Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
202
result(s) for
"Medical assistance Case studies."
Sort by:
Scrambling for Africa
Countries in sub-Saharan Africa were once dismissed by Western experts as being too poor and chaotic to benefit from the antiretroviral drugs that transformed the AIDS epidemic in the United States and Europe. Today, however, the region is courted by some of the most prestigious research universities in the world as they search for \"resource-poor\" hospitals in which to base their international HIV research and global health programs. InScrambling for Africa, Johanna Tayloe Crane reveals how, in the space of merely a decade, Africa went from being a continent largely excluded from advancements in HIV medicine to an area of central concern and knowledge production within the increasingly popular field of global health science.
Drawing on research conducted in the U.S. and Uganda during the mid-2000s, Crane provides a fascinating ethnographic account of the transnational flow of knowledge, politics, and research money-as well as blood samples, viruses, and drugs. She takes readers to underfunded Ugandan HIV clinics as well as to laboratories and conference rooms in wealthy American cities like San Francisco and Seattle where American and Ugandan experts struggle to forge shared knowledge about the AIDS epidemic. The resulting uncomfortable mix of preventable suffering, humanitarian sentiment, and scientific ambition shows how global health research partnerships may paradoxically benefit from the very inequalities they aspire to redress. A work of outstanding interdisciplinary scholarship,Scrambling for Africawill be of interest to audiences in anthropology, science and technology studies, African studies, and the medical humanities.
eBook
COVID-19 and the governmentality of emergency food in the City of Turin
PurposeThis paper shows the accounting, accountability and calculative practices associated with emergency food allocations by the City of Turin through a program to feed the vulnerable during COVID-19.Design/methodology/approachThis is a single case study framed by Foucault's governmentality concept. The data was collected through interviews with key institutional actors and triangulated against decrees, circulars, ordinances and other publicly available documents.FindingsThe accounting tools of governmentality are always incomplete. Sometimes unique situations and crises help us to revise and improve the tools we have. Other times, they demand entirely new tools.Research limitations/implicationsAccounting needs both things to count and a context to count them. In the case of food assistance, what is counted is people. In Turin's case, many people had never been counted – either because there was no need or because they were unaccounted for by choice. Now, the government was accountable for the welfare of both. Thus, new classification systems emerged, as did organisational and accounting solutions.Originality/valueAlthough the accounting-for-disasters literature is diverse, studies too often favour the macro social, economic and political issues surrounding crises, neglecting the micro issues associated with governmentality and calculative practices.
Journal Article
Examining the influence of health sector coordination on the efficiency of county health systems in Kenya
Background
Health systems are complex, consisting of multiple interacting structures and actors whose effective coordination is paramount to enhancing health system goals. Health sector coordination is a potential source of inefficiency in the health sector. We examined how the coordination of the health sector affects health system efficiency in Kenya.
Methods
We conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 37) with national and county-level respondents, and document reviews. We analyzed the data using a thematic approach.
Results
The study found that while formal coordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the coordination of the health sector. These challenges were observed in both vertical (coordination within the ministry of health, within the county departments of health, and between the national ministry of health and the county department of health) and horizontal coordination mechanisms (coordination between the ministry of health or the county department of health and non-state partners, and coordination among county governments). These coordination challenges are likely to impact the efficiency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate coordination also impairs the implementation of health programmes and hence compromises health system performance.
Conclusion
The efficiency of the Kenyan health system could be enhanced by strengthening the coordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector-specific coordination mechanisms, strengthening the implementation of the Kenya health sector coordination framework at the county level, and enhancing donor coordination through common funding arrangements and integrating vertical disease programs with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff, respectively. Finally, counties should consider initiating health sector coordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.
Journal Article
Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia
Background
Trained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities.
Methods
A descriptive observational study design used mixed methods to collect data from CHWs (structured survey,
n
= 60; focus group discussions,
n
= 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records.
Results
Coverage for community-based treatment of child diarrhea and pneumonia continued throughout the outbreak in project areas. A slight decrease in cases treated during the height of the outbreak, from 50 to 28% of registers with at least one treatment per month, was attributed to directives not to touch others, lack of essential medicines and fear of contracting Ebola. In a climate of distrust, where health workers were reluctant to treat patients, sick people were afraid to self-identify and caregivers were afraid to take children to the clinic, CHWs were a trusted source of advice and Ebola prevention education. These findings reaffirm the value of recruiting and training local workers who are trusted by the community and understand the social and cultural complexities of this relationship. “No touch” integrated community case management (iCCM) guidelines distributed at the height of the outbreak gave CHWs renewed confidence in assessing and treating sick children.
