Suchergebnisse

Kari Margrete Hjelle,1,2 Olbjørg Skutle,2,3 Oddvar Førland,2,4 Herdis Alvsvåg4 1Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 2Centre for Care Research Western Norway, Bergen University College, Bergen, Norway; 3Department of Health and Social Educators, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 4VID Specialized University, Bergen, Norway Background: Reablement is an early and time-limited home-based rehabilitation intervention that emphasizes intensive, goal-oriented, and multidisciplinary assistance for people experiencing functional decline. Few empirical studies to date have examined the experiences of the integrated multidisciplinary teams involved in reablement. Accordingly, the aim of this study was to explore and describe how an integrated multidisciplinary team in Norway experienced participation in reablement.Methods: An integrated multidisciplinary team consisting of health care professionals with a bachelor's degree (including a physiotherapist, a social educator, occupational therapists, and nurses) and home-based care personnel without a bachelor's degree (auxiliary nurses and nursing assistants) participated in focus group discussions. Qualitative content analysis was used to analyze the resulting data.Results: Three main themes emerged from the participants' experiences with participating in reablement, including "the older adult's goals are crucial", "a different way of thinking and acting – a shift in work culture", and "a better framework for cooperation and application of professional expertise and judgment". The integrated multidisciplinary team and the older adults collaborated and worked in the same direction to achieve the person's valued goals. The team supported the older adults in performing activities themselves rather than completing tasks for them. To facilitate cooperation and application of professional expertise and judgment, common meeting times and meeting places for communication and supervision were necessary.Conclusion: Structural factors that promote integrated multidisciplinary professional decisions include providing common meeting times and meeting places as well as sufficient time to apply professional knowledge when supervising and supporting older persons in everyday activities. These findings have implications for practice and suggest future directions for improving health care services. The shift in work culture from static to dynamic service is time consuming and requires politicians, community leaders, and health care systems to allocate the necessary time to support this approach to thinking and working. Keywords: multidisciplinarity, rehabilitation, goal-setting, framework conditions, work culture, reablement

Patrick Melmer,1 Margo Carlin,2 Christine A Castater,2 Deepika Koganti,2 Stuart D Hurst,2 Brett M Tracy,2 April A Grant,2 Keneeshia Williams,2 Randi N Smith,2 Christopher J Dente,2 Jason D Sciarretta2 1Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC 29572, USA; 2Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA 30303, USACorrespondence: Jason D Sciarretta Tel +1 404 251-8914Fax +1 404 523-3931Email jason.d.sciarretta@emory.eduAbstract: Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.Keywords: mass casualty, multidisciplinary, mass shooting

Sarah D Kosa,1,2 Sheila Macdonald,1 Maureen Etkin,3 Raeann Rideout,3 Janice Du Mont2,4 1Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, ON, Canada; 2Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; 3Elder Abuse Ontario, Etobicoke, ON, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CanadaIt has been acknowledged globally and in Canada that to address the growing and significant health and social problem of violence against older women, it is essential that key stakeholders work collaboratively across sectors and disciplines to identify research priorities, as well as methodological approaches and potential challenges to consider in moving these priorities forward.1–3 To this end, we engaged leaders of professional health care associations, managers of health, social, and community services, government policymakers, and researchers in a two-step Delphi consensus process in Canada's largest province, Ontario.4–6

