Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Impact of correlated private signals on continuous-time insider trading

A model of continuous-time insider trading in which a risk-neutral in-sider possesses two imperfect correlated signals of a risky asset is studied.By conditional expectation theory and filtering theory,we first establish three lemmas:normal corre-lation,equivalent pricing and equivalent profit,which can guarantee to turn our model into a model with insider knowing full information.Then we investigate the impact of the two correlated signals on the market equilibrium consisting of optimal insider trading strategy and semi-strong pricing rule.It shows that in the equilibrium,(1)the market depth is constant over time;(2)if the two noisy signals are not linerly correlated,then all private information of the insider is incorporated into prices in the end while the whole information on the asset value can not incorporated into prices in the end;(3)if the two noisy signals are linear correlated such that the insider can infer the whole information of the asset value,then our model turns into a model with insider knowing full information;(4)if the two noisy signals are the same then the total ex ant profit of the insider is increasing with the noise decreasing,while down to O as the noise going up to infinity;(5)if the two noisy signals are not linear correlated then with one noisy signal fixed,the total ex ante profit of the insider is single-peaked with a unique minimum with respect to the other noisy signal value,and furthermore as the noisy value going to O it gets its maximum,the profit in the case that the real value is observed.

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Construction of competency evaluation system for infection control personnel in traditional Chinese medicine hospitals

Background:This study uses a literature review and the Delphi expert consultation method to construct a competency evaluation model for infection control personnel in traditional Chinese medicine(TCM)hospitals.The aim is to strengthen infection control management in TCM hospitals,assess the competency of infection control personnel in their positions,and assist them in identifying the competencies that need improvement.Methods:Based on the literature research method and the Delphi expert consultation method,a competency model for the position was constructed through two rounds of expert consultations,analyzing the relationships between various factors and establishing a hierarchical structure model.Pairwise comparisons were made among the elements at the same level to construct a judgment matrix.Through the analytic hierarchy process,the weight coefficients of the indicators at each level in the competency model were obtained.Results:This study conducted a comprehensive assessment of various capabilities and practices related to hospital infection control.The survey results indicate that participants excelled in multiple areas,with a high overall satisfaction rate.95.28%of participants were able to develop hospital infection monitoring plans based on national infection control policies,demonstrating a good understanding and execution of these policies.94.09%of participants were familiar with high-risk populations and key departments in the hospital.91.73%of participants were able to establish monitoring scopes based on the trends of multidrug-resistant bacteria and conduct information monitoring,reflecting strong response capabilities.92.91%of participants were able to collaborate with relevant departments to conduct bacterial resistance monitoring,showing a good team spirit.94.49%of participants were able to perform targeted monitoring,including surgical site infections,indicating that they have effective monitoring strategies.91.34%of participants were able to collect and organize monitoring data and establish a systematic database,demonstrating good data management skills.90.16%of participants were able to interpret laws and regulations related to hospital infection management,indicating a high level of legal knowledge.89.37%of participants generally possessed good communication skills.92.52%of participants were able to guide medical staff on occupational safety and protective knowledge,showing an emphasis on occupational health.Participants demonstrated a strong desire to learn and innovate,with 87.01%actively participating in continuing education and research activities,reflecting a pursuit of professional development.Conclusion:Based on the results of the two rounds of expert consultations,a competency evaluation model for infection control personnel in TCM hospitals was formed.Through the analytic hierarchy process,the weight coefficients of various indicators at different levels in the model were obtained,and the research results have good scientific validity and reliability.

Research on the Innovative Decisions of Supermarket Private Brands and Designated Manufacturers

One of the core competencies of a supermarket lies in its branding.With the continuous development of the market economy and the ongoing evolution of consumer demand,private brands have progressively emerged as significant contributors to supermarket growth.However,a pivotal developmental challenge for supermarkets is navigating the innovative decision-making process between private brands and designated manufacturers.This paper aims to investigate the innovative decisions between private brands and designated manufacturers,along with the relevant promotional strategies employed during entry into the United States market.

Research on the Development Path and Mechanism of“Double-Qualified”Teachers in Private Universities Under the Background of Digital Transformation

This article explores the development path and mechanism of“double-qualified”teachers in private universities under digital transformation.Through literature review,theoretical analysis,and other research methods,this study conducts an in-depth analysis of the impact of digital technology on the development of“double-qualified”teachers in private colleges and universities and puts forward corresponding strategies and suggestions.Research shows that digital transformation provides new opportunities and challenges for developing“double-qualified”teachers in private colleges and universities.To adapt to this trend,teachers must continuously improve their digital skills,and schools should establish a complete incentive mechanism and evaluation system,strengthen school-enterprise cooperation and the integration of industry and education to promote the comprehensive development of“double-qualified”teachers,and provide a useful guideline for private universities to promote the development of“double-qualified”teachers in digital transformation.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Management Measures for Preventing Postoperative Incision Infections in General Surgery at Primary Hospitals

