Special Issue:
Challenges and Opportunities in Healthcare Management
Vako Ilda
Healthcare Management, Hellenic Open University, Greece; Evaggelismos General Hospital, Greece.
Eirini Patsaki
Department of Physiotherapy, University of West Attica, Greece
Alexandros Kouvarakos
Evaggelismos General Hospital, Greece
Vaios Grammatis
Healthcare Management, Hellenic Open University, Greece
Ioannis Kouroutzis
Healthcare Management, Hellenic Open University, Greece; Nursing Department, University of Thessaly, Greece
Theodora Paisia Apostolidi
Medicine University of Sofia, Bulgaria
Vasiliki Roka
Healthcare Management, Hellenic Open University, Greece
Anastasia Kotanidou
Evaggelismos General Hospital, Greece
Pavlos Sarafis
Healthcare Management, Hellenic Open University, Greece; University of Thessaly, Greece
Maria Malliarou
Healthcare Management, Hellenic Open University, Greece; Nursing Department, University of Thessaly, Greece
Abstract
Healthcare professionals during the pandemic in the Greek public healthcare system have experienced increased psychological distress, fear and a greater intention to quit their jobs. This study analyzes the factors of moral distress and moral resilience of healthcare professionals employed during the second wave of the pandemic. The target group was the healthcare professionals (HP = 169) who served in the Evaggelismos General Hospital Covid-clinics and -ICU for 2022 and data were collected through life protocols.
Healthcare professionals believe that when faced with moral challenges, they are able to discern them and think clearly. They are especially stressed when they care for more patients than they can safely handle when they are involved in care that causes unnecessary suffering or does not adequately relieve pain or symptoms, and when they notice that patient care is getting worse. Also stressful are the situations, leading to the creation of possible moral distress, when they witness a violation of a standard of practice or moral code. Factors that lead or may lead healthcare professionals to moral distress are nursing safety, unnecessary and deteriorating patient care, and violation of medical confidentiality, violation of standards of practice or moral codes.
The score on the MMD-HP scale indicates low-to-moderate levels of moral distress. Based on the RMRS scale the moral resilience of healthcare professionals is characterized by moderate-to-high with the highest scores per statement seen when patient care is getting worse and feel pressured to ignore situations where patients have not been given adequate information. The healthcare professionals report that they have either left or have considered leaving their position in a clinic due to moral distress, although they are not currently thinking of leaving their position. The factors that increase the frequency of moral distress and decrease their moral resilience are feeling powerless anxiety, nursing/treatment errors, aggressive treatment, caring for more patients than they can handle, substandard patient care, and hierarchical teams.
Janice Hoffman-Simen, PharmD, EdD, APh, BCGP, FASCP
Associate Professor of Pharmacy Practice and Administration, Western University of Health Sciences, 309 East Second Street, Pomona California 91766 USA
Abstract
Background: Healthcare teams possess multiple clinical capabilities to meet the demands and challenges of individual patient-centered care. Teams in healthcare have been used for centuries, but the functionality of a team largely depends on the leader facilitating. With the complexities of healthcare, single leadership models often do not apply.
This study aimed to complete a multi-method qualitative study looking at four healthcare settings to explore the applicable use of the Simen-Schreiber leadership model to best describe the needs of healthcare teams (ambulatory diabetes clinic; skilled nursing facility [SNF], acute inpatient geriatric-psychiatric unit, and outpatient high-risk geriatric clinic).
Methods: The key constructs researched in this mixed-method qualitative study were: 1) skills needed for good healthcare team participation and 2) essential outcomes needed for successful patient-centered care (e.g. communication, interpersonal engagement, and shared decision-making). The qualitative portion of this study included three distinctive methods: 1) observation of each team functionality; 1,2 2) interview to obtain background information about each facility; and 3) Focus Group session composed of 10 questions and a duration of approximately 75 to 90 minutes. Additional methodology utilized for this study included two validated and reliable quantitative assessments: 1) a healthcare team observation tool1,2 and 2) emotional intelligence questionnaire.3
This multi-method, multi-case study design was selected to allow for triangulation of the data to support the seven constructs of the leadership model. The constructs include rotation of the leader; clinical expertise; emotional intelligence; and managerial skills, with the outcomes of communication; interpersonal engagement and share decision-making.
Results: There appears to be a slight trend of higher-functioning teams demonstrated higher emotional intelligence scores, according to the TEI-Que questionnaire and the Team Observation Tool results. From the managerial skills perspective, the Focus Groups results suggests that these skills, particularly in time management, are a target area for improvement among all four teams. Furthermore, these findings support the need to improve training in managerial skills to prepare professionals adequately for healthcare teamwork.
it is widely accepted that, good communication is vital within a healthcare team and is related to positive patient outcomes. Unfortunately, poor communication is seen daily in healthcare and can lead to serious health consequences for the patient and dissatisfaction with care by patients, family members, other caregivers, along with clinicians and other healthcare team members. Lastly, there appeared to be support from this study that involvement of the patient, family and interprofessional team in the shared decision-making process is helpful for successful patient outcomes.
