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1.
J Thorac Cardiovasc Surg ; 161(6): 2108-2113, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33840466

RESUMO

BACKGROUND: Rheumatic heart disease (RHD) affects more than 33,000,000 individuals, mostly from low- and middle-income countries. The Cape Town Declaration On Access to Cardiac Surgery in the Developing World was published in August 2018, signaling the commitment of the global cardiac surgery and cardiology communities to improving care for RHD patients. METHODS: As the Cape Town Declaration formed the basis for which the Cardiac Surgery Intersociety Alliance (CSIA) was formed, the purpose of this article is to describe the history of the CSIA, its formation, ongoing activities, and future directions, including the announcement of selected pilot sites. RESULTS: The CSIA is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment, and publication of selection criteria for cardiac surgery centers to apply for CSIA support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care, and desire to engage in future research. Eleven applications were received for which three finalist sites were selected and site visits conducted. The two selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda). CONCLUSIONS: Substantial progress has been made since the passing of the Cape Town Declaration and the formation of the CSIA, but ongoing efforts with collaboration of all committed parties-cardiac surgery, cardiology, industry, and government-will be necessary to improve access to life-saving cardiac surgery for RHD patients.


Assuntos
Fortalecimento Institucional/organização & administração , Cardiopatia Reumática/cirurgia , Cirurgia Torácica/organização & administração , Humanos , Moçambique , Ruanda
2.
Int J Health Serv ; 51(3): 300-304, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33684016

RESUMO

The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and concern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society's unmet needs.


Assuntos
COVID-19/epidemiologia , Saúde Global , Disparidades nos Níveis de Saúde , Fortalecimento Institucional/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Equidade em Saúde/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , SARS-CoV-2
3.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 79-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666916

RESUMO

BACKGROUND: Keller Army Community Hospital, a 12-bed community hospital located in the Hudson Valley of New York State, within the pandemic epicenter anticipated the surge of critically ill patients, which would overwhelm local resources during the coronavirus pandemic sweeping across the globe. In this facility, there were no Intensive Care Unit (ICU) beds and resources were mobilized in order to create a negative pressure Corona Virus Unit (CVU) consisting of seven ICU beds and two step-down beds. Although the creation of the CVU decreased the non-COVID inpatient capacity to five beds, the hospital also formulated a plan to expand overall bed capacity from 12 inpatient beds to 45 beds within 24 hours. OBJECTIVE: To create a ICU embedded within a CVU and implement a three day curriculum to prepare four mixed teams of critical care and non-critical care staff nurses to manage critically ill patients with the novel coronavirus disease 2019 (COVID-19). METHODS: Nursing leaders and hospital education staff developed a critical care curriculum utilizing Elsevier didactic, the DoD COVID-19 Practice Guide, and hands-on training for 34 nurses.1,2 Nurses had varied scope of practice levels from licensed practical nurses to advance practice nurses, with diverse critical care expertise to non-critical care nursing staff from the primary care medical home (PCMH), all of which participated in the cross-leveling to the CVU unit during the pandemic response. Educational elements included PPE donning and doffing, mechanical ventilation, central venous catheter maintenance, arterial catheter management, hemodynamics, and critical care pharmacotherapy. A medical model skills station with common critical care equipment such as ventilators allowed for instantaneous feedback and 13 hands-on skills training. RESULTS: A fully functional ICU and CVU was created with thirty-four nurses who completed training within seven days with a didactic completing rate of 94.65 % and 100% hands-on skills. The program endures with monthly tailored re-fresher training to improve efficiency and maintain critical competencies. The team maintained operational readiness through the surge and remain resolute for the next surge. CONCLUSIONS: On-going program execution and evaluation continues to develop new staff members due to permanent change of station, recent on-boarding, or because of evidence based clinical guideline changes. Training has continued, but shifted to include normal inpatient operations over the summer of 2020. Re-fresher classes covering the treatment and care of COVID patients continue with the anticipation of a second wave surge of COVID-19 cases emerges this fall based on epidemiology predictions.