Objective:To analyze the management measures and effects of preventing postoperative incision infections in the general surgery department of primary hospitals.Methods:Forty-nine surgical patients with 11 healthcare workers who were admitted to the general surgery department of the primary hospital between August 2021 and August 2022 were selected as the routine group for routine incision infection management.Forty-nine surgical patients with 11 healthcare workers admitted to the same department between September 2022 and September 2023 were selected as the prevention group for prophylactic management of postoperative incision infections.The incision infection rate,knowledge,attitude,and practice(KAP)scores,and management satisfaction of the patients as well as the management skill scores of healthcare workers were compared between the two groups.Results:The rate of postoperative incision infection in the prevention group was lower than that in the routine group;after implementing management measures,patients in the prevention group had higher KAP scores than those in the routine group;patients in the prevention group were more satisfied with the management than those in the routine group;and healthcare workers in the prevention group had higher scores than those in the routine group,with P<0.05 for the comparison between the groups.Conclusion:The implementation of preventive management for general surgery patients in primary hospitals can reduce the incidence of postoperative incision infection and improve the KAP of patients,with higher management satisfaction.It can also enhance the management skills of healthcare workers,thus improving their overall management level.

Comparative Analysis of Differences among Northern,Jiangnan,and Lingnan Classical Private Gardens Using Principal Component Cluster Method

This paper investigates the design essence of Chinese classical private gardens,integrating their design elements and fundamental principles.It systematically analyzes the unique characteristics and differences among classical private gardens in the Northern,Jiangnan,and Lingnan regions.The study examines nine classical private gardens from Northern China,Jiangnan,and Lingnan by utilizing the advanced tool of principal component cluster analysis.Based on literature analysis and field research,273 variables were selected for principal component analysis,from which four components with higher contribution rates were chosen for further study.Subsequently,we employed clustering analysis techniques to compare the differences among the three types of gardens.The results reveal that the first principal component effectively highlights the differences between Jiangnan and Lingnan private gardens.The second principal component serves as the key to defining the types of Northern private gardens and distinguishing them from the other two types,and the third principal component indicates that Lingnan private gardens can be categorized into two distinct types as well.

A Study on the Internal Control and Countermeasures of Fixed Assets in Private Universities:A Case Study of N College

Fixed assets in universities occupy an important position in university management due to their wide coverage and large amount of money.Due to insufficient funding supply,private universities mainly focus on the allocation and utilization of fixed assets,which reflects the overall characteristics of cautious allocation,maximum utilization,and delayed elimination in the actual management of fixed assets.This article aims to conduct research and analysis on the entire lifecycle process of the allocation,use,and disposal of fixed assets in private universities,summarize the problems existing in the internal control of fixed assets in private universities,and propose corresponding countermeasures and suggestions in a targeted manner.

A Comparative Analysis of the Control Effect of Medical Expenses between General Hospitals and Traditional Chinese Medicine Hospitals from 2012 to 2021

Objective To analyze the changing trend of average medical expenses and structure in general hospitals and traditional Chinese medicine(TCM)hospitals and the effects and differences achieved by the two kinds of hospitals through controlling unreasonable growth of medical expenses,so as to provide reference for controlling the rapid rise of medical cost in public hospitals and optimizing the cost structure.Methods Based on the changes of related indicators of medical expense control from 2012 to 2021,the overall characteristics,changes of cost structure and trends of medical expenses in general hospitals and TCM hospitals were investigated.Results and Conclusion From 2012 to 2021,the increase of medical expenses in general hospitals and traditional Chinese medicine hospitals had slowed down,the proportion of drug revenue to medical income began to decline,and the medical service income increased.However,the proportion of inspection,test and sanitary materials income has increased instead of decreasing,but the management cost has decreased.The two kinds of hospitals have achieved certain cost control results,the structure of medical cost has changed greatly,and the technical service and labor value of medical personnel have been reflected to a certain extent.However,it is still necessary to explore a more scientific and reasonable cost control mechanism to promote the further optimization of medical cost structure.

Research on the High-Quality Development Path of Listed Private Education Groups

The rapid growth of the education industry and private education groups has brought the high-quality development of listed private education companies into focus for both the educational sector and the capital market.This study employs the fuzzy-set qualitative comparative analysis(fsQCA)method to explore pathways to high-quality development for these companies.Necessity analysis confirms that no single factor guarantees a company’s success,highlighting the importance of multi-factor interactions.Three main paths to high-quality development are identified:human resource optimization,precise market positioning,and comprehensive advantage.Conversely,four development paths for non-high-level companies are identified:dual insufficiency in resources and market,high turnover and over-investment,scale expansion with resource mismatch,and inadequate human resource development.The findings indicate that optimal allocation of educational resources,precise market positioning,rational resource allocation,and staff training are crucial for achieving high-quality development.Robustness tests,which raise the consistency threshold,verify the reliability and stability of the results.These findings provide a reference for policymakers,investors,and managers in the education industry.