Conclusions: The findings of this study support the Simen-Schreiber leadership model as applicable to healthcare teams. Each healthcare professional should possess clinical expertise, high emotional intelligence and good managerial skills, to be able to best function on a healthcare team. The Simen-Schreiber leadership model may be useful in preparing healthcare professionals for participation in teamwork, leading to more efficient and effective patient-centered care.
Jijo Paul, Ph.D., M.Phil., E.MBA, M.S.
Varian, a Siemens Healthineers company Advanced Oncology Services (AOS) 3100 Hansen Way, Palo Alto, CA 94304, United States Sutter Health/ Ridley-Tree Cancer Center Department of Radiation Oncology, 540 W Pueblo St, Santa Barbara, CA 93105, United States
Abstract
Objective: United States healthcare systems faced enormous pressure from the Coronavirus disease 2019 (COVID-19) crisis, and such scenarios may arise again at any time in the future, so an appropriate crisis action plan should be ready to face them effectively. This study explores the significance of crisis management in healthcare organizations and explains some of the foremost institutional best practices to preserve their reputations in the community. Moreover, the study aimed to detail various strategies targeted for effective crisis management in healthcare organizations to overcome the issues caused by the pandemic.
Methods: A literature survey was conducted using a comprehensive search in PubMed, Research Gate, Scopus, and Google Scholar databases. The gathered articles underwent double screening processes, and the eligible articles were included in this study to formulate this review. Broad search terms were used to find relevant literature articles, including the COVID-19 pandemic, healthcare, crisis, business strategies, and patient safety.
Results: Major healthcare systems in the United States had a proper crisis management plan to continue departmental clinical operations while upholding basic principles. The healthcare organizations acknowledged the crisis, approached it responsibly, and overcame it by reformulating appropriate crisis management plans. Clear communication, delegation, and sustainability were the basic principles held by the institutions in managing crises and serving communities. Crisis team leaders developed intranet pages for fast communication and conducted electronic discussion boards and virtual town hall meetings. They were Responsible, Accountable, Consulted, and Informed (RACI) approaches to manage the crisis by focusing on society, people, and sustainability.
Conclusion: A time-sensitive crisis management plan is critical for every institution’s reputation and survival since they face unexpected issues, threats, risks, and crises from time to time. The best strategies/ practices for effective crisis management may include bold decisions, well-outlined policies, planning, informing stakeholders in time, and taking rapid action to avoid a disaster. Organizations must establish suitable crisis management teams, well-structured strategic plans, communication channels, implementation procedures, and evaluation methods to overcome a crisis.
Montella Emma, MD
Department of Public Health, University of Naples “Federico II”, Italy
Iodice Sabrina, MD
Department of Public Health, University of Naples “Federico II”, Italy
Frangiosa Alessandro, MD
Department of Public Health, University of Naples “Federico II”, Italy
Salvatore Bellopede, MD
Department of Public Health, University of Naples “Federico II”, Italy
Ugo Trama, Dr Pharm
Department of Public Health, University of Naples “Federico II”, Italy
Maria Triassi, MD
Professor, Department of Public Health, University of Naples “Federico II”, Naples; Interdepartmental Centre for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, Naples, Italy
Abstract
Background: Healthcare workers were at high risk of contracting COVID-19 during the pandemic due to their frontline commitment. This risk was higher than in the general population because they were exposed to the virus both at work and outside the hospital. Healthcare workers suffered from physical and psychological stress, which could lead to mental health problems.
Aims: The aim of the study was to evaluate the effectiveness of four proactive interventions implemented to protect workers’ health during the COVID-19 pandemic at the “Federico II” University Hospital in Naples, Italy. The study aimed to prevent both clinical and non-clinical risks, such as infections contagion and work-related stress.
Methods: A prospective observational study was conducted between April 9 and May 21, 2020, at the “Federico II” University Hospital. Healthcare personnel, who worked during the study period, were subject to four proactive interventions: (I) Classification based on the risk of exposure to SARS-Cov-2; (II) Healthcare surveillance: diagnostic surveillance (nasopharyngeal swabs for SARS-Cov-2, rapid antigen tests and serological for the detection of IgM/IgG antibodies against SARS-Cov-2), clinical and epidemiological surveillance (physical examination and contact tracing), individual psychological support; (III) Contacts-tracing;(IV) Constant training and information. The study analysed the number of positive swabs in healthcare workers and hospitalised patients during the same period, comparing the incidence of cases with international data. Feedback from psychologists and occupational doctors was also collected to evaluate the impact on non-clinical risks.