Assuntos
COVID-19/terapia , Fortalecimento Institucional/organização & administração , Cuidados Críticos/organização & administração , Currículo , Hospitais Militares , Capacidade de Resposta ante Emergências/organização & administração , COVID-19/epidemiologia , Número de Leitos em Hospital , Hospitais Comunitários , Humanos , New York
4.
Lancet Gastroenterol Hepatol ; 6(5): 381-390, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33713606

RESUMO

BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.


Assuntos
COVID-19 , Fortalecimento Institucional , Endoscopia do Sistema Digestório , Gastroenteropatias , Utilização de Procedimentos e Técnicas , Triagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Gestão de Mudança , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Imunoquímica , Controle de Infecções , Avaliação de Processos e Resultados em Cuidados de Saúde , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , SARS-CoV-2 , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Triagem/métodos , Triagem/estatística & dados numéricos , Reino Unido/epidemiologia , Listas de Espera
5.
JAMA Netw Open ; 4(3): e212382, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739431

RESUMO

Importance: The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. Objective: To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. Design, Setting, and Participants: In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. Main Outcomes and Measures: Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. Results: A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. Conclusions and Relevance: The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.


Assuntos
Fortalecimento Institucional , Gestão de Mudança , Defesa Civil/organização & administração , Planejamento em Desastres/métodos , Surtos de Doenças , Influenza Humana , COVID-19/epidemiologia , COVID-19/prevenção & controle , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/terapia , Administração de Recursos Humanos/métodos , Pesquisa Qualitativa , SARS-CoV-2 , Estações do Ano , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
6.
Nurs Adm Q ; 45(2): 85-93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570875

RESUMO

When the Covid 19 pandemic affected New York State, Federal and mostly State, mandates were given to hospitals to prepare for the expected influx of patients. This is a community hospital's planning journey that includes preparing for placing patients, educating caregivers, matching the abilities of the available caregivers with the needs of the patients, securing needed equipment and supplies, and caring for the caregivers. Planning for patient placement resulted in a phased-in guide, accommodating seriously and critically ill affected patients. Education and training were initial and ongoing, rapidly changing as new information became available. Effective care delivery models that focused on team were modified depending on the needs of patients and staff competence. Securing and maintaining equipment and supplies were challenging and caring for the caregivers was a priority. Working as a team, this community hospital developed a road map that was effective in planning for the surge and allowed the hospital to maintain a safe environment for staff and patients who received quality care in difficult time.


Assuntos
COVID-19/epidemiologia , Fortalecimento Institucional/organização & administração , Pessoal de Saúde/educação , Hospitais Comunitários/organização & administração , Humanos , New York/epidemiologia , Pandemias , Equipamento de Proteção Individual/provisão & distribuição , SARS-CoV-2
7.
J Occup Environ Med ; 63(5): 411-421, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560069

RESUMO

OBJECTIVES: To describe the process used to build capacity for wider dissemination of a Total Worker Health® (TWH) model using the infrastructure of a health and well-being vendor organization. METHODS: A multiple-case study mixed-methods design was used to learn from a year-long investigation of the experiences by participating organizations. RESULTS: Increased capacity for TWH solutions was observed as evidenced by the participation, plans of action, and experience ratings of the participating organizations. The planning process was feasible and acceptable, although the challenges of dealing with the COVID-19 pandemic only afforded two of the three worksites to deliver a comprehensive written action plan. CONCLUSIONS: A suite of services including guidelines, trainings, and technical assistance is feasible to support planning, acceptable to the companies that participated, and supports employers in applying the TWH knowledge base into practice.


