Availability of stroke services and hospital facilities at different hospital levels in Thailand: a cross-sectional survey study.

BACKGROUND: Stroke has one of the biggest burden of disease in Thailand and all health regions have been tasked to develop their service delivery to achieve the national key performance indicators set out by the Thai service plan strategy 2018-2022. Our aim was to characterise stroke services and hospital facilities by investigating differences in facilities across different hospital levels in Thailand. METHODS: Self-complete questionnaires were distributed to 119 hospitals in 12 health regions between November-December 2019. Participants were health professionals whose main responsibilities are related to stroke service provision in their hospital. Descriptive statistics were used to report differences of stroke service provision between advanced-level, standard-level and mid-level referral hospitals. RESULTS: Thirty-eight (32% response rate) completed questionnaires were returned. All advanced-level, standard-level (100%) and 55% of mid-level referral hospitals provided stroke units. Neurologists were available in advanced-level (100%) and standard-level referral hospitals (50%). Standard-level and mid-level referral hospitals only had a quarter of rehabilitation physicians compared to advanced-level referral hospital. Home-based rehabilitation was provided at 100% in mid-level but only at 16% and 50% in advanced-level and standard-level referral hospitals. CONCLUSIONS: Setting up a stroke unit, as a national goal that was set out in the service plan strategy 2018-2022, was achieved fully (100%) in advanced-level and standard-level referral hospitals including key essential supportive components. However, capacity in hospitals was found to be limited and stroke service delivery needs to be improved especially at mid-level referral hospitals. This should include regular organisational surveys and the use of electronic records to facilitate monitoring of clinical/health outcomes of patients.

On photovoice-Applications and reflections to an intensive care context.

BACKGROUND: In this paper, we share our experiences of using 'photovoice' methodology as a way to generate data in intensive care units concerning the place and space of care. We have adapted and modified 'photovoice' in researching people's lived experiences of ICU. Researching lived experiences in an intensive care context is challenging because of the complex nature of critical care. AIM: This study aims to explore and discuss photovoice methodolgy in ICU as a data collection method. MATERIALS AND METHODS: Photos and interviews collected from patients, loved ones and staff collected in a previous research proejct. RESULTS: Although there are challenges in using cameras and photographing the environment in the ICU, due to ethics and the voiceless patients therein, many advantages are presented to the researchers in capturing the meaning of lived experiences of various phenomena in the lifeworld in general and in the meaning of place and space. This paper offers applications and reflection over ontological, epistemological and methodological concerns and also offers a detailed approach on how to employ photovoice for successful and rich data generation. DISCUSSION: developing and adapting scientific methods and methodologies contributes to knowledge development in caring science and is therefore an important subject of matter. CONCLUSIONS: Photovoice also presents a powerful tool in disseminating the findings as it opens up the closed world of ICU to the public and increases people's understanding of the significance of place and space of caring practice.

Exploratory assessment of the occurrence of SARS-CoV-2 in aerosols in hospital facilities and public spaces of a metropolitan center in Brazil.

Although much has been discovered regarding the characteristics of SARS-CoV-2, its presence in aerosols and their implications in the context of the pandemic is still controversial. More research on this topic is needed to contribute to these discussions. Presented herein are the results of ongoing research to detect SARS-CoV-2 RNA in aerosol in different hospital facilities (indoor environments) and public spaces (outdoor environments) of a metropolitan center in Brazil. From May to August 2020, 62 samples were collected using active sampling method (air samplers with filters) and passive method (petri dishes) in two hospitals, with different occupancies and infrastructure for contamination control. Outdoor public spaces such as sidewalks and a bus station were also investigated. Five air samples from four facilities in a hospital tested positive for SARS-CoV-2 in suspended and sedimentable particles. SARS-CoV-2 was found in aerosols inside the Intensive Care Unit (ICU), in the protective apparel removal room, in the room containing patient mobile toilets and used clothes (room with natural ventilation) and in an external corridor adjacent to the ICU, probably coming from infected patients and/or from aerosolization of virus-laden particles on material/equipment. Our findings reinforce the hypothesis of airborne transmission of the new coronavirus, contributing to the planning of effective practices for pandemic control.

Assessment of Neonatal Mortality and Associated Hospital-Related Factors in Healthcare Facilities Within Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana.

Objectives: Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. Methods: The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies. Results: The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility. Conclusions: Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality.

Hospital-based salient prevention and control measures to counteract the 2022 monkeypox outbreak.