Results: The study found a low correlation between positive swabs in healthcare workers and patients, suggesting that the preventive measures in place were effective. Furthermore, feedback from psychologists and occupational doctors did not report an increase in stress-related sick leaves, thanks to the proactive actions.
Conclusions: The considered proactive interventions proved to be useful to protect healthcare workers during the pandemic. The study highlights the importance of a proactive approach instead of a reactive one, and the necessity to contemplate both the protection from biological risks and the psychological support.
Ifeoluwa Mary Falade, MD
Mersey and West Lancashire Teaching Hospitals, United Kingdom.
Gideon Kwame Siaw Gyampoh, MBChB
Eastern Regional Hospital, Koforidua, Ghana
Emmanuel Onyekachi Akpamgbo, MBBS
Abia State University College of Medicine, Abia State, Nigeria
Oragui C. Chika, MD
Stanford University School of Medicine, Pala Alto, California, USA
Okiemute Rita Obodo, MD
Windsor University School of Medicine, Cayon, St Kitts and Nevis
Okelue E. Okobi, MD
Larkin Community Hospital, Miami, FL, USA
John Chika Aguguo, MD
University of Nigeria, Nsukka, Nigeria
Victor Ugochukwu Chukwu, MBBS
College of Medicine, Abia State University, Uturu, Abia State, Nigeria.
Abstract
Ensuring patient safety and enhancing quality of care are paramount objectives in healthcare, pivotal for minimizing errors and optimizing care outcomes. This review synthesizes diverse strategies aimed at improving patient safety and quality across various healthcare sectors. Key initiatives highlighted include specialized training programs for ICU handovers, leadership practices in radiology, and enhancing interprofessional communication to bolster medication safety. The review underscores the positive impact of these strategies on fostering a culture of safety among hospital staff, drawing insights from nationwide safety protocols and simulation-based training in oncology. Furthermore, the review discusses advancements such as machine learning applications in pre-hospital care, standardized prescription protocols, and cultural safety initiatives tailored for Indigenous populations, all significantly improving healthcare outcomes. Additional critical areas encompass structured case management, frameworks for pandemic management, virtual interprofessional education initiatives, incident reporting enhancements in surgical settings, and interventions addressing verbal mistreatment in mental health settings. These efforts highlight the importance of interdisciplinary collaboration, evidence-based practices, and continuous improvement in optimizing patient outcomes and healthcare delivery.
In conclusion, the review emphasizes the effectiveness of diverse strategies and interventions in enhancing patient safety and quality improvement across healthcare settings. These main safety strategies include targeted training programs like the “Room of Improvement” simulation, which enhances error detection during ICU handovers. Standardized practices and effective communication across healthcare facilities ensure consistent quality care. Virtual interprofessional education improves teamwork and discharge processes. Early integration of quality improvement and patient safety education in health curricula equips students with essential skills. Zero-harm programs and simulation-based training also significantly enhance patient safety and readiness to manage complex situations.
Each approach plays a crucial role in mitigating risks and cultivating a robust safety culture, from targeted training and leadership practices to innovative technologies. Embracing proactive measures, interdisciplinary teamwork, and ongoing learning is essential for achieving safer and more effective healthcare delivery globally, underscoring the need for integrated strategies to enhance patient care amidst evolving challenges.
Grace A. Gbigbi-Jackson
All Saints University School of Medicine, Dominica
John Chika Aguguo, MD
University of Nigeria, Nsukka, Nigeria
Okelue E. Okobi, MD
Larkin Community Hospital, Hialeah, Florida, USA
Oluwatosin B. Iyun, MD, MPH
University of Cape Town, Cape Town, South Africa
Linda Angela Mbah, MD
VA Northern Indiana Healthcare, Fortwayne, Indiana, USA
Abstract
Chronic diseases, such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD), persist over a year and necessitate ongoing medical attention or limit daily activities, posing significant challenges to global healthcare systems and economies. Chronic disease management programs (CDMPs) aim to provide comprehensive, patient- centered care worldwide. This review synthesizes evidence from diverse studies, including observational research, systematic reviews, randomized trials, and retrospective analyses, to evaluate CDMP effectiveness across different populations and settings. Positive impacts include Chronic Disease Self- Management Education workshops reducing loneliness among older adults, eHealth interventions enhancing self- management skills and quality of life for chronic kidney disease patients, and lifestyle interventions benefiting cardiovascular health in low-income women. Technological innovations, such as personalized messaging systems, have improved engagement in diabetes prevention. CDMPs are pivotal in enhancing clinical outcomes, patient satisfaction, and reducing healthcare utilization through tailored, multidisciplinary approaches integrating technology. Challenges include ensuring consistent implementation and addressing access disparities. Future research should refine strategies, assess long-term sustainability, and explore innovative approaches to optimize chronic disease management globally. Continuous evolution of CDMPs is essential to mitigate chronic disease impacts, improving health outcomes and quality of life globally.