Assuntos
Fortalecimento Institucional/organização & administração , Promoção da Saúde/organização & administração , Modelos Organizacionais , Fortalecimento Institucional/métodos , Estudos de Viabilidade , Guias como Assunto , Promoção da Saúde/métodos , Humanos , Estudos de Casos Organizacionais , Projetos Piloto
8.
J Am Board Fam Med ; 34(Suppl): S55-S60, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622819

RESUMO

BACKGROUND: The COVID-19 (C-19) pandemic required swift response from health care organizations to mitigate spread and impact. A large integrated health network rapidly deployed and operationalized multiple access channels to the community, allowing assessment and triage to occur virtually. These channels were characterized by swift implementation of virtual models, including asynchronous e-visits and video visits for C-19 screening. PURPOSE: (1) Evaluate implementation characteristics of C-19 screening e-visits and video visits. (2) Identify volume of C-19 screening and other care provided via e-visits and video visits. (3) Discuss future implications of expanded virtual access models. METHODS: Retrospective analysis of implementation data for C-19 screening e-visits and video visits, including operational characteristics and visit/screening volumes conducted. RESULTS: Virtual channels were implemented and rapidly expanded during the first week C-19 testing was made available. During the study period, primary care clinicians conducted 10,673 e-visits and 31,226 video visits with 9,126 and 26,009 patients, respectively. Within these 2 virtual modalities, 4,267 C-19 tests were ordered (10% of visits). Four hundred forty-eight clinicians supported 24/7 access to these virtual modalities. DISCUSSION: Given ongoing patient interest and opportunity, virtual health care services will continue to be available for an expanded number of symptoms and diagnoses.


Assuntos
Fortalecimento Institucional/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Telemedicina/métodos , COVID-19/epidemiologia , COVID-19/terapia , Humanos , Programas de Rastreamento/métodos , Pandemias , Atenção Primária à Saúde/organização & administração , Estudos Retrospectivos , SARS-CoV-2
10.
Nurs Adm Q ; 45(2): 102-108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570876

RESUMO

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.


Assuntos
COVID-19/epidemiologia , Fortalecimento Institucional/organização & administração , Arquitetura Hospitalar/métodos , Unidades Móveis de Saúde/organização & administração , Boston , Feminino , Humanos , Liderança , Masculino , Unidades Móveis de Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Incerteza
11.
Nurs Adm Q ; 45(2): 126-134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570880

RESUMO

This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.


Assuntos
Centros Médicos Acadêmicos/organização & administração , American Nurses' Association/organização & administração , COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Liderança , Fortalecimento Institucional/organização & administração , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , SARS-CoV-2
12.
J Plast Reconstr Aesthet Surg ; 74(2): 396-400, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33051175

RESUMO

Clinical governance is the structured approach to maintaining and improving the quality of patient care and is a vital part of global surgery. BFIRST and BSSH closely collaborate with local doctors on a number of overseas projects, seeking to strengthen and develop local knowledge and skills, aiming for an independent local practice in reconstructive and upper limb surgery. Thoughts on essential requirements, improvements and pitfalls in the ethical approach to global collaboratives are presented.


Assuntos
Missões Médicas/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Procedimentos Cirúrgicos Reconstrutivos/normas , Assistência ao Convalescente , Fortalecimento Institucional/organização & administração , Saúde Global , Humanos , Consentimento Livre e Esclarecido , Garantia da Qualidade dos Cuidados de Saúde/métodos
13.
J Nurs Manag ; 29(3): 412-420, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33107099

RESUMO

AIM: This study aims to report on the actions and incident management of the advanced practice nurses of a disaster operation team who were deployed in response to the COVID-19 outbreak, and to explore how it illustrated the Core Competencies in Disaster Nursing Version 2.0 delineated by the International Council of Nurses in 2019. METHODS: This is a descriptive study. The participants (responders) communicated and reported their actions in the operation with headquarter on a popular social media platform in China (WeChat), established specifically for the three-rescue teams. RESULTS: The response approach of advanced nurses to COVID-19 encompassed six of the eight domains of the competencies outlined in ICN CCDN V2.0, namely on preparation and planning, communication, incident management systems, safety and security, assessment and intervention. CONCLUSIONS: The response teams of advanced practice nurses in this study clearly demonstrated their competencies in disaster rescue, which fulfilled most of the core competencies set forth by the ICN. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study contributed to understand the roles played by advanced practice nurses and nurse managers in disaster management and how these relate to the competencies set forth by the ICN.


