MOSAIC vision and scenarios for mobile collaborative work related to health and wellbeing

The main objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments by shaping future research and innovation activities in Europe. The modus operandi of MOSAIC is to develop visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. This paper relates to one specific domain, that of Health and Wellbeing. The focus is therefore is on mobile working environments which enable mobile collaborative working related to the domain of healthcare and wellbeing services for citizens. This paper reports the work of MOSAIC T2.2 on the vision and scenarios for mobile collaborative work related to this domain. This work was also an input to the activity of developing the MOSAIC roadmap for future research and development targeted at realization of the future Health and Wellbeing vision. The MOSAIC validation process for the Health and Wellbeing scenarios is described and one scenario – the Major Incident Scenario - is presented in detail

Conceptual Drivers for an Exploration Medical System

Interplanetary spaceflight, such as NASA's proposed three-year mission to Mars, provides unique and novel challenges when compared with human spaceflight to date. Extended distance and multi-year missions introduce new elements of operational complexity and additional risk. These elements include: inability to resupply medications and consumables, inability to evacuate injured or ill crew, uncharted psychosocial conditions, and communication delays that create a requirement for some level of autonomous medical capability. Because of these unique challenges, the approaches used in prior programs have limited application to a Mars mission. On a Mars mission, resource limitations will significantly constrain available medical capabilities, and require a paradigm shift in the approach to medical system design and risk mitigation for crew health. To respond to this need for a new paradigm, the Exploration Medical Capability (ExMC) Element is assessing each Mars mission phase-transit, surface stay, rendezvous, extravehicular activity, and return-to identify and prioritize medical needs for the journey beyond low Earth orbit (LEO). ExMC is addressing both planned medical operations, and unplanned contingency medical operations that meld clinical needs and research needs into a single system. This assessment is being used to derive a gap analysis and studies to support meaningful medical capabilities trades. These trades, in turn, allow the exploration medical system design to proceed from both a mission centric and ethics-based approach, and to manage the risks associated with the medical limitations inherent in an exploration class mission. This paper outlines the conceptual drivers used to derive medical system and vehicle needs from an integrated vision of how medical care will be provided within this paradigm. Keywords: (Max 6 keywords: exploration, medicine, spaceflight, Mars, research, NASA