Vladimir Bukvič
GEA College Faculty of Entrepreneurship, Ljubljana, Slovenia
Abstract
The author links together business analysis as a practically oriented scientific discipline and business excellence as an ideal that all well-performing organisations wish to achieve while attaining and continuously maintaining superior levels of business performance, thus fulfilling and even exceeding the expectations of their stakeholders. The aim of his research is to present a model and to expose its usefulness as an instrumental tool for operation analysis of an organisation. Thus, he leans on the European Foundation for Quality Management (EFQM) Excellence Model and uses it as an excellent tool for analysing the business of an organisation throughout all the phases defined by traditional business analysis. The scope of the author’s research is to highlight the areas across an organisation, whereat the EFQM model can serve as a very efficient approach to measuring business performance of an organisation. This includes the observation of facts and identification of problems, which can be construed as defining the organisation’s strengths and areas for improvement. This entails setting up hypotheses and testing them by applying appropriate measures. A comparative analysis is used as a main kind of study design. In addition to that, some other special methods are used, like synthesis, method of deduction, method of induction, method of elimination. After a short introduction, the author makes first a thorough literature review on business excellence in the last two decades with an emphasis on the EFQM Model. He focuses particularly on the assessment and critical attitude of individual researchers who have studied this topic. Further, the author presents the basic concepts and elements of the EFQM model of business excellence, with a particular emphasis on the RADAR matrix (Results, Approaches, Deployment, Assessment and Refinement) as a very useful instrument (management tool) for business excellence analysis. This can also be designated as the major objective of the author’s research. Further, additional objective is to show the use of the model for analysing and assessing the business excellence of organisations in the public sector, specifically in the healthcare industry (hospitals). He presents the key attributes (select healthcare aspects) that define the quality of healthcare services for its key participants, i.e., patients and the payers of these services. These attributes, namely technical performance, interpersonal relationships, amenities and access, patient preferences, efficiency and cost effectiveness, are then highlighted by select business excellence criteria, mainly referring to the stakeholders’ perception of the organisation in question and business performance indicators. The author rounds off his paper with a couple of recommendations regarding the identification of strengths and areas for continuous improvement, which he, as a leading assessor with many years’ experience, including in the healthcare industry, considers as the most important aspect of business excellence analysis.
Reem Abu Hwaij
Department of Social and Behavioural Sciences, Faculty of Arts, Birzeit University & Jannati Academy for Mental Health Education, Ramallah, Palestine
Farid Ghrayeb
Department of Nursing, Faculty of Health Professions, Al-Quds University, Jerusalem, Palestine
Roy Rillera Marzo
Department of Public Health, Faculty of Medicine, Asia Metropolitan University, Johor, Malaysia
Ayesha AlRifai
Institute of Community and Public Health, Birzeit University & Abu Hwaij Assurance and Consulting Services, Ramallah, Palestine
Abstract
Healthcare workers have been working on the frontlines since the COVID-19 pandemic in 2019. In Palestine Healthcare workers have been experiencing compounded stress given their preexisting limited access and resources as imposed by the Israeli colonial system and their management of the novel coronavirus. This study aimed to investigate the impact of COVID-19 on Palestinian healthcare workers’ mental health in relationship to various demographic variables that have been found to correlate to expressed distress in previous literature. Using brief online questionnaires, 596 healthcare workers from various professions rated their experiences of depression, anxiety and risk perception. Descriptive analysis was carried out to analyze the data. Our findings indicate that the overwhelming majority of our participants were experiencing depressive and anxious symptoms, with females, physicians, and less experienced Healthcare workers showing elevated levels of symptomology. It is recommended that psychological services be offered to healthcare workers in Palestine with specific emphasis on the identified risk factors.
Jijo Paul, Ph.D., M.Phil., E.MBA, M.S.
Varian, a Siemens Healthineers company, Advanced Oncology Services (AOS), 3100 Hansen Way, Palo Alto, CA 94304, United States; Sutter Health/ Ridley-Tree Cancer Center, Department of Radiation Oncology, 540 W Pueblo St, Santa Barbara, CA 93105, United States
Abstract
Leading the organizational change process in healthcare requires a clear vision, effective communication, and deep involvement. The team leaders effectively lead the proposed organizational changes that begin from the top executive level, involve organizational layers, engage stakeholders, perform assessments, and adapt the changes as a new norm.
Experienced leaders gathered various decision alternatives from numerous communications with the stakeholders and rapidly implemented the workflow adaptations efficiently in oncology practice organizations. They identified multiple attributes of alternatives for cancer patient management in healthcare institutions without compromising treatment outcomes. Good leaders easily recognize and exclude information bias influences to eliminate impacts on decision-making. Healthcare executive members, leaders, administrators, managers, physicians, physicists, and nurses are reliable sources of information for change management in oncology.
