The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding dec...The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding decade.Twenty-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be performed.This policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and workforce.Additionally,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.展开更多
Introduction: Caesarean section is the delivery of a foetus through an incision made on the uterus. It is useful in situations where vaginal delivery is not feasible. Women in our setting usually see it as a reproduct...Introduction: Caesarean section is the delivery of a foetus through an incision made on the uterus. It is useful in situations where vaginal delivery is not feasible. Women in our setting usually see it as a reproductive failure and a sign of weakness. Our aim was to evaluate the perception of caesarean section among pregnant women attending antenatal clinic in a rural missionary hospital. Methodology: This was a cross-sectional study conducted at Mile 4 missionary hospital, Abakaliki among women attending routine antenatal clinic. Information was obtained from respondents with the aid of a questionnaire. Ethical clearance was obtained for the study. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 209 pregnant women participated in this study. Their age ranged from 14 to 43 with a mean age of 27 ± 5 years. One hundred and seventy two women (82.3%) have heard of caesarean section in the past. Eighteen (8.6%) have had caesarean section in the past while 5 were not willing to undergo the procedure again. Sixty (28.7%) are not willing to undergo caesarean section even when it is indicated. Conclusion: Despite awareness of caesarean section, women do not appear to have a positive attitude towards the procedure.展开更多
<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpart...<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.展开更多
Objectives:The unrelenting migration trend of Filipino nurses to other countries has threatened the quality of patient care services in the country.This study explored the extent of nurses'organizational commitmen...Objectives:The unrelenting migration trend of Filipino nurses to other countries has threatened the quality of patient care services in the country.This study explored the extent of nurses'organizational commitment and turnover intention in the Philippines.Furthermore,predictors of nurses'organizational commitment and turnover intention were identified.Methods:A cross-sectional research design was adopted for this study.Two hundred nurses from nine rural hospitals in the Central Philippines were asked to participate in the study and 166 nurses responded(an 83%response rate).Two standardized instruments were used:the Organizational Commitment Questionnaire and the Six-item Turnover Intention Inventory Scale.Results:Findings revealed that Philippine nurses were moderately committed(3.13±0.24)to and were undecided(2.42±0.67)whether or not to leave their organization.Nurses'age(P=0.006),gender,(t=-2.25,P=0.026),education(t=2.38,P<0.001),rank(t=4.38,P<0.001),and work experience(t=2.18,P=0.031)correlated significantly with organizational commitment,while nurses'age(P=0.028)and education(t=1.99,P=0.048)correlated significantly with turnover intention.An inverse relationship was identified between the organizational commitment and turnover intention(r=-0.22,P=0.005).Conclusion:The findings of this study highlight the need for formulation and implementation of interventions to promote life-long commitment in nurses and to reduce turnover rates.展开更多
Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (...Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.展开更多
文摘The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding decade.Twenty-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be performed.This policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and workforce.Additionally,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.
文摘Introduction: Caesarean section is the delivery of a foetus through an incision made on the uterus. It is useful in situations where vaginal delivery is not feasible. Women in our setting usually see it as a reproductive failure and a sign of weakness. Our aim was to evaluate the perception of caesarean section among pregnant women attending antenatal clinic in a rural missionary hospital. Methodology: This was a cross-sectional study conducted at Mile 4 missionary hospital, Abakaliki among women attending routine antenatal clinic. Information was obtained from respondents with the aid of a questionnaire. Ethical clearance was obtained for the study. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 209 pregnant women participated in this study. Their age ranged from 14 to 43 with a mean age of 27 ± 5 years. One hundred and seventy two women (82.3%) have heard of caesarean section in the past. Eighteen (8.6%) have had caesarean section in the past while 5 were not willing to undergo the procedure again. Sixty (28.7%) are not willing to undergo caesarean section even when it is indicated. Conclusion: Despite awareness of caesarean section, women do not appear to have a positive attitude towards the procedure.
文摘<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.
文摘Objectives:The unrelenting migration trend of Filipino nurses to other countries has threatened the quality of patient care services in the country.This study explored the extent of nurses'organizational commitment and turnover intention in the Philippines.Furthermore,predictors of nurses'organizational commitment and turnover intention were identified.Methods:A cross-sectional research design was adopted for this study.Two hundred nurses from nine rural hospitals in the Central Philippines were asked to participate in the study and 166 nurses responded(an 83%response rate).Two standardized instruments were used:the Organizational Commitment Questionnaire and the Six-item Turnover Intention Inventory Scale.Results:Findings revealed that Philippine nurses were moderately committed(3.13±0.24)to and were undecided(2.42±0.67)whether or not to leave their organization.Nurses'age(P=0.006),gender,(t=-2.25,P=0.026),education(t=2.38,P<0.001),rank(t=4.38,P<0.001),and work experience(t=2.18,P=0.031)correlated significantly with organizational commitment,while nurses'age(P=0.028)and education(t=1.99,P=0.048)correlated significantly with turnover intention.An inverse relationship was identified between the organizational commitment and turnover intention(r=-0.22,P=0.005).Conclusion:The findings of this study highlight the need for formulation and implementation of interventions to promote life-long commitment in nurses and to reduce turnover rates.
文摘Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%;n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81;p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care;and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00;n = 122;91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.