Shrinking the Malaria Map: A Prospectus on Malaria Elimination

\ud Thirty-nine countries across the world are making progress toward malaria elimination. Some are committed to nationwide elimination, while others are pursuing spatially progressive elimination within their borders. Influential donor and multilateral organizations are supporting their goals of achieving malaria-free status. With elimination back on the global agenda, countries face a myriad of questions. Should they change their programs to eliminate rather than control malaria? What tools are available? What policies need to be put into place? How will they benefit from elimination? Unfortunately, answers to these questions, and resources for agencies and country program managers considering or pursuing elimination, are scarce. The 39 eliminating countries are all positioned along the endemic margins of the disease, yet they naturally experience a variety of country characteristics and epidemiologies that make their malaria situations different from one another. The Malaria Elimination Group (MEG) and this Prospectus recognize\ud that there is no single solution, strategy, or time line that will be appropriate for every country, and each is encouraged to initiate a comprehensive evaluation of its readiness and strategy for elimination. The Prospectus is designed to guide countries in conducting these assessments. The Prospectus provides detailed and informed discussion on the practical means of achieving and sustaining zero transmission. It is designed as a road map, providing direction and options from which to choose an appropriate path. As on all maps, the destination is clearly marked, but the possible routes to reach it are numerous. The Prospectus is divided into two sections: Section 1 Eliminating Malaria comprises four chapters covering the strategic components important to the periods before, during, and after an elimination program. Section 2 Tools for the Job, comprises six chapters that outline basic information about how interventions in an elimination program will be different from those in a control setting. Chapter 1, Making the Decision, evaluates the issues that a country should consider when deciding whether or not to eliminate malaria. The chapter begins with a discussion about the quantitative and qualitative benefits that a country could expect from eliminating malaria and then recommends a thorough feasibility assessment. The feasibility assessment is based on three major components: operational, technical, and financial feasibility. Cross-border and regional collaboration is a key subject in this chapter. Chapter 2, Getting to Zero, describes changes that programs must consider when moving from sustained control to an elimination goal. The key strategic issues that must be addressed are considered, including supply chains, surveillance systems, intersectoral collaboration, political will, and legislative framework. Cross-border collaboration is again a key component in Getting to Zero. Chapter 3, Holding the Line, provides recommendations on how to conduct an assessment of two key factors that will affect preventing the reemergence of malaria once transmission is interrupted: outbreak risk and importation risk. The chapter emphasizes the need for a strong surveillance system in order to prevent and, if necessary, respond to imported cases. Chapter 4, Financing Elimination, reviews the cost-effectiveness of elimination as compared with sustained control and then presents the costs of selected elimination programs as examples. It evaluates four innovative financing mechanisms that must support elimination, emphasizing the need for predictable and stable financing. Case studies from Swaziland and two provinces in China are provided. Chapter 5, Understanding Malaria, considers malaria from the point of view of elimination and provides a concise overview of the current burden of the disease, malaria transmission, and the available interventions that can be used in an elimination program. Chapter 6, Learning from History, extracts important lessons from the Global Malaria Eradication Program and analyzes some elimination efforts that were successful and some that were unsuccessful. The chapter also reviews how the malaria map has been shrinking since 1900. xiv A Prosp ectus on Mala ria Elimi natio n\ud Chapter 7, Measuring Malaria for Elimination, provides a precise language for discussing malaria and gives the elimination discussion a quantitative structure. The chapter also describes the role of epidemiological theory and mathematical modeling in defining and updating an elimination agenda for malaria. Chapter 8, Killing the Parasite, outlines the importance of case detection and management in an elimination setting. Options for diagnosis, the hidden challenge of Plasmodium vivax in an elimination setting, and the impact of immunity are all discussed. Chapter 9, Suppressing the Vector, explores vector control, a necessary element of any malaria program. It considers optimal methods available to interrupt transmission and discusses potential changes, such as insecticide resistance, that may affect elimination efforts. Chapter 10, Identifying the Gaps — What We Need to Know, reviews the gaps in our understanding of what is required for elimination. The chapter outlines a short-term research agenda with a focus on the operational needs that countries are facing today. The Prospectus reviews the operational, technical, and financial feasibility for those working on the front lines and considers whether, when, and how to eliminate malaria. A companion document, A Guide on Malaria Elimination for Policy Makers, is provided for those countries or agencies whose responsibility is primarily to make the policy decisions on whether to pursue or support a malaria elimination strategy. The Guide is available at www.malaria eliminationgroup.org

MDG Acceleration Framework and Country Action Plan: Maternal Health

According to the 2010 MDG Report, Ghana's progress in achieving the MDGs is mixed. The country is largely on track to achieve the MDG 1 target of reducing by half the proportion of the population living in extreme poverty. The overall poverty rate has declined substantially over the past two decades from 51.7 percent in 1991 -- 1992 to 28.5 percent in 2005 -- 2006 while the proportion of the population living below the extreme poverty line also declined from 36.5 percent to 18.2 percent over the same period against the 2015 national target of 26 percent and 19 percent respectively. Although current data on poverty is not available, trends in economic growth suggest a further decline in poverty between 2006 and 2008