Assuntos
Prática Avançada de Enfermagem/organização & administração , COVID-19/epidemiologia , COVID-19/enfermagem , Competência Clínica/normas , Desastres , Enfermeiras Administradoras/organização & administração , Prática Avançada de Enfermagem/normas , Fortalecimento Institucional/organização & administração , China/epidemiologia , Protocolos Clínicos/normas , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Masculino , Saúde Mental , Enfermeiras Administradoras/normas , SARS-CoV-2 , Triagem/organização & administração , Fluxo de Trabalho
15.
J Pediatr Adolesc Gynecol ; 34(1): 26-32, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32730800

RESUMO

STUDY OBJECTIVES: Many pediatric providers serving adolescents are not trained to offer comprehensive contraceptive services, including intrauterine devices (IUDs) and implants, despite high safety and satisfaction among adolescents. This study assessed an initiative to train providers at school-based health centers (SBHCs) to offer students the full range of contraceptive methods. DESIGN: Surveys were administered at baseline pre-training and at follow-up 3 months post-training. Data were analyzed using generalized estimating equations for clustered data to examine clinical practice changes. SETTING: Eleven contraceptive trainings at SBHCs across the United States from 2016-2019. PARTICIPANTS: A total of 260 providers from 158 SBHCs serving 135,800 students. INTERVENTIONS: On-site training to strengthen patient-centered counseling and to equip practitioners to integrate IUDs and implants into contraceptive services. MAIN OUTCOME MEASURES: The outcomes included counseling experience on IUDs and implants, knowledge of patient eligibility, and clinician method skills. RESULTS: At follow-up, providers were significantly more likely to report having enough experience to counsel on IUDs (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.62-6.36]) and implants (aOR, 3.06; 95% CI, 2.05-4.57). Provider knowledge about patient eligibility for IUDs, including for adolescents, increased (P < .001). Providers were more likely to offer same-visit IUD (aOR, 2.10; 95% CI, 1.41-3.12) and implant services (aOR, 1.66; 95% CI, 1.44-1.91). Clinicians' skills with contraceptive devices improved, including for a newly available low-cost IUD (aOR, 2.21; 95% CI, 1.45-3.36). CONCLUSIONS: Offering evidence-based training is a promising approach to increase counseling and access to comprehensive contraceptive services at SBHCs.


Assuntos
Fortalecimento Institucional/organização & administração , Anticoncepção/métodos , Aconselhamento/educação , Serviços de Saúde Escolar/organização & administração , Adolescente , Competência Clínica , Aconselhamento/métodos , Feminino , Humanos , Dispositivos Intrauterinos , Inquéritos e Questionários , Estados Unidos
17.
Global Health ; 16(1): 120, 2020 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-33380341