Various business analysis models, such as SWOT analysis, Porter’s five forces framework, FMEA, etc., can measure organizational strengths, weaknesses, opportunities, and threats. Conducting detective and preventive actions helps reduce the accepted risks’ impacts on radiation oncology practices. An excellent action plan can be used to compare the completed system process to its initial requirements and directly support fostering enhancement efforts by steering actions. Task analysis helps track the follow-up actions to achieve final objectives, and continuous monitoring is considered a valuable feedback tool.
Vincent J.T. Peters
Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands; Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
Abstract
Down syndrome is a complex congenital condition and the most prevalent genetic cause of intellectual disability in humans. Although people with Down syndrome share a typical appearance, intellectual disability, and delayed motor development, each individual with Down syndrome is unique. In addition, many individuals with Down syndrome experience various comorbidities, therefore, people with Down syndrome have complex healthcare needs. The prevalence and severity of these comorbidities varies. This makes individuals with Down syndrome a very diverse and heterogeneous patient group from an early age, despite their common genetic background (trisomy 21). Providing adequate healthcare and interventions in the early life of individuals with Down syndrome improves physical and mental development. In the Netherlands, 22 pediatric outpatient clinics organize multidisciplinary team appointments (so-called "Downteams") to address the complex healthcare needs of children with Down syndrome. In this study, we present the healthcare provided by these multidisciplinary teams in a modular way and show that this modular approach results in improved healthcare provision for children with DS.
Vaios Grammatis
Master of Healthcare Administration, Hellenic Open University, Greece
Ioannis Kouroutzis
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Nikoletta Apostolidi
Department of Nursing, University of Thessaly, Greece
Ilda Vako
Master of Healthcare Administration, Hellenic Open University, Greece
Theodora-Paisia Apostolidi
Department of Nursing, University of Thessaly, Greece; Medical University of Sofia, Bulgaria
Vasiliki Roka
Master of Healthcare Administration, Hellenic Open University, Greece
Pavlos Sarafis
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Maria Malliarou
Master of Healthcare Administration, Hellenic Open University, Greece; Department of Nursing, University of Thessaly, Greece
Abstract
Moral distress is the situation in which nurses know the moral principles that should guide their actions but are not allowed by the constraints of the health system. Moral sensitivity is the ability of nurses to perceive the moral dimensions of certain situations or actions. Safe care is a range of services provided to patients by nurses and consequently nurses with the aim of monitoring, promoting, maintaining or restoring the health of patients. Moral distress negatively affects safe health care, and moral sensitivity is the solution to moral distress. This study investigates the relationship between both moral distress and moral sensitivity of nurses with safe nursing care. A total of 163 nurses from a General Greek Hospital participated in the research. The protocol included the Moral Resilience (RMRS), Moral Distress (MMD-HP) and Moral Sensitivity Control (Byrd’s NEST) scales.
For the Moral Resilience scale, higher scores are recorded for the moral efficacy dimension. Moderate scores are recorded for the Moral Distress scale, so nurses are characterized by moderate moral sensitivity. None of the nurses had left or considered leaving the clinic due to moral distress, up to the time of the present study. Health professionals based on Byrd’s NEST scale are characterized by moderate moral sensitivity. The greater the integrity of the relationships, the greater the reactions to moral adversity. The greater the moral distress, or the better the perceptions of the security offered by management, the greater nurses’ personal integrity. As relational integrity or the distress decreased, moral efficacy increased. The higher the moral distress of the nurses, the greater the integrity of the relationships. Nurses who had children also felt more secure about working conditions than those who did not. The greater the dynamics of the clinic, the less reactions to moral adversity. Finally, greater moral deadlock was associated with both greater personal integrity and greater relational integrity, and less moral efficacy. Increased moral sensitivity prevents the occurrence of moral distress and has a positive effect on the provision of safe health care.
Shirley Lecher
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
David Bressler
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Monte Martin
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Introduction: Waste generated from HIV viral load testing and SARS CoV-2 for diagnosis of COVID-19 contains potentially hazardous guanidinium thiocyanate. Guanidinium thiocyanate may be toxic to humans and if not properly disposed of can pollute waters and harm aquatic life. Sub-Saharan African countries are particularly challenged by limited resources to suitably manage waste generated at health care facilities and laboratories. There is a need to identify waste management challenges and develop strategies to mitigate this type of laboratory testing waste in resource limited countries.
Methods: HIV viral load data used for this analysis were standardized monitoring evaluation and reporting Presidents Emergency Plan for AIDS Relief datasets for Malawi, Mozambique, South Africa, and Zimbabwe. COVID-19 data was obtained from the Johns Hopkins Coronavirus Resource Center.
