRACT FROM AUTHOR]

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = −0.76, 95% CI: −1.49, −0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff. [ABSTRACT FROM AUTHOR]

Abstract Background Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains – relational, management and informational continuity – with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals’ perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. Methods This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. Results CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). Conclusions Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level.

The article is devoted to investigate and interpret the contents and correlation for the concepts of "medical care" and "medical service" in the context of public healthcare. Here, we demonstrate the defective features of the Russian legislation regarding accepting the necessary legal definitions for such concepts. At the same time, while performing a comprehensive formal legal analysis and applying interpretation by analogy, we provide generalizations allowing to understand the essence of the concepts analyzed as well as their inter-relationship. We interpret two definitions for the concept of "medical service", and envision that medical care vs. medical service is an ontological unit of a more general and higher level. Understanding the differences in the definitions of "medical care" and "medical service", demonstrated in the article, will be useful to healthcare organizers.

Carbapenem-resistant Enterobacterales (CRE) are multidrug resistant organisms that pose a significant risk in the health care setting. Standardized identification ensures prompt isolation and is imperative to maintain patient safety. • Varying definitions of what consitutes a carbapenem-resistant Enterobacterales complicate identification and isolation of patients within the healthcare environment. • A crosswalk of definitions was reviewed by a multi-disciplinary workgroup. • A standardized definition of CRE was adopted by the system. • The electronic medical record was updated to promptly identify patients with carbapenem-resistant Enterobacterales. [ABSTRACT FROM AUTHOR]