Hani B Albalawi,1 Faris Hashem,1 Amal Nafea J Alharbi,2 Naif M Alali,1 Wejdan Mohammed S Alshehri,2 Abdulrahman Arshed N Alharfy,2 Abdulmajeed Mousa M Alzahrani,2 Nouf Mohammed A Albalawi,2 Moustafa S Magliyah,3 Saad H Alenezi4 1Department of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia; 2Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia; 3Department of Ophthalmology, Prince Mohammed Medical City, Aljouf, Saudi Arabia; 4Department of Ophthalmology, College of Medicine, Majmaah University, Almajmaah, Saudi ArabiaCorrespondence: Hani B AlbalawiDepartment of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia, Email hb.albalawi@ut.edu.saPurpose: This study aims to measure the knowledge levels toward retinopathy of prematurity (ROP) among pediatricians covering neonatal intensive care units (NICUs) in the major hospitals in Tabuk, Saudi Arabia. To our knowledge, this is the first report to assess the awareness level of ROP in the NICU pediatricians in the region.Patients and Methods: This is a quantitative, non-experimental, cross-sectional, descriptive study using self-administered electronic questionnaires to assess the knowledge level among NICU pediatricians at the main hospitals of Tabuk city. We used a self-administer online validated knowledge, attitude, and practice (KAP) questionnaire. A scoring system was implemented in the data analysis, depending on the correct chosen answers on the KAP questionnaire, to present the ROP knowledge level in the participants.Results: The study included 41 NICU pediatricians. Most of the participants' age exceeded 40 years (51.2%). The majority were recruited from either King Salman Military hospital (34.1%) or King Khalid hospital (31.7%). The average frequency of preterm infants seen per month exceeded 15 infants among 41.4% of the respondents. Most pediatricians recognized the important treatment modalities available for ROP (92.7%); however, only 24.4% of them could recognize that 32 weeks or less is the gestational age of the screening criteria for ROP. The overall knowledge score ranged between 4 and 10, out of a possible maximum of 12 with a mean ± SD of (6.68± 1.47). The majority (75.6%) believe that the ROP treatment can successfully prevent blindness.Conclusion: Our study demonstrated that the NICU pediatricians have good knowledge about the treatment modalities of ROP. However, their knowledge about the inclusion criteria of ROP screening was insufficient. Thus, we highlighted the necessity of raising the awareness level and the strict application of the clinical guidelines among NICU pediatricians and healthcare workers involved in managing ROP.Keywords: retinopathy of prematurity, pediatricians, preventable, preterm infant, knowledge, attitude, practice, ROP

Rita Nugem,1,2 Ronaldo Bordin,1 Christophe Pascal,3 Anne-Marie Schott-Pethelaz,2 Beatrice Trombert-Paviot,4 Vincent Piriou,2 Philippe Michel2 1Post-Graduate Program in Management – PPGA, Federal University of Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil; 2Health Services and Performance Research – HESPER, Université Claude Bernard Lyon 1. Faculté de Médecine, Lyon, Rhône-Alpes, France; 3Institut de Formation et de Recherche Sur les Organizations Sanitaires e Sociales – IFROSS, Université Jean Moulin Lyon 3, Lyon, Rhône-Alpes, France; 4Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet Université, Lyon, Department of Public Health and Medical Informatics, University of Saint-Etienne, Saint-Etienne, Rhône-Alpes, FranceCorrespondence: Rita NugemFaculté de Médecine, HESPER, 8, Avenue Rockefeller, Lyon, CP 69008, FranceTel +330658818090Email rcnugem@gmail.comObjective: To identify the commonalities and discrepancies between national health policies to combat stroke in France and Brazil.Justification: Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. France is an industrialized, high-income country, with health care involving copayment and reimbursement of expenses, and spontaneous demand for services. Brazil is a member of the BRICs, of upper middle income with totally free health care, with an active search for hypertension and diabetes in the general population.Methods: Data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017, were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies.Results: About acute stroke hospitalizations, on average, Brazil has 0.75 per 1000 annual population hospitalizations versus 1.54 per 1000 in France. Brazil has 0.21 per 1000 population deaths per year versus 0.40 per 1000 in France. The in-hospital mortality rate in Brazil has 139 per 1000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old (this rate is stable); 40– 59 years (it is increasing in both countries); and 60– 79 and 80+ years (this rate has been increasing in France and decreasing in Brazil).Conclusion: No major differences were found about the health policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care, and the moments after hospital care, such as secondary prevention and palliative care.Keywords: stroke, risk factors, health policies, health care, Brazil, France

Jie Wang,1,2 Ruilian Zhang3 1School of Public Administration, Hohai University, Nanjing, 211100, People's Republic of China; 2School of Law, Anhui Normal University, Wuhu, Anhui, 241002, China; 3Sustainable Minerals Institute, The University of Queensland, Brisbane, 4072, AustraliaCorrespondence: Ruilian ZhangSustainable Minerals Institute, The University of Queensland, Brisbane, 4072, AustraliaTel +61481120982Email ruilian.zhang@uq.edu.auAbstract: A public health crisis is a "touchstone" for testing the ability and capacity of rural and urban health systems. In the context of coronavirus disease 2019 (COVID-19) in China, we track the features, challenges, and implications of the temporary disruption of the health system in rural China and its response to this major public health crisis. We examine the general content and logic of village pandemic prevention and control regarding COVID-19 through a case study. Accordingly, we identify the challenges to the rural health system, including logic failure and its causes. It is strongly suggested that the government strengthen rural health system reform, balance medical services between rural and urban areas, and strengthen public health awareness and education.Keywords: public health crisis, rural area, health system, challenges, COVID-19

