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This paper questions to what extent particular calculative practices used for inter-organisational decision-making help or hinder boundary spanners meet performativity ideals. It uses programmatic rationalities of government as a framework to study reciprocity between them and the conditions of performativity. Empirical data were collected from healthcare commissioning spaces of English National Health Service (NHS). Data triangulation was achieved through documentary analysis, data collected through interviews, and observation notes taken in local commissioning meetings and national conferences. Findings revealed an apparent lack of reciprocity between programmatic rationality and calculative practices surrounding the commissioning activities of boundary spanners. As a consequence, in local commissioning situations boundary spanners with formal roles used calculative practices differently than semi-formal boundary spanners. Unlike their formal counterparts, who used mainly accounting information in their calculative practices, semi-formal boundary spanners incorporated non-accounting information and devised alternative calculative practices. In addition, while formal boundary spanners on NHS Committees used calculative practices in maintaining clear boundaries between commissioning and provider organisations, semi-formal boundary spanners made use of the data of both parties in order to reach inter organisational decisions. The study has three main contributions. First, it differentiates boundary spanners and explains differences in their interaction with calculative practices. Second, it introduces the concept of reciprocity to inter-organisational studies in accounting. Third, it shows how conditions of performativity reflected in micro-settings influenced how semi-formal boundary spanners used calculative practices (and other supplementary information) to achieve performance ideals of government programmes.

Aims Co‐design implies genuine partnership in the generation of knowledge between service users and researchers. Service user involvement in research has been encouraged in government policy, but it is rarely achieved, especially at trial initial stages. Co‐designed with service users, we adapted existing manualised social cognition intervention for people with a first episode of psychosis to a virtual world environment. Methods We invited a group of young people who have used mental health services to co‐design a virtual environment to deliver an accessible social cognition intervention to a hard to engage service user group. We used an iterative process with young service users and the design team that included developing initial ideas, creating a prototype and testing the virtual world. Results Twenty young service users of local mental healthcare services provided feedback on the design and delivery of the intervention. Reflecting the demographic of the sample, young people felt the virtual environment should be familiar, urban spaces, akin to therapy rooms or classrooms they have used in real‐life situations rather than non‐traditional therapy spaces that were initially proposed. Conclusion The co‐design process led to the development of a specific design, approach and protocol to be tested in a proof‐of‐concept trial. Young service users were integral to an agile and iterative design. Technological innovations should be routinely co‐designed and co‐produced if they are to realise their potential to deliver acceptable and affordable mental health interventions.

Objective Health outcome prioritisation is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyse the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. Background Dementia has been described as the greatest global health challenge in the 21st century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritising outcomes; and when individual preferences are sought. Methods Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematised and discussed key issues of ethical salience. Results Eight areas of ethical salience for outcome prioritisation emerged: (1) Public health and distributive justice, (2) Scarcity of resources, (3) Heterogeneity and changing circumstances, (4) Knowledge of treatment, (5) Values and circumstances, (6) Conflicting priorities, 7) Communication, autonomy and Caregiver issues, (8) Disclosure of risk. Conclusion These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritising outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritising outcomes, and eliciting stakeholder preferences.

Infectious diseases can impose considerable mortality and morbidity for children and adult populations resulting in both short- and long-term fiscal costs for government. Traditionally, healthcare costs are the dominant consideration in economic evaluations of vaccines, which likely ignores many costs that fall on governments in relation to vaccine-preventable conditions. In recent years, fiscal health modeling has been proposed as a complementary approach to cost-effectiveness analysis for considering the broader consequences for governments attributed to vaccines. Fiscal modeling evaluates public health investments attributed to treatments or preventive interventions in the case of vaccination, and how these investments influence government public accounts. This involves translating morbidity and mortality outcomes that can lead to disability, associated costs, early retirement due to poor health, and death, which can result in lost tax revenue for government attributed to reduced lifetime productivity. To assess fiscal consequences of public health programs, discounted cash flow analysis can be used to translate how changes in morbidity and mortality influence transfer payments and changes in lifetime taxes paid based on initial health program investments. The aim of this review is to describe the fiscal health modeling framework in the context of vaccines and demonstrate key features of this approach and the role that public economic assessment of vaccines can make in understanding the broader economic consequences of investing in vaccination programs. In this review, we describe the theoretical foundations for fiscal modeling, the aims of fiscal model, the analytical outputs, and discuss the relevance of this framework for evaluating the economics of vaccines.

