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Background
Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educa...
Context in source publication
Context 1
... accessibility was the highest ranked quality dimension (61%) followed by efficacy, safety, and acceptability. Less than 40% of participants ranked any other dimension as high priority (see Table 1). Equity was ranked lowest; 11% of participants ranked it high priority, whereas 61% ranked it as low priority. ...
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OBJECTIVES:The study's main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition. STUDY DESI...
Citations
... Hospital bed overcrowding is problematic in low-and middle-income countries and any reduction in SSIs would help increase capacity in bed days. [22,23] conclusIon This study suggests that with time, laparoscopic approach of hysterectomy has proved various advantages over the abdominal route with a decreased rate of operative and postoperative complications and hospital stay, thus preventing psychological, physical, and financial burdens to patients and health-care centers. ...
Objective
Surgical site infection (SSI) is an unsettled complication seen in any surgery. The aim of this study is to assess the rate of postoperative SSIs between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Can the rate of SSI be reduced with the use of a laparoscopic mode of hysterectomy over abdominal?
Materials and Methods
It was a retrospective comparative study. The study was conducted in the obstetrics and gynecology department at a tertiary care center from June 2016 to March 2020. A total of 300 patients who underwent hysterectomy either via laparoscopic or abdominal route were included in the study. They were subdivided into two groups: a total of 167 underwent TLH (Group 1) and 133 had TAH (Group 2). The results were compared. It included the age and body mass index of the patient, indication of surgery, size of the uterus, intraoperative blood loss, postoperative SSIs, duration of hospital stay, and readmission rates.
Results
It was found a high rate of SSI in TAH (82.4% vs. 17.6%, P < 0.001, Cramer’s V-0.18), the operative time taken (75 ± 25 min vs. 128 ± 52 min, P < 0.001), and the mean blood loss during TLH (110 ± 30 ml vs. 160 ± 116 ml, P < 0.001) was found significant for patients. The hospital stay after TLH was found to be significantly shorter (4 ± 2.47 days vs. 7 ± 2.43, P < 0.001).
Conclusion
TLH has improved the psychological, physical, and financial burden on the health care department. Thus, it has proved a preferred route over TAH.
... The terms junior and development in this study refer to athletes under 19 years of age who are progressing through the various and undulating stages of their sport (Gulbin et al., 2013). Each question limited responses to three attributes with the purpose of narrowing coaches' focus and encouraging them to prioritise the most important performance attributes (DeWulf et al., 2017). However, this approach did not restrict further probing and exploration of topics that arose during the interviews. ...
The understanding of rowing performance has been predominantly gained through quantitative sports science-based research. In combination with this objective information, coaches' experiences may provide important contextual information for how this quantitative evidence is implemented into training programmes. The aims of this study were to (1) explore coaches' perspectives of performance indicators for competitive rowing in junior rowers, and (2) identify coaches' recommendations for developing effective technique and movement competency among junior rowers who have the potential to transition to elite competition. Twenty-seven semi-structured interviews were conducted with experienced rowing coaches through purposive sampling of an accredited coaching network. Participants' coaching experience ranged from 5 to 46 (M = 22, SD = 10) years. Data were analysed using thematic analysis. Three overarching themes were identified including, (1) getting the basics right, (2) targeting types of talent, and (3) complexities of performance. Based on these findings, sequence and boat feel, supported through the movement competency provided by hip flexibility and the trunk musculature, were considered critical for executing correct technique. Developing talent and understanding successful performance are both complex concepts when considering the individual athlete. Coaches' perspectives provided insight into key components of performance to enhance our understanding of how to better develop junior rowers.
... Frontiers in Health Services emergency services and staff being disgruntled that they receive few incentives despite their heavy workloads were mentioned as contributors to the "no bed syndrome" (33,44,48,52). Inadequate monitoring and supervision of frontline providers by management staff were felt by some to be a factor fuelling what were seen as negative attitudes such as turning away emergencies (49). ...
... Inadequate supplies of emergency drugs, tools, logistics (including beds), laboratories, equipment, infrastructure, and transport emerged frequently as a contributor to the "no bed syndrome". This included challenges with maintenance of broken-down emergency diagnostic equipment, or procurement of sub-standard quality (33,43,44,(51)(52)(53)(54)(55). Limited bed availability to meet the increases in patient numbers often resulted in healthcare workers in densely populated urban areas with already overcrowded public sector emergency rooms providing emergency care to patients on floors, benches, and chairs improvised as beds or referring patients to other facilities even when the health professionals with needed expertise to provide care were present in the referring facility (57). ...
Objectives: “No bed syndrome” has become a familiar phrase in Ghana. Yet, there
is very little in medical texts or the peer reviewed literature about it. This review
aimed to document what the phrase means in the Ghanaian context, how and
why it occurs, and potential solutions.
Design: A qualitative desk review using a thematic synthesis of grey and published
literature, print and electronic media content covering the period January 2014 to
February 2021. Text was coded line by line to identify themes and sub-themes
related to the research questions. Analysis was manual and with Microsoft Excel
to sort themes.
Setting: Ghana.
Participants and Intervention: Not applicable.
Results: “No bed syndrome” describes the turning away by hospitals and clinics of
people seeking walk in or referral emergency care with the stated reasons “no bed
available” or “all beds are full”. There are reported cases of people dying while
going round multiple hospitals seeking help and being repeatedly turned away
because there is “no bed”. The situation appears to be most acute in the highly
urbanized and densely populated Greater Accra region. It is driven by a complex
of factors related to context, health system functions, values, and priorities. The
solutions that have been tried are fragmented rather than well-coordinated
whole system reform.
Discussions and recommendations: The “no bed syndrome” describes the
challenge of a poorly functioning emergency health care system rather than just
the absence of a bed on which to place an emergency case. Many low and
middle income countries have similar challenges with their emergency health
care systems and this analysis from Ghana is potentially valuable in attracting
global attention and thinking about emergency health systems capacity and
reform in low and middle income countries. The solution to the “no bed
syndrome” in Ghana requires reform of Ghana’s emergency healthcare system
that takes a whole system and integrated approach. All the components of the
health system such as human resource, information systems, financing,
equipment tools and supplies, management and leadership need to be
examined and addressed together alongside health system values such as
accountability, equity or fairness in the formulation, implementation, continuous monitoring and evaluation of policies and programs for system reform to expand and
strengthen emergency healthcare system capacity and responsiveness. Despite the
temptation to fall back on them as low hanging fruit, piecemeal and ad-hoc solutions
cannot solve the problem.
... Preventing SSIs will decrease the financial burden of both the patient and health system. Hospital bed overcrowding is problematic in LMICs [76][77][78] and any reduction in SSIs would help to increase capacity in bed days. ...
Background
Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe.
Objective
The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs.
Methods
A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template.
Results
Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174—$29,610) and European countries ($21—$34,000). Huge study design heterogeneity was encountered across the two settings.
Discussion
SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.