Mengistu Meskele,1,2 Nelisiwe Khuzwayo,3 Myra Taylor1 1School of Nursing and Public Health, Discipline of Public Health, Durban, KwaZulu-Natal, South Africa; 2School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3School of Nursing and Public Health, Discipline of Rural Health, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Mengistu Meskele Email mengistu77@gmail.comBackground: Intimate partner violence is a crime against humanity. This study aimed to explore the experiences and challenges in screening for intimate partner violence among women who use antiretroviral therapy and other health services in Wolaita Zone in Ethiopia.Methods: A descriptive phenomenological qualitative study design was used, and 16 in-depth interviews were conducted with healthcare workers from 19 health facilities who were providing healthcare services in Wolaita Zone. We selected participants purposively until data saturation was reached. Colaizzi's descriptive phenomenological method was used for the data analysis, and the Open Code software was used to assist with the data coding. We maintained the scientific rigour of credibility, transferability, dependability, and confirmability.Results: Analysis of the study data identified the following five themes: type of IPV identified by HCWs among women, provider-related barriers, healthcare system barriers, patient-level barriers, and providers' recommendations for improvements. Issues that emerged from these findings were a gap in medico-legal report provision, absence of a separate record-keeping for IPV cases, lack of client follow-up, absence of routine assessment of violence for women who have injuries, and lack of specific coordination with an external organisation. Moreover, the absence of staff training, weak referral systems, and a shortage of necessary medical equipment challenged IPV screening.Conclusion: This study has shown that there are healthcare provider and health system challenges relating to screening clients for intimate partner violence in Wolaita Zone. Provision of separate record-keeping of intimate partner violence cases in the healthcare facilities, standardising the medico-legal reporting system, improving women's access to education, and executing more gender-equitable policies, are needed. Moreover, the inclusion of intimate partner violence-specific policy frameworks in national legislation is necessary.Keywords: healthcare workers, intimate partner violence, screening, Wolaita Zone

Jennifer Chamberlain-Salaun, Jane Mills, Kim Usher School of Nursing, Midwifery and Nutrition, James Cook University, Cairns, Queensland, Australia Purpose: Health systems around the world are struggling to meet the needs of aging populations and increasing numbers of clients with complex health conditions. Faced with multiple health system challenges, governments are advocating for team-based approaches to health care. Key descriptors used to describe health care teams include "interprofessional," "multiprofessional," "interdisciplinary," and "multidisciplinary." Until now there has been no review of the use of terminology relating to health care teams. The purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams. Methods: An integrative review of the literature was conducted because it allows for the inclusion of literature related to studies using diverse methodologies. The authors searched the literature using the terms interprofessional, multiprofessional, interdisciplinary, and multidisciplinary combined with "health teams" and "health care teams." Refining strategies included a requirement that journal articles define the term used to describe health care teams and include a list of health care team members. The literature selection process resulted in the inclusion of 17 journal articles in this review. Results: Multidisciplinary is more frequently used than other terminology to describe health care teams. The findings in this review relate to frequency of terminology usage, justifications for use of specific terminology, commonalities and patterns related to country of origin of research studies and health care areas, ways in which terminology is used, structure of team membership, and perspectives of definitions used. Conclusion: Stakeholders across the health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful. Notwithstanding some congruence in terminology usage, this review highlights inconsistencies in the literature and suggests that broad debate among policy makers, clinicians, educators, researchers, and consumers is still required to reach useful consensus. Keywords: descriptors, interprofessional, multiprofessional, interdisciplinary, multidisciplinary

Modupeoluwa Omotunde Soroye,1,2 Obinna O Oleribe,3 Simon D Taylor-Robinson4 1School of Public Health, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria; 2Department of Preventive Dentistry, Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria; 3Klamath Tribal Health & Family Services, Klamath Falls, OR, 97601, USA; 4Department of Surgery and Cancer, St Mary's Hospital Campus, Imperial College London, London, W2 1NY, UKCorrespondence: Obinna O Oleribe Email obinna.oleribe@klm.portland.ihs.govAbstract: Nigeria's mental health policy was formulated in 1991, but it did not make adequate provision for community-based psychiatric care. Since there are only seven government-owned psychiatry facilities in Nigeria and these are always overwhelmed, there is the need to overhaul the existing policy and emphasise the urgency of a shift from inpatient psychiatric mental healthcare towards a community-based multidisciplinary psychiatric healthcare system.Keywords: community psychiatry, Nigeria, depression, mental health