RESUMO

BACKGROUND: The importance of integrating the social sciences in epidemic preparedness and response has become a common feature of infectious disease policy and practice debates. However to date, this integration remains inadequate, fragmented and under-funded, with limited reach and small initial investments. Based on data collected prior to the COVID-19 pandemic, in this paper we analysed the variety of knowledge, infrastructure and funding gaps that hinder the full integration of the social sciences in epidemics and present a strategic framework for addressing them. METHODS: Senior social scientists with expertise in public health emergencies facilitated expert deliberations, and conducted 75 key informant interviews, a consultation with 20 expert social scientists from Africa, Asia and Europe, 2 focus groups and a literature review of 128 identified high-priority peer reviewed articles. We also analysed 56 interviews from the Ebola 100 project, collected just after the West African Ebola epidemic. Analysis was conducted on gaps and recommendations. These were inductively classified according to various themes during two group prioritization exercises. The project was conducted between February and May 2019. Findings from the report were used to inform strategic prioritization of global investments in social science capacities for health emergencies. FINDINGS: Our analysis consolidated 12 knowledge and infrastructure gaps and 38 recommendations from an initial list of 600 gaps and 220 recommendations. In developing our framework, we clustered these into three areas: 1) Recommendations to improve core social science response capacities, including investments in: human resources within response agencies; the creation of social science data analysis capacities at field and global level; mechanisms for operationalizing knowledge; and a set of rapid deployment infrastructures; 2) Recommendations to strengthen applied and basic social sciences, including the need to: better define the social science agenda and core competencies; support innovative interdisciplinary science; make concerted investments in developing field ready tools and building the evidence-base; and develop codes of conduct; and 3) Recommendations for a supportive social science ecosystem, including: the essential foundational investments in institutional development; training and capacity building; awareness-raising activities with allied disciplines; and lastly, support for a community of practice. INTERPRETATION: Comprehensively integrating social science into the epidemic preparedness and response architecture demands multifaceted investments on par with allied disciplines, such as epidemiology and virology. Building core capacities and competencies should occur at multiple levels, grounded in country-led capacity building. Social science should not be a parallel system, nor should it be "siloed" into risk communication and community engagement. Rather, it should be integrated across existing systems and networks, and deploy interdisciplinary knowledge "transversally" across all preparedness and response sectors and pillars. Future work should update this framework to account for the impact of the COVID-19 pandemic on the institutional landscape.


Assuntos
Fortalecimento Institucional/organização & administração , Controle de Doenças Transmissíveis/organização & administração , Epidemias/prevenção & controle , Saúde Global , Ciências Sociais/organização & administração , Humanos , Pesquisa Qualitativa
18.
Int J Behav Nutr Phys Act ; 17(1): 162, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308237

RESUMO

BACKGROUND: School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. METHODS: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). RESULTS: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. CONCLUSIONS: The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.


Assuntos
Fortalecimento Institucional/métodos , Saúde da Criança , Implementação de Plano de Saúde/métodos , Promoção da Saúde/métodos , Serviços de Saúde Escolar , Adolescente , Fortalecimento Institucional/organização & administração , Criança , Política de Saúde , Estilo de Vida Saudável , Humanos , Iowa , Masculino , Serviços de Saúde Escolar/organização & administração , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
19.
Glob Health Action ; 13(1): 1823101, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33023408

RESUMO

In-service nurse mentoring is increasingly seen as a way to strengthen the quality of health care in rural areas, where healthworkers are scarce. Despite this, the evidence base for designing large-scale programs remains relatively thin. In this capacity-building article, we reflect on the limited evidence that exists and introduce features of the world's largest program, run by CARE-India since 2015. Detail on the mechanics of large-scale programs is often missing from empirical research studies, but is a crucial aspect of organizational learning and development. Moreover, by focusing on the complex ways in which capacity-building is being institutionalized through an embedded model of in-service mentorship, this article bridges research and practice. We point to a number of areas that require further research as well as considerations for program managers designing comparable workforce strengthening programs. With careful planning and cross-national policy learning, we propose that in-service nurse mentoring may offer a cost-effective and appropriate workforce development approach in a variety of settings.


Assuntos
Tutoria/organização & administração , Tocologia/educação , Desenvolvimento de Pessoal/organização & administração , Fortalecimento Institucional/organização & administração , Pesquisa sobre Serviços de Saúde , Humanos , Índia
20.
Glob Health Action ; 13(1): 1831794, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33086945

RESUMO

BACKGROUND: Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). OBJECTIVE: This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. METHODS: Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) - a combination of OD and ICW - were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants' course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. RESULTS: Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). CONCLUSION: The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.


Assuntos
Países em Desenvolvimento , Educação à Distância/organização & administração , Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Desnutrição/epidemiologia , Fortalecimento Institucional/organização & administração , Currículo , Gana , Humanos , Aprendizagem , Estudos Longitudinais , Estudos Prospectivos
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