Downtime and Stability Evaluation of Mechanical Parts for Cobalt-60 Radiotherapy Units According to Standard Recommendation at NCI - U of G

Cobalt radiotherapy is an external beam radiation therapy used to treat primarily bone cancer and tumors of the breast, head, and neck. Most cancer patients need radiation therapy during their curative and palliative treatment to cure or control the disease while minimizing complications to healthy tissues. In developing countries, cobalt radiotherapy machines are the most cost-effective and relevant methods of cancer treatment and cancer control. However, there is an acute shortage of radiotherapy facilities in a number of countries such as Sudan. Keeping the existing facilities functioning within the standard requirements is extremely challenging due to the shortage of spare parts, lack of quality control tools, and complications with calibrating the quality control tools, in addition to the availability of instrumentation of a low quality. The mechanical performance of two cobalt radiotherapy machines was assessed over a span of twelve months to evaluate stability, downtime, and performance. The results show the instabilities of the performance of mechanical machine parts, prolonged downtimes, and increased frequency of breakdowns of the two teletherapy machines considered in this paper. The aim was to ameliorate the availability and reliability of the equipment thus guaranteeing higher performance and reduced problems in clinical service. After the input power supply system was modified, a marked improvement in the availability of the machines was experienced. In addition, it was decided that gantry and collimator checks have to be performed routinely. Complete machine interlock tests take place daily in the morning before clinical service commences and during the day, two biomedical engineers must be in attendance as long as clinical treatment is taking place. Although these measures lead to a reduction in the number of patients treated, the improved reliability and availability of the machines make more than up for the differenc

An Examination of the Maternal Health Quality of Care Landscape in India

India has made significant strides in maternal health over the past several decades, reducingits maternal mortality ratio (MMR) from 556 to 174 maternal deaths per 100,000 live births from1990 to 2015 (World Bank 2016a). Policies and initiatives to increase access to maternal healthservices largely account for this progress. However, the rate of improvement has slowed, and thecountry continues to contribute almost one-quarter of maternal deaths globally (Nair 2011). Inaddition, India is home to a high but difficult to measure rate of so-called near-miss maternaldeaths that often lead to maternal morbidity. Although the incidence of maternal morbidity inIndia is largely unknown due to the country's lack of diagnoses and under-reporting, it isestimated that millions of Indian women experience pregnancy-related morbidity; the GlobalBurden of Disease estimates that India contributes one-fifth of the disability-adjusted life yearslost globally due to maternal health conditions (World Health Organization 2008). These patternssuggest there is still progress to be made in maternal health in India.The John D. and Catherine T. MacArthur Foundation seeks to continue its more than 20-year history supporting population and reproductive health in India and accelerate the country'sadvancement in maternal health. It has chosen to fund a three-and-a-half-year grantmakingstrategy to improve maternal health quality of care, which has emerged as a key means to furtherreduce MMR and related outcomes. This review is intended to describe current issues andinterventions in the delivery of maternal health care and provide a backdrop for the Foundation'sgrantmaking effort

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥ 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels

Identifying common problems in the acquisition and deployment of large-scale software projects in the US and UK healthcare systems

Public and private organizations are investing increasing amounts into the development of healthcare information technology. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardised procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the problems that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail on electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of Healthcare Information Systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems

Using Electronic Technology to Improve Clinical Care -- Results from a Before-after Cluster Trial to Evaluate Assessment and Classification of Sick Children According to Integrated Management of Childhood Illness (IMCI) Protocol in Tanzania.

Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI

Rethinking health sector procurement as developmental linkages in East Africa

Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012–15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa

Leadership conversations: the impact on patient environments

Purpose – The aim of this study is to examine 15 NHS acute trusts in England that achieved high scores at all their hospitals in the first four national Patient Environment audits. No common external explanations were discernible. This paper seeks to examine whether the facilities managers responsible for the Patient Environment displayed a consistent leadership style. Design/methodology/approach – Overall, six of the 15 trusts gave permission for the research to take place and a series of unstructured interviews and observations were arranged with 22 facilities managers in these trusts. Responses were transcribed and categorised through multiple iteration. Findings – The research found common leadership and managerial behaviours, many of which could be identified from other literature. The research also identified managers deliberately devoting energy and time to creating networks of conversations. This creation of networks through managing conversation is behaviour less evident in mainstream leadership literature or in the current Department of Health and NHS leadership models. Practical implications – The findings of this study offer managers (particularly those in FM and managers across NHS) a unique insight into the potential impact of leaders giving an opportunity to re-model thinking on management and leadership and the related managerial development opportunities. It provides the leverage to move facilities management from the role of a commodity or support service, to a position as a true enabler of business. Originality/value – Original research is presented in a previously under-examined area. The paper illuminates how facilities management within trusts achieving high Patient Environment Action Team (PEAT) scores is led.</p

Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania.

Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies. The study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis. Focusing on the third phase of the three-delay model, four main obstacles have been identified: confusions over payment, inadequate referral systems, the inefficient organization of health services and the culture of communication. These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as 'technologies of social exclusion', as they are embedded in the everyday practices of the health facilities in systematic ways. The interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system. Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively into the other two phases of delay