Arash Nemat, Abdullah Asady Department of Microbiology, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Arash NematDepartment of Microbiology, Kabul University of Medical Sciences, Kabul, 1001, AfghanistanTel +9 370 671 7987Email dr.arashnemat@yahoo.comAbstract: The COVID-19 has spread to almost all countries since its emergence from Wuhan, China. Afghanistan has entered the third wave of the COVID-19 pandemic in May 2021. The county is bracing the third wave at a time when challenges like continuous conflict, illiteracy, poverty, inadequate healthcare personnel and service coverage, inadequate testing capacity, shortage of laboratory kits and reagents, lower public awareness and lower public trust on the government have brought it to its knees. All stakeholders including government, healthcare workers, civil societies, the public and the international community should combine their efforts to combat such a devastating situation. Although the inception of vaccination program against COVID-19 seems relieving, but it may take several months until a significant proportion of the people get vaccinated to reach the herd immunity. Thus, non-pharmaceutical intervention should be followed strictly. Moreover, awareness campaigns should also be continued to educate people and keep them supportive of the government plans and policies. Otherwise, the current wave may cause deadly consequences in such a complex situation.Keywords: COVID-19, Afghanistan, pandemic, third wave

Vachira Posai,1 Wanich Suksatan,2 Bovornpot Choompunuch,3 Apinya Koontalay,4 Jatuporn Ounprasertsuk,5 Jonaid M Sadang6 1Nursing Department, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand; 2Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; 3Faculty of Education, Mahasarakham University, Mahasarakham, Thailand; 4Independent Researcher, Melbourne, VIC, Australia; 5College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Samut Songkram Province, Thailand; 6College of Health Sciences, Mindanao State University- Marawi, Marawi, PhilippinesCorrespondence: Wanich SuksatanFaculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, ThailandTel +66 8-27550027Email wanich.suk@pccms.ac.thJatuporn OunprasertsukCollege of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Samut Songkram, ThailandTel +66 9-51942449Email jatuporn.ou@ssru.ac.thBackground: The coronavirus disease 2019 (COVID-19) pandemic has affected the health-related behaviors of patients with non-communicable diseases (NCDs). Thus, the factors predicting the health-promoting behaviors (HPBs) of hospitalized patients with NCDs during the second wave of COVID-19 should be examined.Objective: The aims of this study were to determine the relationships among the patients' characteristics, perceived self-efficacy, social support, perception of the benefits of and barriers, and HPBs, and to determine the predictive factors of HPBs among hospitalized patients with NCDs during the second wave of COVID-19.Patients and Methods: The study had a cross-sectional predictive correlational design and included 250 patients with NCDs 18 years of age or older hospitalized in a tertiary hospital in Thailand. Descriptive statistics, the chi-square test, the Pearson's correlation coefficient, and stepwise multiple linear regression were used for data analysis.Results: Most of the participants had a cardiovascular disease (34.0%). Followed by diabetes (28.8%), cancer (11.2%), hypertension (10.0%), heart disease (9.6%), or chronic obstructive pulmonary disease (6.4%) and had a moderate level of overall HPBs (M = 106.09; SD = 4.66). Among the six components of the HPBs, the participants achieved the moderate levels in nutrition, interpersonal relations, spiritual growth, and stress management, and low levels in physical-activity and health responsibility. The patients' perception of the benefits and barriers to the adoption of HPBs and perceived self-efficacy and social support were able to predict their HPBs, accounting for approximately 38.0% of the variance of such behaviors.Conclusion: On the basis of our study's results, we suggest that researchers, multidisciplinary teams, the government, and policymakers establish effective interventions, guidelines, and policies for the development of HPBs to prevent and control the spread of COVID-19 particularly among patients with NCDs, and to improve their capacity for high-quality and continuing self-care.Keywords: predictive factors, health-promoting behaviors, non-communicable diseases, NCDs, hospitalized patients, COVID-19

