Healthcare Infrastructure

Aim: The present study aims to assess the extent of spatial variation in quality of Primary Healthcare facilities in Murshidabud District, West Bengal. Method: Using data from Office of Chief Medical Officer of Health, Govt. Of West Bengal, on availability of structural inputs for the year 2013-14 in Primary Healthcare Centres (PHCs) from 26 Blocks, an Overall Development Index (ODI) is constructed. ODI is a composite measure of the relative importance of all available structural inputs in PHCs. A spatial variation of ODI is then depicted in map to present the shortfall of existence of structural inputs across different blocks. Mean and Standard Deviation is used to compute the spatial variation in health achievements. Results: The result shows intra district variation in availability of facilities for each selected indicator. The Development Index varies from 0.18 in Beharampur to 0.67 in Suti-II. Infant and Maternal Death also shows variation in various blocks. Conclusion: Different Blocks are performing differently in Murshidabud with respect to both availability of services and manpower and also in health achievements. Detection of blocks with low quality of primary healthcare facilities will help in effective interventions.

Presently it seems that adequate rural healthcare in India is a virtual pot of gold at the end of a long winding road. While
we are making great strides in upgrading our healthcare infrastructure and resources to world standards in the
metropolises and other cities, the gap in accessibility to these resources between the urban and rural population within
the country is ever increasing.
Overall we still can only compare our medical successes with other developing and poorly developed countries and are
still far away from the kind of health changes that has been brought about in developed countries. Previous studies
have suggested that majority of the rural deaths which are preventable, are due to communicable, parasitic,
respiratory diseases and infections. Easily accessible basic interventions can help in minimizing the sufferings.
Problem areas that needs to be looked into while comparing rural and urban healthcare services are inequality and
inadequacy; misallocation of public money and inadequate rural public health expenditure; flagrant
commercialization of healthcare and crippling hold of drug manufacturing companies on distribution and pricing of
life saving medicines.
The selective, institutionalized, centralized and top – down method of healthcare service delivery needs to be
dismantled and a decentralized medical service which can be easily accessed by the people is required for the majority
of the rural population. Small changes along with some drastic ones by the people who develop policies are required
like the concept of rural medical colleges, family physicians, integration of Indian System of Medicine Practitioners
into the registered medical practitioner category. Most important is appropriate allocation of funds and budgets to
upgrade/ develop the healthcare infrastructure among the rural population that is actually utilized and shown through
regular audits.

The adoption of technology in healthcare over the last twenty years has steadily increased, particularly as it relates to medical robotics and Multi-User Virtual Environments (MUVEs) such as Second Life. Both disciplines have been shown to improve the quality of care and have evolved, for the most part, in isolation from each other. In this paper, we present four synergies between medical robotics and MUVEs that have the potential to decrease resource utilization and improve the quality of healthcare delivery. We conclude with some foreseeable barriers and future research directions for researchers in these fields.

Introduction: The primary-secondary care interface provides significant opportunities for medication errors to arise. There has been limited research into mechanisms to facilitate seamless transfer across this interface. The aim of this study was to focus on the potential contribution of community pharmacy services at the interface.

Materials & Methods: The opinions of community and hospital pharmacists were sought in relation to the current situation by means of questionnaires. A log book of communications between a community pharmacy and hospitals was maintained. A comparison of new discharge and post-discharge prescriptions was also performed. The data was coded and analysed in SPSS v.16.

Results: There is currently little communication across the interface at the time of discharge, with 11% of community pharmacists reporting no contact by a hospital at this time and a further 80% stating that they were only contacted occasionally. Hospital pharmacists reported ongoing difficulties in attempting to obtain a medication history on admission. Both parties agreed that the introduction of standard protocols and a designated seamless care pharmacist would improve medication safety at the interface. Most communication occurred between the community pharmacy and hospital on a Friday and also after 3 pm in the evening. When communication did occur the issue was resolved in 81% of all cases. Medication that required a follow up prescription from a patient’s family doctor following a hospital visit was incorrectly transcribed by the family doctor in 27% of cases.

Discussions, Conclusion: The involvement of community pharmacists occurs irregularly at present. There is dissatisfaction with the current situation. Pharmacists at either side of the interface are aware of the importance of the role that the other plays in seamless care, with both parties favouring the introduction of processes to facilitate seamless care at the interface. The involvement of the community pharmacist in the discharge process, through the dispensing of hospital discharge prescriptions, helped to reduce the number of medication errors that could occur at the primary-secondary care interface.

