Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

BACKGROUND: Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. METHODS: A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. RESULTS: Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. CONCLUSIONS: Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process

Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

Transition of patients from intensive care unit: A concept analysis

Background: Patient transition in the health care system is a complex process with several potential challenges including instability and unanticipated changes which usually disturb normal life. Evidence shows that there is a need for greater clarity regarding the concept of patient transition from ICU. Objective: The present study was conducted to clarify the core elements of patient transition from ICU, focusing on healthcare professionals. Methods: The Walker and Avant model was used to provide a comprehensive definition of transition. The literature was reviewed from 2000 until 2020 in different databases with mesh extracted keywords of transition, patient transfer, critical care, ICU, transition care, and transition process. Results: Transition is a complex, multifaceted concept with the following attributes: critical points and events, disturb normal life, the passage of change, instability and un-anticipated changes, multiple needs, multiple factors, collaborative, involving the patient, family/caregivers, multidisciplinary healthcare team, care and service coordination, awareness, engagement, and adaptation. The patient's responses to transition were different and depend on the patient's condition or environmental factors which lead to the development of confidence, adaptation, recovery from critical illness, and return to normal life or disability and other complications. Conclusion: The patient transition from ICU is a complex process, collaborative, patient-centered phenomena. Our conceptual definition can assist healthcare providers, organizational leaders, and policymakers to design and implement effective transition care and guideline. Also, the result of this study provides a definition of patient transition from ICU that can be relevant and useful for clinical and practical research