Discussion: Inadequate management of HIV viral load and COVID-19 guanidinium thiocyanate waste due to lack of policy, guidelines and appropriate procedures for containment, poses a significant public health threat to the environment. Recognizing this gap, the United States Centers for Disease Control and Prevention has decided to provide technical expertise, raise awareness, and work with other international partners to disseminate knowledge and find solutions for the Presidents Emergency Plan for AIDS Relief supported countries in sub-Saharan Africa. The World Health Organization guidelines on safe management of waste from healthcare activities were proposed as a starting point to develop country specific guidelines.
Conclusions: The United States Centers for Disease Control and Prevention, in collaboration with other international partners, is diligently working to provide technical assistance to countries for training and development of mitigation strategies to appropriately manage guanidinium thiocyanate containing waste. Waste management is a growing problem as molecular testing for HIV, COVID-19, and other emerging diseases increase.
M Vorster
University of KwaZulu-Natal, Department of Nuclear Medicine, Durban, South Africa
A Mallum
University of KwaZulu-Natal, Department of Oncology, Durban, South Africa
M Sathekge
Department of Nuclear Medicine University of Pretoria, Pretoria, South Africa
T Pascual
Department of Science and Technology (DOST), Philippine Nuclear Research Institute
Abstract
There is no denying the importance of prostate cancer as a leading cause of mortality and morbidity in men. As such, it represents an important driver of healthcare costs and there is a (mostly unmet) need to provide evidence that assists decision-makers in prioritizing one management strategy over another in budget planning.
Theranostics in prostate cancer represents a non-invasive out-patient strategy for patient management, which consists of imaging with a PSMA-based agent, followed by targeted radionuclide therapy with either a beta emitter (such as Lutetium-177) or an alpha emitter (such as Actinium-225). Evidence for these management approaches is mounting with FDA approval of imaging and therapy agents following landmark trials like the ProPSMA study, the VISION- and the TheraP trial.
Despite the explosion in publications on the use of targeted radionuclide therapies in prostate cancer, studies that compare the cost-effectiveness of available nuclear medicine imaging and treatment strategies remain hard to find. The aim of this mini review was to summarize the most important current evidence related to cost-effectiveness strategies that evaluate imaging and targeted radionuclide therapies for PSMA-based PET theranostics.
We found a paucity of literature that deals with healthcare costs, with an obvious need for more cost-effectiveness studies to demonstrate the positive impact of nuclear medicine in the management of oncology (and other) patients. These studies need to be based on well-conducted clinical trials and meta-analyses, with appropriate model simulations and decision analysis and should ideally be reported according to the CHEERS 2022 guidelines to improve uniformity and robustness.
Mihail Dimitrios
Human Resources Management Lab , Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Papatheodorou Maria
Nursing Department, Papageorgiou General Hospital, Thessaloniki; Human Resources Management Lab , Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Panagiotis Kloutsiniotis
Department of Tourism, Ionian University, Kerkyra, Greece; Human Resources Management Lab , Business Administration Department, University of Macedonia Thessaloniki 546 36, Thessaloniki Greece
Abstract
Background: Leadership becomes crucial during major crises in which one could expect high levels of burnout and decrease in patient quality of care. The Covid-19 pandemic was a major healthcare crisis where healthcare professional and infrastructure had to cope with unprecedented levels of workload and stressful working conditions. Hence, empirical models for estimating the mitigating role of authentic leadership on nurses’ burnout during the pandemic can contribute to the utilization of best practices in managing effectively the scarce nursing personnel resources.
Aims: To model the influence of leadership, through measures on structural empowerment and work-life balance, on nurses’ burnout and patients’ quality of care, and to measure the nurses΄ perception of their leadership, and the opinion of the leaders regarding their role during the Covid-19 pandemic.
Methods: An institution-based cross-sectional study conducted during the third wave of the pandemic (March-July 2021). After implementing measures to enhance structural empowerment and improve work-life balance, four questionnaires referring to Authentic leadership, Structural empowerment, Work life balance, and Work Burnout were distributed to 650 nursing personnel. Moreover, 200 patients were asked to assess the received quality of care.
Results: 530 valid questionnaires included in the study. Using structural equation modeling, we estimated that authentic leadership significantly influences burnout and preserves patients’ quality of care by enhancing structural empowerment and work-life balance. In assessing attitudes, leadership was rated high, 56±5 SD (max =80) by the nursing personnel. Head nurses rated their leadership significantly higher compared to the nurses, 62,13±10 SD, (p<0,001). Structural empowerment and work-life balance measures were rated 3,55±0.6 SD, and 2,67±0,5 SD, (max =5) respectively. On the burnout subscales, emotional exhaustion and cynicism rated 3,1±0,8 and 2,3±0,7 respectively, and high in professional efficacy, 2±0,5. Patients assessed their quality-of-care 3,8±0.48 SD, (4= very good and 5=excellent).
