Role of Human Resources Management in the Effectiveness of Business Process Reengineering

The main idea of the paper to presents a model with the discussion of Human resources management role with line extent of Management competency, team working, effective communication, IT and Organizational structure and there impact on the effectiveness of Business Process Reengineering. The article suggest that the use of HRM with the implementation of the BPR find the better results and support the organizational better performance Keywords: human Resources Management, business process Reengineering, Organizational performanc

The role of TQM and BPR in executing quality improvement: a comparative study

In order to sustain a competitive edge in this global manufacturing era, enterprises need to adopt appropriate improvement schemes. This article examines a detailed study of quality improvement tools mostly used in the organizations. As this is the conceptual paper, the paper focuses on two important quality improvement techniques, BPR (Business Process Reengineering) and TQM (Total quality management). Both the approaches clinch the same thoughts and objectives for organizational enhancement but the difference lies in terms of means used by each technique, the risk, time frame and the magnitude of change expected from each of these programs. In order to attain this comparison, the article first defines and explains each of the approaches for the in depth understanding of the difference as well as similarities between these two. The articles (related to the comparison of these two improvement tools) of almost last 15 years are gathered and studied in detail and then conclusion is drawn based on the findings of different previous articles. The methodology used primarily is literature review as well as the case study method also helps in gathering the data. The study concludes that even though both the approaches intend to enhance organizational competence, they are relatively different both theoretically as well as practically and each of the approach is suitable for different situation depending upon the needs and requirements of the organization. Keywords: Competitive edge, TQM, BP

Oral sildenafil use in neonates with persistent pulmonary hypertension of newborn

Background: The prevalence of PPHN has been estimated at 1.9 per 1000 live births. After the discovery of iNO\u27s, its efficacy and benefit in PPHN is well established. Even in the best of centers equipped with iNo and ECMO the mortality is around 20%. Also, iNO is expensive and difficult to administer and monitor which makes it difficult choice in our part of the world. Furthermore About 40% of patients do not respond or have rebound pulmonary hypertension after discontinuation. Owing to these reasons, other treatment modalities like phosphodiesterase inhibitors such as Sildenafil need to be evaluated.Methods: We report a retrospective case series of eighteen patients with PPHN admitted in NICU and treated with oral sildenafil.Results: Three (17%) babies had mild, 5 (28%) moderate and 10 (55%) severe PPHN based on echocardiography. Sildenafil was started on all patients on a mean of 1.67 days and stopped on mean 12.6 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 40% on mean 10 days. Average length of stay in NICU was 13 days. Twelve (67%) patients survived whereas 6 (33%) expired (Figure 2). No improvement in oxygen Index after 36 hours (p\u3c0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusions: Oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings. However further studies regarding its comparative efficacy need to be done

Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey

Introduction Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada’s National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. Methods and analysis Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August–September 2016 and June–July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. Ethics and dissemination The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16–219). The study will adopt a multimodal approach to disseminate the study’s findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally

Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis

Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The CLEAR toolkit pilot study: an educational intervention for helping health workers address the social causes of poor health