The healthcare services are divided under State list and
Concurrent list in India. While some items such as
public health and hospitals fall in the State list, others
such as population control and family welfare, medical
education, and quality control of drugs are included in the
Concurrent list. The Union Ministry of Health and Family
Welfare (UMHFW) is the central authority responsible for
implementation of various programmes and schemes in areas of
family welfare, prevention, and control of major diseases. In
the case of health the term infrastructure takes on a wider
role than mere physical infrastructure. Healthcare centres,
dispensaries, or hospitals need to be manned by well trained
staff with a service perspective. In this chapter we include
medical staff in our ambit of discussion on rural health
infrastructure.
The current conditions of physical infrastructure, staff,
access, and usage are laid out here before identifying critical
gaps and requirements in infrastructure and services. Issues
related to institutions, financing, and policy are discussed in the
context of these critical need gaps and the potential role of the
private sector in healthcare provisioning in villages is explored.

This paper proposes a model for low cost design of mhealth solutions. The model presented here is based on RF transmitter and receiver, microcontroller and cellular network integration and uses F-BUS protocol for transmitting and receiving data using a NOKIA 3310 handset. The proposed design aims at eliminating the need of smart-phone dependent costly mhealth solutions. Also, the current paper presents the essential comparative data and statistics to support the concerned proposed design.

Cite: Rajat Kumar and Arvind Rehalia, "Proposed Design of a Low Cost mHealth System," International Journal of Modeling and Optimization vol. 2, no. 1, pp. 15-18, 2012.

Rajat Kumar is with the Bharati Vidyapeeth's College of Engineering, Guru Gobind Singh Indraprastha University , New Delhi , India (e-mail: rajatk489@gmail.com).

Arvind Rehalia is with the Bharati Vidyapeeth's College of Engineering, Guru Gobind Singh Indraprastha University, New Delhi, India (e-mail: rehaliaarvind@gmail.com).

his article tells the story of the Uganda Cancer Institute over the past 50 years. I discuss the fundamental dynamism of research collaborations and the ways in which they bring vital yet partial investments in improving the capacity of medical facilities in sub- Saharan Africa. I explore the ways in which patient populations and the needs of caretakers themselves shape research collaborations. I also show how extreme oscillations in the capacity to conduct oncology research and provide care were (and are) tied not only to shifting international research priorities, but also to broader upheaval and periods of stability in Uganda since independence in 1962. Rather than dwelling on the debris, ruins, or an emptying of capacity in the health sector in Africa, this article highlights how this experimental infrastructure in East Africa not only survived, but also fundamentally shaped a culture of care and oncology practice that lived on.

—Low-cost, real-time digital signal processors (DSPs) embedded in generic Internet of Things (IoT) edge devices can make significant contributions to distributed edge computing for industrial IoT (IIoT) networks. The DSP considered in this paper is the Texas Instruments (TI) TMS320C28x DSP (C28x). At the edge of the network, the C28x is programmed using low-level Embedded C programming language to construct the Morlet wavelet. Our implementation at this layer is the first known construction of the Morlet wavelet for C28x DSP using Embedded C. At the fog layer, near the edge of the IoT network, where more computing resources exist, the wavelet is then convolved with healthcare (electrocardiogram) and electrical network signals, using Matlab to reduce signal noise, and to identify important parts of examined signals. Convolution results indicates that the distributed computing approach for low-cost generic devices considered in this paper is suitable for use in large IIoT networks.

Objective. The objective of this study was to explore the experience of patients who had stoma surgery to treat cancer in order to explicate why problems associated with stoma surgery are not decreasing despite technical improvements in stoma care.


Design. A longitudinal design was used in order to capture the process of preparing for surgery and dealing with its aftermath. Participants were interviewed using a semi-structured protocol on three occasions; 1-2 weeks before surgery (eight participants), 1-2 weeks after surgery (seven participants), and 3 months after surgery (four participants).


Method. Transcripts were analysed guided by the procedures of grounded theory. This involved developing categories from the data and linking them together to form a conceptual understanding of our participants' experience.


Results. Lowered personal control was the most important concept to emerge from the analysis. We identified perceived causes of lowered control, its mitigating factors, the strategies used to manage this experience and the consequences of these processes.


Conclusions. We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed adaptation. Finally, we identify a need for more prolonged practical emotional support for at least some stoma out-patients.

This policy note makes an assessment of the present healthcare delivery system in India with a particular focus on the delivery mechanisms present in urban India. Section I – Looks at the treatment-seeking behaviour of the population providing insights into the availability and choice of healthcare providers. Section II – Provides information on the health infrastructure in India which suffers from serious under capacity. Section III – Describes the size, composition and distribution of the health workforce and the suggestions for building a sufficient manpower base for the health sector. Section IV – Looks at trends in health expenditures.