BACKGROUND: With the rapid advances in gene technologies in recent years, the potential benefits of precision medicine (PM) may spread unevenly to disadvantaged populations, such as Hispanics/Latinos. The objective of this study was to explore patient-level barriers and facilitators to dissemination and adoption of PM among Hispanics/Latinos, including knowledge and awareness. METHODS: Self-identified Hispanics/Latinos from diverse countries in Latin America (N = 41) participated in the study. Using a cross-sectional observational qualitative research design, six focus groups and a demographic questionnaire were collected in English and Spanish. Qualitative content analysis was utilized to code the transcripts and identify emerging themes. RESULTS: Hispanics/Latinos never heard of and had no knowledge about PM. Barriers to dissemination and adoption of PM included lack of health insurance, financial burden, participants' immigration status, distrust of government, limited English proficiency, low literacy levels, cultural norms, fear about genetic testing results, lack of transportation, newness of PM, and lack of information about PM. Facilitators included family support; information provided in Spanish; use of plain language and graphics; assistance programs for uninsured; trust in physicians, healthcare staff, well-known hospitals, academic institutions, and health care providers and community organization as sources of reliable information; personal motivation, and altruism or societal benefit. CONCLUSIONS: Culturally-and linguistically-tailored, low-literacy educational material about PM should be created in English and Spanish. Future research should examine provider-level and system-level barriers and facilitators to implementation and adoption of PM among Hispanic/Latino patients.

Life expectancy in Spain is among the highest in the world. Nevertheless, we do not know if improvements in health conditions at older ages have followed postponements of death. Previous studies in Spain show a stable trend in years lived in ill health in the past. In this paper we investigate changes between 2006, 2012 and 2017 in life expectancy with and without disease at age 65 in Spain and, for the first time, in Spanish regions, which have autonomous powers of health planning, public health and healthcare. Results show that, at the country level, disease-free life expectancy reduced between 2006 and 2017 in Spain. This was explained by an expansion of most diseases except for some cardiovascular and respiratory chronic conditions. However, at the regional level the evolution was different, especially regarding each disease and sex. First, regional differences reduced between 2006 and 2012 but largely widened in 2017, suggesting that not all regions had the same ability to recover after the 2008 financial crisis that caused government cuts to health services. Second, regional analysis also highlighted diverging trends by sex. While men experienced expansion of morbidity in most regions, women experienced a compression in about half of them, ending up with women showing higher disease-free life expectancies than men in 9 out of the 17 regions considered. This study, then, calls attention to the importance of focusing the analysis of health surveillance to more disaggregated levels, more in accordance with the level of health management, as regional trends showed heterogeneity in the prevalence of diseases and different progresses in the relationship between sexes.

The health of women during pregnancy, childbirth and the postpartum period is maternal health. This study examined the influence of family planning and maternal health education on reproductive-aged women's health in Ijebu zone of Ogun state, Nigeria. The population of the study includes all reproductive-aged women who have accessed and used family planning and maternal health care services in Ijebu zone of Ogun State. This study was a descriptive survey. The instrument used was self-structured. Four health centres were randomly selected for the study, while 300 participants were purposively selected for the study. Chi-square (X2) was the main statistical tool used for the analysis. All hypotheses formulated were rejected at 0.05 alpha level of significance. The findings of this study show that the influence of family planning and maternal health care /education on reproductive-aged women's health in Ijebu zone of Ogun state include lengthening the interval between pregnancies, reduce the number of high-risk pregnancies, promotes efficiency and cost-effectiveness of health services, and improve women's lives and satisfaction with health services. Based on the findings of this study, it is therefore concluded that family planning and maternal health education will influence maternal mortality as well as promote maternal health and child care among married people in Ijebu zone of Ogun state if integrated. It is therefore recommended that maternal health education services should be carried out in the public through the media by both governmental and non-governmental organizations. Maternal healthcare and family planning should be integrated in the health centres.

