Exploring the determinants of mobile health adoption by hospitals in China: Empirical study

Background:Although mobile health (mHealth) has the potential to transform health care by delivering better outcomes at a much lower cost than traditional health care services, little is known about mHealth adoption by hospitals.Objective:This study aims to explore the determinants of mHealth adoption by hospitals using the technology-organization-environment (TOE) framework.Methods:We conducted an interviewer-administered survey with 87 managers in Chinese public hospitals and analyzed the data using logistic regression.Results:The results of our survey indicate that perceived ease of use (β=.692; P< .002), system security (β=.473; P< .05), top management support (β=1.466; P< .002), hospital size (β=1.069; P< .004), and external pressure (β=.703; P< .005) are significantly related to hospitals’ adoption of mHealth. However, information technology infrastructure (β=.574; P< .02), system reliability (β=−1.291; P< .01), and government policy (β=2.010; P< .04) are significant but negatively related to hospitals’ adoption of mHealth.Conclusions:We found that TOE model works in the context of mHealth adoption by hospitals. In addition to technological predictors, organizational and environmental predictors are critical for explaining mHealth adoption by Chinese hospitals

Status and trends of e-Health tools in Kuwait: A narrative review

Background: Kuwait is witnessing an alarming increase in diabetes and high prevalence of multi-drug resistant strains. E-Health solutions have the potential to deliver timely, quality and cost-effective solutions to these public health challenges. However, little is known about the existing e-health solutions in Kuwait. Aims: This study aims to explore the current e-health tools and applications in Kuwait, and the factors that affect their adoption and implementation. Methods: A literature search was carried out for articles on e-health in Kuwait using the following electronic databases: PubMed, Google Scholar, Scopus, Web of Science, CINAHL, Medline and Proquest. Reference lists of all included items were additionally searched. A manual search was also conducted using WHO EMRO Virtual Health Sciences Library and MOH policies and standards. Results: 1121 papers were retrieved from databases and 29 papers were added from manual searching of reference lists. 495 papers were considered for review after the removal of duplicates. Thirty studies met the inclusion/exclusion criteria. Implementing electronic health records and establishing a childhood-onset diabetes registry are the main e-Health achievements to date. Implementing e-Health tools has been hindered by various socio-political, financial, infrastructural, organizational, technical and individual barriers. Conclusion: The modest e-Health achievements warrant bigger and faster implementation steps focusing on developing an e-Health policy framework and drawing an implementation road-map that is evidence based and research informed

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

© 2019 International Society for Chemotherapy of Infection and Cancer Objectives: This study explored antimicrobial stewardship programme (ASP) team members’ perspectives regarding factors influencing the adoption and implementation of these programmes in Saudi hospitals. Methods: This was a qualitative study based on face-to-face semistructured interviews with healthcare professionals involved in ASPs and activities across three Ministry of Health (MoH) hospitals in Saudi Arabia (n = 18). Interviews were also conducted with two representatives of a General Directorate of Health Affairs in a Saudi region and two representatives of the Saudi MoH (n = 4) between January–February 2017. Results: Despite the existence of a national strategy to implement ASPs in Saudi MoH hospitals, their adoption and implementation remains low. Hospitals have their own antimicrobial stewardship policies, but adherence to these is poor. ASP team members highlight that lack of enforcement of policies and guidelines from the MoH and hospital administration is a significant barrier to ASP adoption and implementation. Other barriers include disintegration of teams, poor communication, lack of recruitment/shortage of ASP team members, lack of education and training, and lack of health information technology (IT). Physicians’ fears and concerns in relation to liability are also a barrier to their adoption of ASPs. Conclusion: This is the first qualitative study exploring barriers to ASP adoption and implementation in Saudi hospitals from the perspective of ASP team members. Formal endorsement of ASPs from the MoH as well as hospital enforcement of policies and provision of human and health IT resources would improve the adoption and implementation of ASPs in Saudi hospitals

Antibiotics' use in Thailand: Community pharmacists' knowledge, attitudes and practices

Thailand spends $203 million on antibiotics every year, and patients can still access antimicrobials over the counter without a prescription. Community pharmacy plays a pivotal role in improving access and ensuring the appropriate use of antimicrobials. However, little is known about current practices in this setting. This study aims to assess Thai community pharmacists’ knowledge, attitudes and practices (KAP) regarding antimicrobials’ use and resistance. A cross-sectional study was conducted in Bangkok and Chonburi province in 2017 using an online self-administered questionnaire. The questionnaire was completed by 372 community pharmacists (71.4% response rate). The most commonly encountered infections in the community were upper and lower respiratory tract infections. The most commonly dispensed antimicrobials were broad-spectrum antibiotics including aminopenicillins and fluoroquinolones. Thai pharmacists have a good knowledge, attitude, and practice regarding antimicrobials’ use and resistance. They dispense anti-microbials in line with local guidelines, although international guidelines may not indicate anti-biotics for viral self-limiting infections. While community pharmacy in Thailand could be the most accessible healthcare resource for patients, inappropriate provision of antimicrobials for self-limiting viral infections by pharmacists will increase antimicrobial resistance. This highlights the need for updated guidance and improved pharmacists’ training

The role of glucocorticoid receptor phosphorylation in Mcl-1 and NOXA gene expression