Conclusion: Our study demonstrates that during major crises, leadership through structural empowerment measures and better work-life conditions mitigates nurses’ burnout and lead them to high levels of professional efficacy, thus preserving patients-quality of care. Moreover, team leaders in healthcare services should be modest and aware of their tendency to overestimate their leadership abilities.
Jijo Paul, Ph.D.M.Phil., E.MBA, M.S.
Varian, a Siemens Healthineers company, Advanced Oncology Solutions (AOS), 3100 Hansen Way, Palo Alto, California 94304, United States 2Sutter Health/ Ridley-Tree Cancer Center, Department of Radiation Oncology, 540 W Pueblo St, Santa Barbara, California 93105, United States
Abstract
Objective: This study aims to explore the roles of strategic leaders in business concerns and how they maintain sustainability in business during an unexpected crisis like the COVID-19 pandemic. The present study investigated the effects of the COVID-19 pandemic crisis on the healthcare industry, organizational performance, and various leadership strategies to overcome such a crisis.
Methods: Hospital leaders frequently face new challenges, especially in a healthcare crisis like a pandemic, which may be beyond the scope of the current leadership practices. Additional unavoidable responsibilities may arise, affecting employees’ productivity, emotions, adaptability, and leadership styles in a crisis.
Result: Transformational leadership is identified as suitable for leaders in a crisis to motivate employees and introduce rapid changes to maintain sustainability. Employee engagement, motivation, innovation, creativity, and many more are critical for a business’s survival in a crisis. Transformational leaders are active and utilize different tactics to formulate and implement decisions, provide motivation, promote innovation, display the significance of supporting the organization, and strengthen employee engagement.
Conclusion: Influential leaders have roles ranging from routine management activities to handling extra-work roles such as strategy formulation, technology expert, coach, mentor, entrepreneur, etc. Swift changes in leadership styles are necessary to accommodate such rapid changes brought by crises in the healthcare sector for work situations.
Dr. Manjuri Sharma
Prof & Head, Dept. of Nephrology, Gauhati Medical College & Hospital.
Dr. Benjamin S Sangma
Senior Resident, Dept. of Nephrology, Gauhati Medical College & Hospital.
Abstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with varied manifestations, significantly impacting women and potentially leading to Lupus Nephritis (LN), a major cause of morbidity and mortality. The review article explores the unique challenges and opportunities in managing lupus nephritis (LN) in North Eastern India, a region characterised by diverse ethnicities, cultures, and socioeconomic challenges. With a higher than average prevalence of systemic lupus erythematosus (SLE) and lupus nephritis (LN), the region presents distinct epidemiological patterns, likely influenced by genetic, environmental, and lifestyle factors. The management and prognosis of LN are further complicated by the region’s geographical and infrastructural limitations, including access to specialised healthcare and socioeconomic barriers, which impacts the patient’s outcome. Despite the challenges, there are emerging opportunities for improvement through innovations in healthcare delivery, governmental and non-governmental initiatives aimed at enhancing healthcare access, and the adaptation of treatment guidelines to the local context. This review article underscores the importance of region-specific research and healthcare strategies to improve care and outcome for lupus nephritis (LN) patients in North Eastern India, thus contributing to the broader understanding of the disease in diverse populations and settings.
Joyce E. Johnson, PhD, RN, NEA-BC, FAONL, FAAN
The Catholic University of America Conway School of Nursing 620 Michigan Avenue NW Washington, D.C. 20064
Petra Goodman, PhD, WHNP-BC, FAANP
The Catholic University of America Conway School of Nursing 620 Michigan Avenue NW Washington, D.C. 20064
Abstract
Healthcare in the U.S. is the most expensive in the world, presenting a complex environment that demands nurse leaders possess consummate business skills. This article chronicles the 30-year journey of incorporating business acumen into nursing education, detailing the resistance and gradual acceptance within the nursing profession. Despite significant progress, a notable gap remains in financial literacy and business proficiency among nurse leaders, often limiting their engagement in financial management roles. The discussion extends to the challenges and opportunities the evolving healthcare landscape presents, where business and financial competencies are increasingly essential for effective leadership.
This article aims to underscore the critical need for nurse leaders to be equipped with advanced business skills to successfully navigate the complex healthcare environment. It also emphasizes the pivotal role of nursing academia in integrating business education into program curricula. The Doctor of Nursing Practice/Master of Business Administration dual degree is presented as an innovative educational pathway designed to bridge this gap by providing comprehensive business knowledge and skills. With this degree, the next generation of nurse executives will be well-prepared to become ‘guardians at the gate’ in the complex world of healthcare, driving meaningful change and improving healthcare outcomes.