Challenges and Countermeasures for Private Universities in Providing Education for International Students

Private universities are one of the forces driving the internationalization of higher education in China.Private universities are taking advantage of the trend to provide education for international students,playing an important role in the high-quality development of higher education in China.However,they also face challenges such as insufficient policy support,lack of management experience,and limited enrollment channels.Breakthroughs can be made through methods such as refining content,expanding enrollment channels,and attracting talent.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

What Business Models Best Suit the Private Sector in Achieving the SDGs

Since the United Nations Sustainable development goals and the 2030 agenda were initiated in 2015,it has provided governments with a comprehensive blueprint to take action and meet the challenges of the world’s most pressing issues today.But the private sector also plays a large role in contributing to the problems highlighted in the SDGs and companies ranging from many different industries have increasingly become more involved in developing new and innovative solutions to solve the issues highlighted in the SDGs.Social and environmental accountability has been one of the areas that the private sector has been focusing its attention on.Companies in the corporate sector across all industries have adopted Environmental,Social,and Governance(ESG)regulations and targets,that aim to ensure ethical responsibility within private companies and promote transparency about their role in promoting social and environmental well-being across the world.This has allowed many companies to align their values and business models to emphasize the importance of the SDGs.Furthermore,innovative technologies are being utilized to ensure that public reports about the company’s practices are fully accountable and transparent to the public community and the overall private sector.For example,some private companies are using Natural Language Processing and Artificial Intelligence to analyze sustainable practices highlighted in the company’s ESG reports and see if they are genuine and free of greenwashing.This shows that technologies are playing a key role in promoting corporate accountability in terms of sustainability and encouraging private companies to adhere to the guidelines highlighted within the SDGs.Furthermore,private companies have adapted their business models to better promote innovations and collaboration with governments,other private companies as well as NGOs.Since the SDGs were designed to be interconnected and not siloed into their own different challenges,many companies who adopt the SDGs as a major sustainability framework will often develop partnerships and connections with other private sector groups so that they could develop new innovative solutions to meet the challenges posed by current global issues.This is especially prevalent in the clean energy sector,which aims to solve SDG 7 and SDG 13 both important in eradicating the issue of climate change.For example,the solar energy private sector has been currently collaborating with a wide range of universities and research institutions in order to develop solar panels that are more energy efficient and affordable for everyday consumers,while still allowing the private companies to generate significant returns in revenue.When private sector Industries adopt the measures highlighted in the SDGs,not only does it allow them to work with other industries to contribute to combating the world’s most pressing issues,but also maintains and improves their sources of revenue and profit.Overall,in order to meet the world’s most pressing challenges and issues,the private sector has increasingly adopted the SDGs in their business models,so that they would be able to better collaborate with others to develop innovative solutions and to bridge commitment to sustainable development throughout different industries.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Research on the Relationship between the School-Running Characteristics of Private Colleges and Universities and the Development Objectives of the Government

The development objectives of the Chinese government have a guiding effect on the school-running characteristics of private colleges and universities.This paper explores the relationship between the characteristics of private colleges and universities and the development objectives of the provincial government,using Jiangsu Province as a case study.All the schools have the consciousness of fully considering the development objectives of Jiangsu Province when formulating the school-running characteristics.Their characteristics all contain some training methods,training courses,or institutional construction aiming at the development objectives.Most universities can support the government’s objectives on employment and innovation.Only a third of the schools provide government support for science research.Private colleges and universities should make full use of the free and flexible advantages of private education,combine them with the continuous changes of policies and markets,and create clear,scientific,and dynamic school-running characteristics,in order to achieve long-term development.

The Nigeria Government Engagement with the Private Health Sector

In Nigeria, the healthcare sector is divided into primary health which is under the local government’s authority that oversees the Primary Health centers, secondary health which is under the supervision of the State Ministry of Health in charge of the State General Hospitals that cater to primary and secondary healthcare. Tertiary health is supervised by the Federal Ministry of Health that oversees the Federal Medical Centres, the Teaching Hospitals, and Specialist Training Centres. Not to be excluded from Nigeria’s healthcare system are the private clinics and the public-private partnership. The funding for healthcare systems is mainly budgetary allocations from the government. This systemic review was done using secondary literature, policy documents, peer-reviewed literature, and national newspapers, collected using search engines such as Google Scholar, PubMed, and Medline. The review was done over 2-month period from February-April 2024. The literature was arranged in order of relevance and the literature not used was kept aside. The World Health Organization (WHO) has recommended that 11% of a country’s budget be allocated to health. African countries that make up the African Union (AU) recommended that 15% of each member African country’s yearly budget should be committed to providing healthcare services to her citizens. Unfortunately, Nigeria has yet to attain either the WHO target or the AU target while committing an average, of 6% of her budgetary allocation to health. On the other hand, her neighbouring West African country Ghana, has met the average of 15% recommended by AU. The improved National Health Insurance Authority and the government’s partnership with the private health sector in Public-Private Partnership (PPP) is hoped and would improve access to affordable healthcare in general and oral healthcare in particular.