<p>Abstract</p> <p>Background</p> <p>The cyclin-dependent kinase (CDK) and mitogen-activated protein kinase (MAPK) mediated phosphorylation of glucocorticoid receptor (GR) exerts opposite effects on GR transcriptional activity and affects other posttranslational modifications within this protein. The major phosphorylation site of human GR targeted by MAPK family is the serine 226 and multiple kinase complexes phosphorylate receptor at the serine 211 residue. We hypothesize that GR posttranslational modifications are involved in the determination of the cellular fate in human lymphoblastic leukemia cells. We investigated whether UV signalling through alternative GR phosphorylation determined the cell type specificity of glucocorticoids (GCs) mediated apoptosis.</p> <p>Results</p> <p>We have identified putative Glucocorticoid Response Elements (GREs) within the promoter regulatory regions of the Bcl-2 family members NOXA and Mcl-1 indicating that they are direct GR transcriptional targets. These genes were differentially regulated in CEM-C7-14, CEM-C1-15 and A549 cells by glucocorticoids and JNK pathway. In addition, our results revealed that the S211 phosphorylation was dominant in CEM-C7-14, whereas the opposite was the case in CEM-C1-15 where prevalence of S226 GR phosphorylation was observed. Furthermore, multiple GR isoforms with cell line specific patterns were identified in CEM-C7-14 cells compared to CEM-C1-15 and A549 cell lines with the same antibodies.</p> <p>Conclusions</p> <p>GR phosphorylation status kinetics, and site specificity as well as isoform variability differ in CEM-C7-14, CEM-C1-15, and A549 cells. The positive or negative response to GCs induced apoptosis in these cell lines is a consequence of the variable equilibrium of NOXA and Mcl-1 gene expression potentially mediated by alternatively phosphorylated GR, as well as the balance of MAPK/CDK pathways controlling GR phosphorylation pattern. Our results provide molecular base and valuable knowledge for improving the GC based therapies of leukaemia.</p

Perceptions regarding antimicrobial use and resistance among adult hospital patients in Saudi Arabian Ministry of Health (MOH) Hospitals

Background: Education, a key strategy within antimicrobial stewardship programmes (ASPs), has been mainly directed towards healthcare professionals and prescribers more than hospitalised patients. Aim: To examine patients' knowledge and perceptions of antibiotic use and resistance, while evaluating the institutional role of patient education on antibiotic use in two Saudi Arabian hospitals, one with an implemented ASP and one without an ASP. Method: A cross-sectional self-administered survey was developed and piloted. A total of 400 surveys were distributed , 200 within the hospital with an ASP and another 200 within the hospital without an ASP. Data were coded and analysed. Ethical approval was obtained before the start of the study. Findings: 176 patients responded to the survey with 150 surveys completed and analysed. 78% of patients agreed that they should only take an antibiotic when prescribed by the doctor, however they still tended to keep left over antibiotics for future use. 84% of patients were unaware 'antibiotic resistance', with 48% believing that antibiotics help them get better quicker when they had a 'cold'. Information on antibiotic use and resistance were provided to patients in the hospital with an ASP in contrast to the hospital without an ASP. Conclusion: Overall there are poor perceptions regarding antibiotic use and resistance among hospital patients in Saudi Arabia. Patients in the hospital with ASP demonstrated greater knowledge during their hospitalisation. ASPs should not only focus on educating healthcare professionals but should involve the patients and seize the opportunity to educate them while hospitalised

Robust Surgical Tools Detection in Endoscopic Videos with Noisy Data

Over the past few years, surgical data science has attracted substantial interest from the machine learning (ML) community. Various studies have demonstrated the efficacy of emerging ML techniques in analysing surgical data, particularly recordings of procedures, for digitizing clinical and non-clinical functions like preoperative planning, context-aware decision-making, and operating skill assessment. However, this field is still in its infancy and lacks representative, well-annotated datasets for training robust models in intermediate ML tasks. Also, existing datasets suffer from inaccurate labels, hindering the development of reliable models. In this paper, we propose a systematic methodology for developing robust models for surgical tool detection using noisy data. Our methodology introduces two key innovations: (1) an intelligent active learning strategy for minimal dataset identification and label correction by human experts; and (2) an assembling strategy for a student-teacher model-based self-training framework to achieve the robust classification of 14 surgical tools in a semi-supervised fashion. Furthermore, we employ weighted data loaders to handle difficult class labels and address class imbalance issues. The proposed methodology achieves an average F1-score of 85.88\% for the ensemble model-based self-training with class weights, and 80.88\% without class weights for noisy labels. Also, our proposed method significantly outperforms existing approaches, which effectively demonstrates its effectiveness

Antimicrobial stewardship program implementation in a Saudi medical city: An exploratory case study

Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials’ use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how they were overcome, and the program outcomes. A key stakeholder case study design was used, involving in-depth semi-structured interviews with the core members of the ASP team and analysis of 35 ASP hospital documents. ASP implementation followed a top-down approach and involved an initial preparatory phase and an implementation phase, requiring substantial infectious diseases and clinical pharmacy input throughout. Top management support was key to the successful implementation. ASP implementation reduced rates of multi-drug resistance and prescription of broad-spectrum antimicrobials. The implementation of ASPs in hospital is administrator rather than clinician driven. Outsourcing expertise and resources may help hospitals address the initial implementation challenges