Resilience Culture in the Healthcare Team During COVID-19

Abstract Background: Resilience commonly refers to the ability of an individual or organization to continue to maintain routine, normal, function despite sudden disruptions. Purpose: The purpose of this dissertation research was to provide a deeper understanding of healthcare team resilience. The goal of this research dissertation was to investigate how resilience manifested itself in the healthcare team during the COVID-19 pandemic. AIM 1: What is the concept of resilience in healthcare teams? AIM 2: Identify the barriers and facilitators of healthcare team resilience during the COVID-19 pandemic. AIM 3: Describe how the pandemic influenced healthcare team decision making. Methods: In the first manuscript we performed a comprehensive systematic analysis that delves into the concept of healthcare team resilience in the literature. Based on these results, in the second manuscript the authors utilized an adapted model developed by the research team that frames the healthcare team as a cohesive and aware entity, rather than merely a group of individuals or a subset of personnel within a healthcare system. Finally, the third manuscript uses this adapted model to present research findings from interviews on resilience culture, based on a thematic analysis. Findings: In chapter 2, we found 41 distinct definitions of the concept, with three defining attributes: 1) resilience is triggered by an a priori disruptive event that serves as a catalyst activating the healthcare team\u27s latent potential; 2) this potential leads to the actualization of skills and abilities that enable the team to respond to the disruption in an adaptive manner; 3) the team’s adaptive response enables them to continue executing responsibilities in the face of the disruption. This contributed to AIM 1 by describing the concept of resilience in healthcare teams during COVID-19. The concept analysis brought to light a significant disparity arising from the prevailing literature primarily emphasizing individual resilience as a lens to understand healthcare team resilience, thus potentially obscuring any hidden aspects of resilience within the healthcare team. This discrepancy underscored the necessity to develop a comprehensive model to explore healthcare team resilience during COVID-19 that acknowledges the healthcare team as a singular cognizant entity and not an individual or group of individuals. In chapter 3, we found by integrating knowledge and principles from the domains of resilience engineering, systems engineering, patient safety, and naturalistic decision- making we could create a framework by which AIM 2 and AIM 3 could be addressed. An adapted model was created. The exploration of the barriers and facilitators of resilience and the impact of COVID-19 on the decision-making processes in healthcare teams could be thoroughly explored using the adapted model. A qualitative descriptive study was conducted in 2021 and data were analyzed using reflexive thematic analysis. Chapter 4 presents the findings of this study related to AIM 2 and AIM 3. The study utilized the adapted model as a guide for the interview questions. The author developed the interview questions, which were reviewed and approved by faculty mentors. The author interviewed (N=22) interprofessional healthcare participants who worked during the COVID-19 pandemic. A thematic analysis of the interview data resulted in the identification of five themes related to resilience in the healthcare team during COVID-19: working in a pressure cooker; healthcare team cohesion; applying past lessons to current challenges; knowledge gaps, and altruistic behaviors. The evidence indicates that the pressures form working during COVID-19 and gaps in explicit knowledge, negatively influenced adaptive behaviors to maintain healthcare team resilience. Team cohesion, tacit knowledge and altruistic behaviors positively influenced adaptive behaviors and decision making. Conclusion: This compendium presents the exploration of resilience within healthcare teams amidst the challenges posed by the COVID-19 pandemic. The literature review revealed that the conventional approach to understanding the concept and measuring healthcare team resilience primarily focused on individual resilience. However, this research recognized the need for an adapted model that recognizes the healthcare team as a cohesive and cognizant entity to identify barriers and facilitators of resilience that may be otherwise obscured when solely emphasizing the resilience of individuals, or specific groups. Through a reflexive thematic analysis, several significant findings were identified regarding the impact of the COVID-19 pandemic on the healthcare team: 1) Emotionality played a crucial role in influencing adaptive behaviors, encompassing emotions such as fear, stress, anxiety, and frustration; 2) Drawing upon their tacit knowledge gained from prior experiences, the healthcare team demonstrated the capacity to anticipate and effectively respond to the crisis despite their lack of explicit knowledge, and 3) The solidarity and camaraderie within the healthcare team not only bolstered their overall functionality but also facilitated unified decision-making processes

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

Globally, 303 000 women die each year from preventable causes related to pregnancy, with the Democratic Republic of Congo (DRC) having the tenth highest maternal mortality rate. Maternal Death Surveillance and Response (MDSR) is a surveillance-action cycle that aims to eliminate preventable maternal mortality by linking actionable data on maternal deaths with multi-level actions. While countries are increasingly adopting MDSR, there are research gaps on its implementation, outcomes, and best practices in developing countries including the DRC. This study assessed MDSR implementation in Goma Health Zone (HZ), DRC, specifically its structure, process, quality, outcomes, and influencing factors. A qualitative case study design was utilized, comprising semi-structured interviews with 15 key informants from seven sites, a review of 52 MDSR documents, and an observation of a maternal death review. Data analysis was conducted in Dedoose using the constant comparative method. Findings suggest that MDSR integration into an existing Integrated Disease Surveillance and Response system in the DRC has facilitated its acceptability and institutionalization in integrated (i.e. government-affiliated) health facilities in Goma HZ, where it is sustained by existing organizational resources. However, the MDSR system had weak community and private health sector linkages. Additionally, this study revealed a systematic implementation of early MDSR phases (notification-review) but gaps in completing advanced MDSR functions such as response implementation. With respect to quality, the MDSR system’s major strengths were its simplicity, acceptability, and timeliness in integrated health facilities, while its major challenges were its acceptability, data quality, and timeliness in communities and non-integrated facilities. The political commitment to MDSR and strong support from the HZ and facility leadership were key enablers of MDSR implementation, while unregulated private facilities and the links between MDSR and disciplinary action were the most prominent barriers. While MDSR in Goma HZ has yielded some improvements in the quality of care at HZ and facility levels, its overall impact on maternal health outcomes remains reportedly weak due to limited response implementation at higher levels of the health system.To strengthen Goma’s MDSR, this study suggests the need for a non-threatening MDSR environment, multisectoral partnerships, and mechanisms to follow-up on recommendations