INTRODUCTIONSocial determinants of health are widely recognized as root causes of health disparities between and within countries. Health care workers can play a significant role to improve the health of individuals and populations if provided proper training on how to address the social causes of poor health in day-to-day clinical practice. The objectives of this study were: (1) To determine whether the CLEAR toolkit, a clinical decision-aid designed to help frontline health workers ask about and act upon the social determinants of health, is considered useful and applicable to health workers at a large university-affiliated family medicine teaching centre serving a highly ethnically diverse population in inner city Montreal, (2) To elicit what changes should be made to this toolkit to make it even more useful for frontline health workers, (3) To understand how the toolkit should be adapted to the local setting and how to train health workers to use it in practice, and (4) To better understand the kind of organizational support available to frontline health workers to address the social causes of poor health of their patients, and what more could be done to further support health workers in taking on a social determinants of health approach. METHODSWe conducted a multi-method study involving: (1) an online survey of frontline health workers to assess current practices and collect feedback on the feasibility of using the CLEAR toolkit in clinical practice, (2) in-depth interviews to understand why health workers consider certain patients to be more vulnerable and how to best help such patients, (3) focus groups to explore barriers to asking about social determinants of health during routine clinical practice, and (4) key informant interviews with high-level administrators to identify organizational levers for promoting widespread change in health workers’ practices. RESULTSOf the 100 health workers surveyed, fifty health workers responded to the questionnaire (Response Rate 50%). We continued the in-depth interviews until data saturation was reached (15 in-depth interviews). We conducted two focus groups of 6-8 health workers in each group, and three key informant interviews with senior health administrators. There was a high level of agreement that it is the role of frontline health workers to address the underlying social issues that are the root causes of their patient’s health problems (n=44/50, 88%,). The majority of health workers found the CLEAR toolkit easy to understand (n=36/37, 97.3%), relevant to their work (n=33/37, 89.2%), and can help them to address the social causes of poor health (n=32/37, 86.5%). Health workers who already had specific ways of asking their patients about social issues were twice as likely to report having helped their patients with social issues (n=15/16, 93.7%, vs. n=9/17, 52.9%; p=0.003). Organizational barriers to asking about the social determinants of health in clinical practice included lack of role modeling, training and time. Facilitators for adopting a social determinants of health approach included having access to clinical practice tools and a short list of local referral resources.CONCLUSIONSFrontline health workers appreciate the value of taking action to address the social determinants of health. However, there is a need to provide health workers more education, training and organizational support. The CLEAR toolkit has the potential to contribute to reducing health disparities by training the frontline health workers to ask about and act upon the social causes of poor health.INTRODUCTIONLes travailleurs de la santé peuvent jouer un rôle important pour améliorer la santé des individus et des populations s’ils reçoivent une formation adéquate sur la façon d'aborder les déterminants sociaux de la santé dans leur pratique clinique courante. Les objectifs de cette étude étaient: (1) de déterminer si la boîte à outils CLEAR, un outil d’aide à la décision clinique sur les déterminants sociaux de la santé, est considéré comme utile et applicable par des travailleurs de la santé provenant d’un grand centre universitaire d'enseignement de la médecine familiale servant une population ethnique diversifiée dans la région de Montréal, (2) d’identifier les changements qui devraient être apportés à cette boîte à outils pour la rendre encore plus utile pour les travailleurs de la santé de première ligne, (3) de comprendre comment la boîte à outils doit être adaptée au contexte local et comment former les travailleurs de la santé pour l'utiliser dans leur pratique courante, et (4) de mieux comprendre le soutien organisationnel mis à la disposition des travailleurs de la santé de première ligne dans leur pratique courante pour mieux soutenir leurs patients à agir sur les déterminants sociaux.METHODE Nous avons mené une étude multi-méthode incluant: (1) un sondage en ligne avec des travailleurs de la santé de première ligne afin d'évaluer les pratiques actuelles et de recueillir des commentaires sur la faisabilité de l'utilisation de la boîte à outils CLEAR dans la pratique clinique, (2) des entrevues en profondeur pour comprendre pourquoi les travailleurs de la santé considèrent certains patients comme plus vulnérables et comment les aider, (3) des groupes de discussion pour explorer les obstacles pour aborder les déterminants sociaux de la santé dans leur pratique clinique courante, et (4) des entretiens avec des informateurs-clés (cadres supérieurs) afin d'identifier les leviers organisationnels pour promouvoir un changement dans la pratique des travailleurs de la santé.RESULTATSSur les 100 travailleurs de la santé interrogés, 50 ont répondu au questionnaire (taux de réponse : 50%). Les entretiens en profondeur ont été effectués jusqu'à saturation de données (n=15). Nous avons effectué deux groupes de discussion avec respectivement 6 et 8 travailleurs de la santé dans chaque groupe, et trois entretiens avec des cadres supérieurs de la santé. Il y avait un niveau d'accord élevé que les travailleurs de la santé de première ligne devraient assumer la tâche d’identifier les déterminants sociaux qui causent des problèmes de santé à leurs patients (n=44/50, 88%). La majorité des travailleurs de la santé ont trouvé la boîte à outils CLEAR facile à comprendre (n=36/37, 97,3%), pertinente à leur travail (n=33/37, 89,2%), et utile pour aborder les déterminants sociaux de la santé (n=32/37, 86,5%). Les travailleurs de la santé qui posaient des questions sur les déterminants sociaux étaient deux fois plus susceptibles d’indiquer avoir aidé leurs patients avec des problèmes sociaux (n=15/16, 93,7%, par rapport à n=9/17, 52,9%; valeur p = 0,003). Les obstacles organisationnels à poser des questions sur les déterminants sociaux de santé dans la pratique clinique incluent l’absence de modèles, la formation et le temps. Les facilitateurs de l'adoption de déterminants sociaux dans la démarche de santé incluent avoir accès à des outils de pratique clinique et à une courte liste de ressources locales.CONCLUSION Les travailleurs de la santé de première ligne reconnaissent l’importance d’aborder les déterminants sociaux de la santé. Cependant, il y a un besoin de fournir aux travailleurs de la santé plus d'éducation, de formation et de soutien organisationnel. La boîte à outils CLEAR peut contribuer à réduire les disparités en santé par la formation des travailleurs de la santé de première ligne pour agir sur les déterminants sociaux de la santé