BACKGROUND: Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment. OBJECTIVE: To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania. METHOD: Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis. RESULTS: Guardians experienced several issues during the initial stages of their child's cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope. CONCLUSION: Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment. IMPLICATIONS FOR PRACTICE: Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders' support needs.

On February 19th 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. As such, the Iranian government, through the establishment of the "National Headquarters for the management and control of the novel Coronavirus", has started implementing policies and programs for the prevention and control of the virus. These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. Iran is a developing country and its economic infrastructure has been hit hardly by embargo and sanctions. While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. All relevant actors and stakeholders should work together to fight this disease. © 2020 The Author(s).

Background: During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed 'health outcome descriptors' for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers. Methods: We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys. Results: Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes. Conclusions: Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.

The coronavirus disease 19 (COVID-19) pandemic poses a serious threat to the sustainability of healthcare systems and is currently having a significant effect on living conditions worldwide. No therapeutic agent has yet proven to be effective for the treatment of COVID-19. The management of this disease currently relies on supportive care and the off-label and compassionate use of antivirals and immunomodulators. Nevertheless, there has been a great worldwide effort to progress research and test the efficacy and safety/tolerability profiles of numerous candidate agents that may positively affect the various clinical syndromes associated with COVID-19. In parallel, vaccination and chemoprophylaxis strategies are being investigated. This article provides a summary of interventional studies targeting COVID-19 during the emergency phase of the outbreak to broadly inform clinicians and researchers on what happened and what they can expect in upcoming months. The clinicaltrials.gov database and the European Union (EU) Clinical Trials Register were investigated on March 31, 2020, to identify all ongoing phase 1–4 research protocols testing pharmacological interventions targeting SARS-CoV-2 infection and/or clinical syndromes associated with COVID-19. Overall, six phase 1, four phase 1-2, 14 phase 2, ten phase 2-3, 19 phase 3, and nine phase 4 studies were identified, and the features of these studies are described in the present review. We also provide an updated overview of the change overtime in the pipeline following this emergency phase and based on the current epidemiology of the COVID-19 pandemic.

The Information and Communications Technology (ICT) has a huge potential of changing the landscape of service delivery across the globe. It acts as a catalyst for the speedy delivery of services. The Government of India is in the transition phase, moving from traditional paper mode to using Information and Communications Technology (ICT) in the governance process. The use of ICT in the governance process is called e-Governance. The Government of India has been increasingly focusing on the use of Information and Communications Technology (ICT) to overcome issues like red-tapism, lack of accountability and transparency in public services, lack of access to information, slow movement of files and other documents, ineffective delivery of public services etc. This is a concept paper based on secondary data collected from government websites and documents, various national and international Journals and private websites. The present paper discusses the concept of e-Governance, pillars of e-Governance, objectives of e-Governance, types of interaction in e-Governance, guiding principles for e-Governance and benefits of e-Governance. The paper presents a review of evolution of e-Governance in India. It gives a detailed account of e-Governance initiatives in India. The document lays specific emphasis on e-Governance initiatives in healthcare in India, both at the National and State level. Further, the key challenges related e-Governance in India are discussed. The paper also put forward some recommendations which may help in the implementation of e-Governance in the Indian context.