Veralia Gabriela Sánchez,1 Camilla Anker-Hansen,2 Ingrid Taylor,3 Grethe Eilertsen3,4 1Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-Eastern Norway, Porsgrunn, Telemark, Norway; 2Faculty of Health and Welfare, Østfold University College, Fredrikstad, Østfold, Norway; 3Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Buskerud, Norway; 4Research Group of Studies on Older People, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Buskerud, NorwayCorrespondence: Veralia Gabriela SánchezUniversity of South-Eastern Norway, Postbox 235, Kongsberg 3603, NorwayTel +47 35 57 53 61Email veralia.g.sanchez@usn.noBackground: In Norway, as in other European countries, the ageing population is increasing rapidly. Governments seek to enable older people stay in their homes for as long as possible, and welfare technology (WT) has been proposed as a possible solution. Human behaviour modelling (HBM) is a welfare technology that identifies an individual's behaviour patterns and detects abnormal behaviours, including falls and early signs of dementia. However, the successful development of HBM WT requires the consideration of the older people's attitudes on this.Aim: The present study sought to explore attitudes and perspectives about welfare technology among older people living alone in Norway.Methods: We used an exploratory, qualitative approach in which semi-structured, in-depth interviews were conducted with five women and four men between the ages of 79 and 91. The interviews were analysed using qualitative content analysis.Results: Two categories and four subcategories were identified: 1) preferences and concerns of welfare technology (i) feeling confident-proactive approach of future technology, (ii) concerns and dilemmas, and 2) reflections of today and tomorrow- awareness of own health (i) feeling healthy, independent, self-sufficient and safe, (ii) facing own ageing- preparedness on unpredictable scenarios. The main theme, welfare technology - a valuable addition to tomorrow's homes, represents how the participants held positive and proactive attitudes towards the use of WT in their homes.Conclusion: Participants trusted the Norwegian healthcare system and did not rely on their families for care. Independence, autonomy, and feeling safe were essential for all participants, and most participants regarded welfare technology as empowering them to remain in their homes for as long as possible. Participants already confidently used various technologies in their daily lives. Surprisingly, they expressed no concerns about privacy, but some mention concerns about loss of autonomy and dignity. We conclude that a person-centred approach to integrating new WT is necessary.Keywords: assistive technology, ambient assistive living, ethical challenges, healthcare, ageing in place, human behaviour

Abdullah A Alharbi,1 Khalid I Alqumaizi,2 Ibrahim Bin Hussain,3– 5 Nasser S AlHarbi,6 Abdulmalik Alqahtani,7 Wala Alzawad,8 Hussam M Suhail,9 Mohammed I Alamir,9 Mohammed A Alharbi,9 Hamad Alzamanan10 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia; 2Family Medicine Department, Faculty of Medicine, AlMaarefa University, Riyadh, Saudi Arabia; 3Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; 5Southern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Riyadh, Saudi Arabia; 6Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Ophthalmology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia; 8Eastern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Khobar, Saudi Arabia; 9Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia; 10The Vision Realization Office (VRO), Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Abdullah A Alharbi, Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, 45142, Jazan, Saudi Arabia, Tel +966556966880, Email aaalharbi@jazanu.edu.saObjective: To assess the length of stay (LoS) variation for COVID-19 inpatients among the four regions of the Southern Business Unit (SBU).Methods: This is a comparative retrospective study of the LoS of COVID-19 inpatients in the four regions of the SBU in the KSA. Data was collected from the Ministry of Health (MoH) in all hospitals in the SBU. Participants were all patients admitted with confirmed COVID-19 between March 2020 and February 2021. Variables included region (variable of interest), demographics, comorbidities, and complications. Multilinear regression was performed to control for any factors that might have had an association with LoS.Results: The mean LoS of the total sample was 10 days and Bisha (the reference) was 7 days. Compared to Bisha, LoS in Jazan was 34% longer, in Najran 62% longer, and Aseer 40% longer. We observed that other factors also had an association with LoS, compared to Bisha, compared to the references, Saudi patients had a 15% shorter stay; admission to ICU increased LoS by 57%; patients who died during hospitalization had a 39% shorter LoS; the complications from COVID-19 of acute kidney injury and ARDS increased LoS by 22% and 48% respectively.Conclusion: After statistically controlling for confounders, this study reveals that LoS was significantly impacted by region in the SBU in the KSA. We recommend that further study be conducted to illuminate the underlying causes of this variation which may be organizational or structural to ensure high quality of care, access to care, and equity of resources throughout all regions of the SBU in accordance with the new Model of Care in Vision 2030.Keywords: COVID-19, length of stay, Southern Business Unit, Health Holding Company, KSA