Modeling the Rice Land Suitability Using GIS and Multi-Criteria Decision Analysis Approach in Sindh, Pakistan

The objective of this research was to evaluate rice land suitability in Sindh, Pakistan, by designing GIS-based Multi-Criteria Decision Analysis (MCDA) spatial model to aggregate interdisciplinary aspects including factors of soil physical and chemical properties, ground water quality, soil pH, agro-ecological zones, canal command area and temperature. A constraint map of water bodies was also utilized in this model. On the basis of these parameters,standardized raster maps were created, and then Pair-Wise Comparison Matrix (PWCM) of Analytical Hierarchy Process (AHP) was developed to calculate significant weights by means of Principal Eigen vector by Saaty’s method, with accepted Consistency Ratio (CR) of 0.10. Furthermore, Multi-Criteria Evaluation (MCE) employing Weighted Linear Combination (WLC) aggregated all the suitability maps to yield rice land suitability map. Final output map of this work demonstrated 30.2% increase in area suitable for rice cultivation with an increased production of 14,716,592.17 tonnes as compared to existing rice practices in Sindh. This increase in the area and production of the potential land shows the capability of our novel model and offers an opportunity to improve cultivation by providing the much required information at local level that could benefit farmers, vision scientists and decision makers to select appropriate cropping site and agricultural planning making the best use of available data

Qualitative evaluation of the helping baby breathe training for community midwives in Gujrat, Pakistan

Pakistan\u27s neonatal mortality rate has the highest proportion in the South Introdu ared to Asian region (Ahmed & Won, 2017) and it is more common in rural areas, as comp the urban areas. Poor resuscitation techniques, as well as the absence of basic newborn tion skills in birth attendants, are contributing factors of neonatal deaths (Jacobs et resuscita al., 2018). Neonatal mortality can be prevented by skilled birth attendants, especially the midwives, in low-income settings (Khalid, 2018). Based on the significant outcomes of the Helping Baby Breathe (HBB) training, a similar training was implemented for CMWs in the low resource setting of Gujrat, Pakistan, in order to improve their knowledge and skills. The training had two evaluation methods; the quantitative and the qualitative. This study selected the qualitative method of the evaluation, that is, interviewing HBB trained CMWs and their facilitators, to determine the effectiveness of HBB training. odolo: A qualitative descriptive design was used in this study. The purposive Meth gy lin technique was chosen. The study included a total of five interviews: two focus samp g group interviews with CMWs (10 in each group), and three key informants. A semistructured interview guide was used to conduct the interviews. ndins: The content analysis of the qualitative data led towards three themes; the Fi g veness of training, challenges, and suggestions. The findings revealed that HBB effects ing was effective for the CMWs in terms of the use of advanced teaching-learning train loies, competency of facilitators and training content, and continuing supervision, methodo g as it resulted in improvement in their knowledge and skills regarding newborn resuscitation. it enhanced confidence and satisfaction among the CMWs. However, less volume Moreover, of patients was a challenge for few CMWs in practicing their skills. iv Conclusion: As several CM Ws mentioned that the other healthcare providers downplay their role, and resultantly, a limited number of patients visited them that\u27s why they get fewer opportunities for practicing their skills and utilizing their knowledge. They recommended that they required such training regularly in order to maintain their competency. CMW role and competency programs should be initiated by the government for bringing awareness. CMWs also recommended that HBB training should be part of the Diploma in Midwifery curriculum. Similar training for other health care providers working in low resource areas including doctors and nurses were also endorsed