ÖZ:
Dünya tıp literatüründe yaygın bir uygulama olan triyaj sistemi Sağlık Bakanlığı mevzuatı gereği Türkiye’de de uygulanmaktadır. Sosyal güvenlik mevzuatı yönünden özellik arzeden bir uygulama olan triyajın uygulanma esasları Sağlık Uygulama Tebliği’nde belirlenmiştir. Buna göre triyaj kapsamında yapılan değerlendirme sonucu yeşil alan muayenesi kapsamına giren sağlık hizmetlerinden katılım payı ve ilave ücret alınabilmekteyken, yeşil alan muayenesi kapsamı dışında kalan acil sağlık hizmetlerinden bu tutarlar alınamamaktadır. Bu uygulamayla, acil hizmetlerindeki gereksiz iş yükünün azaltılması yanında aile hekimliği sisteminin sağlıklı işlemesinin sağlanması ve sevk zinciri sistemine geçiş için sağlık hizmetlerinin olgunlaştırılması hedeflenmektedir. Bu çalışma, triyaj sistemlerinin tanımı ve amaçlarının açıklanması yanında sağlık hizmetleri ve sosyal güvenlik mevzuatı açısında Türkiye’de uygulanan triyaj sisteminin yeri ve uygulama esaslarının derli toplu bir şekilde ortaya konulmasını amaçlamaktadır.
ANAHTAR KELİMELER: Triyaj sistemleri, genel sağlık sigortası, yeşil alan muayenesi, muayene katılım payı, ilave ücret.
ABSTARCT
Triage system which is a common practice in world medical literature, has been also implementing in Turkey according to legislation of Ministry of Health. The implementaion principles of triage system, which constitutes a special practice in terms of social security legislation, has determined in Health Budget Notification Act. Accordingly, as a result of the evaluation carried out with triage system, it can be taken contribution fee and additional charge from the health care services within the scope of green category examinations while those amounts can not be taken from emergency healt care services except green category examinations. With this implementation it is being targeted to reduce the burden of unnecessary work on emergency services, in addition to ensure healthy functioning of the family practioners system and to elaborate the health care services for transition to the referral system. This study aims to explain the definition and objectives of the triage systems alongside to disclosure neatly the position and application principles of triage system in Turkey in terms of health care services and social security regulations.
KEYWORDS: Triage Systems, General Health İnsurance, Green Category Examination, Examination Contribution Rate, Additional Fee.

Purpose of the study: Uninterrupted hospital services and medical functions are the keys to functional resilience to cope with mass casualties. This paper presents the important level of resilience indicators for hospital functions to withstand natural disasters. Methodology: For the survey, 21 indicators are grouped into three domains focusing on i) general concerns of healthcare infrastructure planning ii) design and planning of hospital buildings iii) emergency service and management. The corresponding indicators were ranked on a Likert scale of 1 to 5. The authors collected 389 responses through an online survey of the healthcare professionals including disaster management professionals, medical officers, hospital architects, planners, project managers, and engineers. Main Findings: The data were analysed for determining the Relative Importance Index (RII) of each indicator. The top 7 indicators as an outcome of this research are: ‘access to the emergency services (0.861), ‘plan...

In socio-geographical studies of public health, the information resources are especially valuable. There is a direct relation between the borders of the studied territory and the provision of information. In this research, an attempt has been made for theoretical substantiation of the processing, analysis and visualization of health information through:-setting up and electronic preparation of the data;-grouping of the data;-calculation of statistical indicator(s);-scientific analysis and interpretation of the obtained results.

Abstract (provisional)
Background
Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.

Methods
A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.

Results
The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.

Conclusions
To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.

Purpose of the study: Uninterrupted hospital services and medical functions are the keys to functional resilience to cope with mass casualties. This paper presents the important level of resilience indicators for hospital functions to withstand natural disasters. Methodology: For the survey, 21 indicators are grouped into three domains focusing on i) general concerns of healthcare infrastructure planning ii) design and planning of hospital buildings iii) emergency service and management. The corresponding indicators were ranked on a Likert scale of 1 to 5. The authors collected 389 responses through an online survey of the healthcare professionals including disaster management professionals, medical officers, hospital architects, planners, project managers, and engineers. Main Findings: The data were analysed for determining the Relative Importance Index (RII) of each indicator. The top 7 indicators as an outcome of this research are: ‘access to the emergency services (0.861), ‘plan...