Muhammad Anwar,1 Abdul Raziq,2 Maryam Shoaib,3 Nosheen Sikandar Baloch,4 Shanaz Raza,5 Bisma Sajjad,5 Nabila Sadaf,5 Zaffar Iqbal,6 Rabia Ishaq,1 Sajjad Haider,1 Qaiser Iqbal,1 Nafees Ahmad,1 Naheed Haque,1 Fahad Saleem1 1Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan; 2Department of Statistics, University of Balochistan, Quetta, Pakistan; 3Sandeman Provincial Hospital, Quetta, Pakistan; 4Bolan Medical College, Quetta, Pakistan; 5Sardar Bahadur Khan Womens' University, Quetta, Pakistan; 6Health Department, Government of Balochistan, Quetta, PakistanCorrespondence: Fahad SaleemFaculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, PakistanTel +92 345 8326545Fax +92 81 9211288Email fahaduob@gmail.comPurpose: Quality use of antibiotics and the development of antibiotic resistance is a global catastrophe. In the conceptual context, the phenomenon is correlated with the healthcare practitioners' understanding of antibiotic use and resistance. Therefore, the study aimed to highlight nurses' perception of antibiotic use and resistance at a public healthcare institute in Quetta City, Pakistan.Respondents and Methods: By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the surgical and medical units of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework.Results: Although the saturation was reached after the 13th interview, an additional two were interviewed for absolute validation. Content analysis revealed five major themes: (1) defining antibiotics and antibiotic resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. Even though the understanding of nurses regarding antibiotic use and resistance was promising, certain apprehensions were also observed. The respondents were aware of the critical situation and provided valuable insights that can offer significant input while promoting the quality use of antibiotics in a developing country.Conclusion: While the perception towards antibiotics appeared positive, potential areas of concern and contributing factors regarding antibiotic resistance were also identified. Importantly, nurses too highlighted possible solutions to address the issue of irrational antibiotic use and the development of antibiotic resistance.Keywords: resistance, quality use of antibiotics, nurses, perception

Retno Asti Werdhani,1 Astrid Widajati Sulistomo,1 Herqutanto,1 Ismail Wirawan,2 Ekowati Rahajeng,3 Adi Heru Sutomo,4 Muchtaruddin Mansyur1,5 1Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 2Department of Management, Faculty of Economy, Universitas Persada Indonesia, Jakarta, Indonesia; 3Researches and Development Unit, Ministry of Health Republic of Indonesia, Jakarta, Indonesia; 4Department of Family Medicine, Community, and Bioethics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; 5SEAMEO-RECFON, Universitas Indonesia, Jakarta, Indonesia Purpose: Primary care physicians have to deal with many aspects of the patients' health problem, which needs cooperation with other health professionals or even nonhealth individuals. To achieve effective results, the primary care physicians should have leadership and coordinating skills, especially when dealing with the health challenges in Asia Pacific region. The care coordinator role of primary care physicians is important to create the bridge between population and health. This study aims to determine the correlation between care coordinator performance and leadership factors among primary care physicians.Materials and methods: A cross-sectional study was conducted, and data collection involved a total of 84 primary care physicians who were randomly selected from a total of 44 subdistricts and worked in 40 randomly selected village government-owned primary healthcare facilities in Jakarta. Pearson's correlation, independent t-test, and one-way ANOVA were used to measure the correlation between care coordination and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as the sociodemographics of the physicians and the professional practice factors. Multiple regressions were conducted to determine the most important factors influencing care coordinator performance.Results: Respondents were mainly female (94%) with an average age of 36 years and were mostly medical doctors without any additional postgraduate degrees (95.2%). There was no correlation between care coordinator scores and organizational culture or commitment. There were positive and significant correlations between care coordinator scores and clinical leadership score (r=0.66; P<0.001), transformational leadership score (r=0.54; P<0.001), job satisfaction score (r=0.31; P=0.004), physician's age (r=0.34; P=0.002), length of time since graduation (r=0.30; P=0.005), duration of employment at their health center (r=0.33; P=0.003), training in family medicine (P=0.04), and employment status (P=0.005). The most important factors in care coordinator performance were clinical leadership (r=0.53; P<0.001) and transformational leadership (r=0.23; P=0.03), with the total R2 being 0.47.Conclusion: Clinical leadership and transformational leadership were the most important factors for care coordinator performance. Therefore, the leadership skills of primary care physicians are important to be considered as a certain competency in practice to manage various resources and coordinate with related healthcare providers for controlling patients' illness as well as dealing with the challenges and managing the overall health. Keywords: care coordinator, clinical, leadership, medicine, transformational