The prevalence of sickle cell anaemia has been shown to be on the increase in Nigeria. Therefore, preventive measures such as premarital genotype screening have been proposed as one of the ways of reducing the scourge of the disease. Therefore, this study was designed to assess the knowledge and attitude of women of child bearing age in Kuma Akko Local Government Area of Gombe State towards premarital genotype screening. The study adopted a descriptive cross-sectional design. A total of 296 respondents were sampled through simple random sampling technique and the collected data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0. Majority of the respondents 200(71.40%) were between the ages of 15-34 years old and 64(22.90%) of the respondents affirmed that they had a family history of sickle cell disease. In addition, 58.60% of the respondents demonstrated poor knowledge of premarital genotype screening while 57.10% exhibited negative perception towards premarital genotype screening and 63.20% exhibited poor attitude towards premarital genotype screening. There was a significant relationship between respondents with family history of sickle cell anaemia and their knowledge of premarital genotype screening. The study therefore recommends that efforts should be intensified by the governments and health workers in primary, secondary and tertiary level of healthcare deliveries, to raise awareness on the importance of premarital genotype screening in order to reduce the prevalence of Sickle cell anaemia in the locality. Agofure, O. | Department of Public and Community Health, Novena University, Ogume, Delta State, Nigeria.

Tuberculosis is a very serious respiratory infectious disease, caused by the bacillus Mycobacterium tuberculosis, which generates a relevant societal and clinical burden. It has always represented a permanent concern and a public health challenge over the course of human history, because of its severe epidemiological, and economic-financial implications. The present review aims at over-viewing the impact on tuberculosis on the Israeli healthcare system, its temporal trend and evolution, stratified according to ethnicities and minorities, the need of establishing new facilities and implementing screening techniques, public health strategies and diagnostic tests, following massive immigration waves from countries characterized by a high incidence rate of tuberculosis during the fifties-sixties until the nineties, and the policies implemented by the Israeli government in the control, management and treatment of tuberculosis, as well as the role played by Israeli prominent scientists in discovering new druggable targets and finding bioactive compounds and bio-molecules in the fight against tuberculosis. Israel represents a unique, living laboratory in which features of developed and developing countries mix together. This country as a case-study of immigrant, pluralistic society underlines the importance of adopting a culturally-sensitive community intervention approach. The understanding of the subtle interplay between race/ethnic host and pathogen factors, including the role of gene variations and polymorphisms can pave the way for a personalized treatment and management of tuberculosis patients, contributing to the development of new tools for targeted tuberculosis therapeutics, immunodiagnostics and vaccination products.

Sunil Shrestha,1,2 Deepa Shakya,1,3 Subish Palaian4 1Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal; 2Department of Pharmacy, Nepal Cancer Hospital and Research Center Pvt. Ltd, Harisiddhi, Lalitpur, Nepal; 3Department of Pharmacy, Norvic International Hospital, Thapathali, Kathmandu, Nepal; 4Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab EmiratesCorrespondence: Sunil Shrestha Email sunilcresta@gmail.comAbstract: This commentary article highlights the challenges in providing clinical pharmacy education in Nepal and suggests a few ways forward. Contrary to other health care professions, clinical pharmacy practice is a new healthcare discipline in the country which is currently undergoing transition. The existing pharmacy curriculum and training in the country can provide competencies needed for pharmacists in industrial settings. Considering the importance of clinical pharmacists in patient care, the Government of Nepal has implemented a policy recommending the recruitment of clinical pharmacists in hospitals. However, the education and training for pharmacists provided in the country are not sufficient enough for optimum patient care and for delivering clinical pharmacy services. International collaborations in terms of faculty and student exchanges, preceptor training, and accreditation by international organizations such as Accreditation Council for Pharmacy Education (ACPE), establishment of need-based curriculum, incorporating clinical pharmacy department under the organizational structure of hospitals, etc., may be the right approaches to improve the current status of clinical pharmacy education in the country.Keywords: clinical pharmacy education, clinical pharmacist, clinical pharmacy practice, clinical pharmacy service, Nepal, pharmacy education