Transformation and change for a better health and care delivery system have been the driving forces behind UK’s government initiatives and investments during the past decade. Questions have been raised in terms of how successful these investments have been and to what extent they have delivered their strategic step changes and benefits to the community and to the healthcare system in itself as a whole. The need to identify a process that will manage and deliver those benefits as well as managing any unanticipated impacts is now greater than ever. This paper investigates the need for a new thinking behind transformation and change and argues that the answer is a benefits driven mindset. A Benefits Realisation Management Process (BRMP) should be the leverage behind any decision making mechanism. It should provide the justification and give purpose to any project or programme no matter how big or small. This paper presents results from a literature review and a case study methodology a...

Missed appointments place a costly and disruptive strain on National Health Service resources in England. One major source of missed appointments appears to be insufficient communication between patients and providers. SMS text messaging shows promise as a simple, cost-effective means of bridging this communications gap. SMS provides an instant and asynchronous means of communication that protects patient privacy. The potential for this technology is balanced, however, by the lack of high-quality evidence to support its use. There is an urgent need for robust evaluation of critical quality, safety, cost implications, and acceptability before the large-scale rollout of SMS-based systems.

ABSTRACT Digital scan conversion (DSC) and speckle reduction imaging (SRI) are basic back-end units of an ultrasound imaging system. In a B-mode ultrasonography (USG) system, DSC is necessary to display a two dimensional image of a tissue structure. Speckle noise, present in an USG system, affects the quality of images observed. Moreover, motion blurring is observed while examining non-stationery organs like the heart. To address these issues, a high speed VLSI design of the USG back-end unit is presented in this paper. The back-end is designed in such a way that it can be integrated with the front-end of the USG system. An FPGA platform is used to prototype these units. Massive usage of the parallel-pipelining technique has helped in achieving high throughput at low power. The DSC architecture operates at 14.66 MHz and is capable of scan converting 132 raw frames per second. Similarly, the SRI unit operates at 221 MHz and is capable of de-speckling images of size 640 9480 at 698 fps. Therefore, it is possible to investigate objects without motion blur using these units. System level integration issues of the DSC–SRI units are also covered in this paper.

Purpose of the study: Uninterrupted hospital services and medical functions are the keys to functional resilience to cope with mass casualties. This paper presents the important level of resilience indicators for hospital functions to withstand natural disasters. Methodology: For the survey, 21 indicators are grouped into three domains focusing on i) general concerns of healthcare infrastructure planning ii) design and planning of hospital buildings iii) emergency service and management. The corresponding indicators were ranked on a Likert scale of 1 to 5. The authors collected 389 responses through an online survey of the healthcare professionals including disaster management professionals, medical officers, hospital architects, planners, project managers, and engineers. Main Findings: The data were analysed for determining the Relative Importance Index (RII) of each indicator. The top 7 indicators as an outcome of this research are: ‘access to the emergency services (0.861), ‘plan...

Missed appointments place a costly and disruptive strain on National Health Service resources in England. One major source of missed appointments appears to be insufficient communication between patients and providers. SMS text messaging shows promise as a simple, cost-effective means of bridging this communications gap. SMS provides an instant and asynchronous means of communication that protects patient privacy. The potential for this technology is balanced, however, by the lack of high-quality evidence to support its use. There is an urgent need for robust evaluation of critical quality, safety, cost implications, and acceptability before the large-scale rollout of SMS-based systems.

In one of his most recent statements, the Prime Minister of Samoa had denounced family planning based not only on religious stances but on effects of stunting population growth. Counterintuitive to development initiatives in 'developing' countries, which normally advocate for population control, Tuila'epa's statement reveals several contradictions about development and health infrastructures in Samoa.

This paper seeks to explore the paradoxes of local pragmatic concerns over development schemes and the impacts on health paradigms and health infrastructure in Samoa and American Samoa as the local populations have transitioned from traditional healing practices towards Western institutions. Family planning as a mechanism of population control, though packaged as necessary to development, has been scapegoated as a hindrance to development itself. Given Samoa's relatively stagnant population growth due to primarily unilateral outward migration, the contradictions become more salient. Donor aid is being poured in to build hospitals, yet the necessary staffing required to operate them is deficient. Money invested in providing scholarships to train healthcare professionals who opt to leave for better paying jobs overseas furthers the brain drain problem. Low-paying wages and salaries for medical professionals contribute to the deficiency of hospital and clinical staffing. Despite the increased reliance on foreign mechanisms of health delivery, much of the population still rely (at least partially) on traditional healing institutions and practices, including the local taulasea (healers) who have have organized their own formal association. What this paper ultimately seeks to address is how adequately 'the clinical way' tackles these development problems in the face of the many contradictory trends.