Conclusions
Investments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and “no touch” iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended.
Journal Article
Viability of Open Large Language Models for Clinical Documentation in German Health Care: Real-World Model Evaluation Study
The use of large language models (LLMs) as writing assistance for medical professionals is a promising approach to reduce the time required for documentation, but there may be practical, ethical, and legal challenges in many jurisdictions complicating the use of the most powerful commercial LLM solutions.
In this study, we assessed the feasibility of using nonproprietary LLMs of the GPT variety as writing assistance for medical professionals in an on-premise setting with restricted compute resources, generating German medical text.
We trained four 7-billion-parameter models with 3 different architectures for our task and evaluated their performance using a powerful commercial LLM, namely Anthropic's Claude-v2, as a rater. Based on this, we selected the best-performing model and evaluated its practical usability with 2 independent human raters on real-world data.
In the automated evaluation with Claude-v2, BLOOM-CLP-German, a model trained from scratch on the German text, achieved the best results. In the manual evaluation by human experts, 95 (93.1%) of the 102 reports generated by that model were evaluated as usable as is or with only minor changes by both human raters.
The results show that even with restricted compute resources, it is possible to generate medical texts that are suitable for documentation in routine clinical practice. However, the target language should be considered in the model selection when processing non-English text.
Journal Article
Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China
Background
The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called “Diagnostic Intervention Package” (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities.
Methods
This study takes Tai’an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels.
Results
The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β
3
= 0.197,
P
< 0.001; secondary hospitals: β
3
= 0.132,
P
= 0.020) and the case mix index (tertiary hospitals: β
3
= 0.022,
P
< 0.001; secondary hospitals: β
3
= 0.008,
P
< 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β
3
= -0.290,
P
< 0.001; secondary hospitals: β
3
= -1.200,
P
< 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β
3
= 0.186, P = 0.002) and the case mix index (β
3
= 0.002,
P
< 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β
3
= -0.515,
P
= 0.005) and primary-DIP-groups coverage (β
3
= -2.011,
P
< 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity.
Conclusion
The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.
Journal Article
Public Health Nursing Case Management for Women Receiving Temporary Assistance for Needy Families: A Randomized Controlled Trial Using Community-Based Participatory Research
Objectives. We evaluated the effectiveness of a community-based participatory research–grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. Methods. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. Results. Medicaid knowledge and skills improved (P < .001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR] = 1.92; P = .007), and this likelihood increased in higher-risk subgroups (OR = 2.03 and 2.83; P = .04 and .006, respectively). Depression and functional status improved in the intervention group over time (P = .016 for both). No differences were found in routine or preventive care, or general health. Conclusions. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population.
Journal Article
Management of human resources for health: implications for health systems efficiency in Kenya
Background
Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya.
Methods
We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (
n
= 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis.
Results
Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency.
Conclusions
Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.
Journal Article
Please sir, I want some more: an exploration of repeat foodbank use
Background
The sharp rise in foodbank use in Britain over the past five years suggests a proliferation of food insecurity that could herald a public health crisis. However, trends in foodbank use rely on imperfect figures that do not distinguish between single and repeat visits. Consequently, the true prevalence of foodbank use in Britain is unknown. By identifying repeat visits, this study provides the first estimate of the proportion of people using foodbanks.
Methods
Using data on referrals to West Cheshire Foodbank in the UK, this study offers a case study of 7769 referrals to one foodbank between 2013 and 2015. Foodbank use was explored in descriptive statistics, then negative binomial regression models were used to identify the household characteristics associated with the number of foodbank visits.
Results
Between 0.9 and 1.3% of people in West Cheshire sought assistance from West Cheshire Foodbank between 2013 and 2015. If scaled up nationally, this would equate to an estimated 850,000 people across Britain. The number of total recipients increased by 29% between 2013 and 2015, while the number of unique recipients rose by 14%. Multivariate analysis revealed that a larger number of visits were recorded in 2015 and among working-age and one-person households, while households referred due to domestic abuse and unemployment made fewer visits.
Conclusion
Food insecurity has emerged as a crucial challenge facing UK health professionals and policymakers. This study provides the first estimate of the proportion of individuals receiving emergency food in a single case study location, and demonstrates that foodbank use is becoming more prevalent, although headline figures overstate the scale of this growth. The potential nutrition and wider health consequences of reliance on emergency food – especially among those using foodbanks on multiple occasions – warns of an unfolding public health crisis.
Journal Article