Perioperative Orientation, Education, and Mentoring (POEM) Program

Perioperative registered nurses (RNs) are vital to the provision of safe patient care for those undergoing invasive and surgical procedures within acute care settings. Unrealistic transition-to-practice (T2P) expectations for novice RNs (newly licensed and experienced RNs new to perioperative nursing) have resulted in significant turnover and attrition rates as high as 45%. A T2P program, known as the Perioperative Orientation, Education, and Mentoring (POEM) program, was developed to address attrition and turnover through mentoring and professional development. The POEM program was a pilot program implemented at a large academic medical center. An evaluation tool known as the Surgical Skill Assessment Tool was developed to evaluate the POEM program. A preintervention score of 56 and a postintervention score of 237 demonstrate an increase in experience, skill, and knowledge acquisition. Content data analysis revealed themes and subthemes from each of the 2 focus groups as well as recommendations from the quality improvement (QI) project leader and project coleader. The recommendations include developing a nurse extern program, advertising and promoting perioperative nursing to local nursing schools, supporting the clinical advisor program, encouraging involvement in the local Association of periOperative Registered Nurses (AORN) chapter, and mentoring novice RNs and RN clinical advisors. The need to evaluate strategies for improvement, recruitment, and retention is critical to sustain the perioperative nursing workforce. Further research is necessary to refine the POEM program and to understand the role of professional mentoring in facilitating a smooth T2P for novice nurses entering perioperative services

Review of Funding and Management Structures of Emergency Medical Teams (EMTs) and International Search and Rescue (ISAR) Teams

When disasters exceed the capacity of the affected country to cope within its own resources, assistance from external source teams is required and typically requested (Bartolucci et al., 2019). Assistance can be Emergency Medical Teams (EMTs - also known as Disaster Medical Teams [DMTs] or Disaster Medical Assistance Teams [DMATs]) and/or International Search and Rescue (ISAR) teams. However, as the structures of these teams differ greatly, their management is paramount to success. Also, the cost of international relief, and the belief that such deployment is cost-effective, has been questioned by the international community. Although overall management and centrally pooled funding is available for EMTs and ISAR teams, this rapid review focuses on organisation and funding at the country and/or regional level. As requested, EMT examples are taken from Australia, China, India, Israel, Malaysia, and the Caribbean. Data on ISAR teams is from Brazil, China, Germany, Indonesia, Scandinavia, and the United States (USA). The assessed ‘grey’ literature included: (i) external evaluations commissioned by funding agencies and/ or humanitarian EMT providers; (ii) institutional reviews of lessons learned; (iii) after-action reports, and (iv) formal reviews commissioned by the authorities of some of the sudden onset disaster (SOD) affected countries. Findings from response to natural disasters (de Ville de Goyet et al., 2003), and conclusions of five Tsunami Evaluation Coalition (TEC) thematic evaluations (de Ville de Goyet, 2007) were used extensively. However, since these publications, there still are few detailed data and evaluations available on EMTs and ISAR teams (Gerdin et al., 2013; Bartolucci et al., 2019). Experts consulted for this rapid review also confirmed this

Health systems determinants of maternal and neonatal health in Rwanda

Contains fulltext : 209057.pdf (publisher's version ) (Open Access)Radboud University, 5 november 2019Promotor : Velden, J. van der Co-promotores : Bijlmakers, L.A., Dillen, J. va