Monkeypox (MPX) has been declared a public health emergency of international concern by the World Health Organization. As of November 4, 2022, 78,000 verified cases from 109 countries and territories, and 40 deaths have been reported due to MPX. The present article highlights salient hospital-based prevention and control measures to be adopted and their critical role to mitigate the ongoing MPX outbreaks and global public health emergency.

Situational assessment of hospital facilities for modernization purposes and resilience improvement.

Modernization of hospital facilities is one of the objectives of administrators and decision-makers of healthcare systems. Hospital facilities are both complex and critical infrastructures, because they are characterized by high level of interconnections, dynamism, technological innovation, and because they offer health and social essential services. Decision-makers have to implement modernization strategies of hospital facilities in order to guarantee a high standard of care and a resilient response during disasters and emergencies. The critical role played by hospital facilities is acknowledge by the international action programs, including the 2030 Agenda of United Nations for Sustainable Development, and it has been emphasized by the COVID-19 pandemic. The paper illustrates the RADAR-Hospital Facilities methodology (RADAR-HF) developed for the situational assessment of the physical environment of hospital facilities. RADAR-HF provides the decision-makers with an overview of the main aspects for modernization (safety, functionality, sustainability, adaptability, comfort) and substantial information for planning interventions, considering hospital facilities as interconnected systems. The outcomes are represented by ad-hoc designed graphical indicators and overview-tools, that summarize the status-conditions of one or a set of existing hospital facilities, the upgrading needs, and the best occupancy of facilities. Decision-makers could use RADAR-HF to define integrated modernization strategies with resilience improvement, monitor the situation of the facilities, and understand the effectiveness of interventions. The paper ends showing the results obtained in a research project, in which RADAR-HF has been applied to assess the existing hospital facilities of the Friuli Venezia Giulia region (North-East of Italy).

Uso de leitos hospitalares privados por sistemas públicos de saúde na resposta à Covid-19 / Use of private hospital beds by public health systems in response to Covid-19

RESUMO Neste estudo, examinaram-se estratégias adotadas por países com sistemas públicos de saúde que expandiram a oferta de leitos por meio da utilização de hospitais privados na resposta à Covid-19. Utilizou-se estudo de casos selecionados para explorar o contexto institucional em que as medidas foram implementadas, os instrumentos de gestão utilizados e como se caracterizou a ação governamental em oito países: Austrália, Espanha, Irlanda, Itália, Chile, México e Peru, além do Brasil. Esta análise pode auxiliar a identificar mecanismos de gestão de sistema de saúde necessários para a coordenação de ações governamentais para resposta a situações de Emergência em Saúde Pública (ESP), bem como para aperfeiçoar a governança dos sistemas de saúde na relação entre os setores público e privado.

ABSTRACT In this study, strategies adopted by countries with public health systems that expanded the supply of beds through the use of private hospitals in response to Covid-19 were examined. The study of selected cases was used to explore the institutional context in which measures were implemented, the management tools used and how to characterize government action in eight countries: Australia, Spain, Ireland, Italy, Chile, Mexico and Peru, in addition to Brazil. This analysis can help to identify health system management mechanisms necessary for the coordination of government actions to respond to Public Health Emergency situations, as well as improve the governance of health systems in the relationship between public and private sectors.

Use of private hospital beds by public health systems in response to COVID-19 / Uso de leitos hospitalares privados por sistemas públicos de saúde na resposta à COVID-19

In this study we examined strategies adopted by countries with public health systems that expanded the supply of beds through the use of private hospitals in response to COVID-19. We used selected case studies to explore the institutional context in which measures were implemented, the management instruments used and how to characterize government action in eight countries: Australia, Spain, Ireland, Italy, Chile, Mexico and Peru, in addition to Brazil. This analysis can help to identify mechanisms of health system management that can control actions to respond to ESP situations, as well as improve the governance of health systems in the relationship between public and private sectors.

Nesse estudo examinamos estratégias adotadas por países com sistemas públicos de saúde que expandiram a oferta de leitos por meio da utilização de hospitais privados na resposta à COVID-19. Utilizamos estudo de casos selecionados para explorar o contexto institucional em que as medidas foram implementadas, os instrumentos de gestão utilizados e como se caracterizou a ação governamental em oito países: Austrália, Espanha, Irlanda, Itália, Chile, México e Peru, além do Brasil. Essa análise pode auxiliar a identificar mecanismos de gestão de sistema de saúde necessários para a coordenação de ações governamentais para resposta a situações de ESP, bem como para aperfeiçoar a governança dos sistemas de saúde na relação entre setores público e privado.