Amosy Ephreim M’Koma, M.D., M.S., Ph.D., AGA., ASCRS.ASI
Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College School of Medicine, Nashville, Tennessee, United States; Department of Pathology, Anatomy and Cell Biology, Meharry Medical College School of Medicine, Nashville General Hospital, Nashville, Tennessee, United States; Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Affiliated Scientist Investigator, The American Society of Colon, and Rectal Surgeons (ASCRS), Arlington Heights, IL 60005, Unite States; The American Gastroenterological Association (AGA), Bethesda, MD 20814, United States
Abstract
Inflammatory bowel disease has an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient’s psychological functioning and endoscopy services. Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn’s disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.
Ilham Zaidi
Advisor, International Society for Chronic Illnesses/ MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Jagadeeswari Vardha
MSC student, University of Glasgow, Scotland, United Kingdom
Abdul khayum
Medical Officer, Dept of Respiratory medicine, JSSMC, Mysuru, India
Sahifa Anjum
MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Shikhar Chaudhary
MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Aditi Bakshi
WHO- TDR scholar, IIHMR University, Jaipur, India
Jasmeen Kaur Gill
MPH Scholar, Indian Institute of Public Health Delhi, India
Jaiprakash Gurav
Advisor, International Society for Chronic Illnesses/ Scholar, Department of Medicine Armed Forces Medical College, Pune
Abstract
Tuberculosis (TB) along with pulmonary co-infections in patients became a grave concern to public health complicating the disease diagnosis, treatment, and prognosis. It became a challenge to healthcare professionals urging to develop new diagnostic tools and treatment regimens. This paper reviews the complex interplay and management strategies for Tuberculosis patients with co-infections. It encompasses antimicrobial therapy tailored to particular pathogens, including their susceptibility profiles to antibiotics, and understanding the potential implications of drug interactions with anti- Tuberculosis medications. In cases of co-infection between Tuberculosis and Human Immuno-Deficiency Virus (HIV), a particular focus is placed on the significance of synergistic methods and treatment duration.
Moreover, immunomodulatory drugs, immunotherapies, cellular treatments, adjunct therapies, and immunomodulatory agents that are customised to the patient’s immunological status and co-infecting pathogens emerge as a crucial component. Mitigating the transmission of pulmonary co-infections requires the implementation of infection control measures in both healthcare settings and communities. A strong barrier against the spread of tuberculosis and related illnesses is formed by administrative, engineering, and personal protective measures combined with screening, education, isolation, and contact tracking.
Prospective approaches underscore the necessity for enhanced diagnostic instruments, promoting cutting-edge technologies including molecular diagnostics, immunological tests, radiological imaging, biosensors, and point-of-care diagnostics. Comprehensive management is emphasised through multidisciplinary care comprising pulmonologists, infectious disease experts, microbiologists, and immunologists. Priorities for research include combination medications, new therapeutic approaches, personalised medicine, and developing diagnostic techniques to improve knowledge of and treatments for pulmonary co-infections.
Jacob Rosenberg Camilla Britt Sørensen
The Copenhagen Sequelae Center CARE, Department of Surgery, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark.
Birthe Thing Oggesen
The Copenhagen Sequelae Center CARE, Department of Surgery, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark.
Abstract
Late complications following colorectal cancer surgery are prevalent, with over 50% of patients experiencing bowel and stool symptoms, up to 70% facing urinary dysfunction, and sexual dysfunction affecting 76% of men and 56% of women. Additionally, 24-39% of patients report depressive symptoms within the first year post-surgery. Traditional physician-led outpatient care models often fail to address the multifaceted needs of these patients, focusing primarily on recurrence detection. In contrast, nurse-led clinics, which are gaining popularity in various areas of cancer care, offer a holistic approach that encompasses both physiological and psychosocial support. We established a specialized nurse-led outpatient clinic for managing late complications after colorectal and anal cancer surgeries. Our model empowers specialized nurses to diagnose and treat a wide range of symptoms independently, involving physicians only when necessary. This nurse-led approach leverages the unique strengths of nursing practice, including empathy, patient education, and comprehensive symptom management, to support patients’ transition to a “new normal” post-surgery. Nurses in our clinic follow treatment algorithms for common symptoms and consult with medical specialists for complex or unresponsive cases. The nurse-led clinic model enhances patient satisfaction, quality of life, and healthcare resource efficiency. However, challenges such as defining the scope of practice, ensuring adequate training, and integrating this model into existing healthcare systems must be addressed. Our experience suggests that this model can be broadly adopted across other healthcare areas. Future research should focus on evaluating long-term outcomes and strategies for broader implementation. In conclusion, integrating nurse-led consultations within a collaborative framework that includes doctors for specialized interventions represents a progressive approach to postoperative care for colorectal and anal cancer patients. This model promises to improve patient outcomes, satisfaction, and healthcare resource optimization by leveraging the holistic care approach of nurses alongside the specialized expertise of doctors.
