Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition.Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

Current status of quality of care for public hospitals in Korea : Comprehensive comparison with private hospitals

Objective: This ecological study aims to perform a comprehensive comparison and evaluation of the quality of care in public and private hospitals according to hospital type.Methods: Thisstudy compared and analyzed the results of the National Quality Assessment Program (NQAP) of Health Insurance Review and Assessment Service (HIRA) and Incentive Scheme for Quality Evaluation of Hospital Services. The NQAP results published on the HIRA website, as of the end of May 2021, and the internal data of HIRA for the 2020 Incentive Scheme for Quality Evaluation of Hospital Services were used as data collection sources.Results: The NQAP analysisrevealed that the overall average scores were higher for public rather than private hospitals, while the Incentive Scheme for Quality Evaluation of Hospital Services analysis reported that the proportion of higher grades (i.e., grades 1 and 2) was higher in public hospitals. Therefore, it was revealed that public hospital quality levels were notlowerthan that of private hospitals.However, itis necessary to improve the quality levelsin terms ofthe quality distribution.Conclusions: The quality levels of public hospitals are notlowerthan that of private hospitals. However,the high average quality level, we identified certain areas that required improvement in their quality level throughout the distribution. Currently, public hospitals that are particularly located in the lower ranks should strive to achieve the average quality level demonstrated by same level private hospitals, thereby, achieving progressive quality levels and minimizing the between institutions. Thus, furtherresearch should focus on identifying the trends of differencesin quality levels, and they should determine the causes by controlling for the characteristics of medical institutions.

Alzheimer’s disease and Aβ pathways

Alzheimer's disease (AD) is a neurodegenerative disease which is one of the major health issues globally. It is the 6th cause of death in the United States. Approximately, 60–70% of cases of dementia are caused by AD. The disease advances with age worsening the symptoms that include problems with declining memory, language, mood swings, loss of motivation, self-neglect, and other behavioral issues. AD patients need a long-term health care and hospital services as the disease worsens with the advancing of their age. However, proper medications and treatment is still unavailable as the cause of AD is poorly understood.

Impact of the COVID-19 Pandemic on Urologic Oncology Surgery: Implications for Moving Forward

The COVID-19 pandemic has caused the destruction of routine hospital services globally, leading to an increase in the backlog of elective surgery cases. The aim of the study was to retrospectively investigate the pandemic’s impact on the urologic oncology surgical activity of a high-volume center located in Milan, Italy. The number and type of procedures performed in 2020 during the COVID-19 pandemic was evaluated using 2019 data as control. Waiting times for each surgical procedure were compared, on a bimonthly basis, between the two different years. Overall, a 26.7% reduction in the number of urologic oncology surgeries between 2019 and 2020 was observed (2019: 720, 2020: 528). Both the main indication for surgery and the type of procedure performed significantly differed between 2019 and 2020 (all p < 0.0001), with a decrease in the number of radical prostatectomies and an increase in the number of radical cystectomies and radical nephrectomies/nephroureterectomies performed in 2020. Waiting time decreased by 20% between 2019 and 2020, with the most significant reduction seen after the first wave of the COVID-19 pandemic (July-October 2020), in particular for partial nephrectomy and radical prostatectomy, possibly due to the underdiagnosis of cases. In conclusion, in accordance with recommendations by international urological societies on prioritization strategies for oncological procedures, a higher proportion of surgeries for high-risk tumors was performed in 2020 at our center at the expense of procedures for lower risk diseases; however, future implications for patients’ prognosis still need to be determined.

NHS International Hospital Branding Image Strategy Through Integrated Marketing Communication

This article results from research on the brand image strategy carried out by the National Hospital Surabaya (NHS) through integrated marketing communications. This study is on health services bases in the community currently entering the industrial and business era. The main problem arises in-hospital services, which have developed into an industry and are profit-oriented. This problem puts pressure on hospital managers and owners, especially on the cost dimension in private hospitals. Private hospitals must continue to improve management capabilities in carrying out hospital operations with good quality standards to the best compared to other hospitals. The research uses a case study research method with a qualitative approach. Data collection and analysis techniques use observation and in-depth interviews so that they can be analyzed exploratively. The results of this study are the first are there are many reasons why the marketing department of NHS adopts Integrated Marketing Communication (IMC) in their sales strategy. It also happens in the healthcare industry, namely hospitals. One of the reasons that become the basis is that marketers understand and recognize strategies integrating into various communication functions rather than running these communication functions alone. Second, marketing communication theory becomes the rationale for processing data and analyzing the phenomenon of problems regarding strategic concepts in policy determination to the direction of marketing communication strategies carried out by NHS hospitals. This research concludes that the main problem arises in hospital services, which have developed into an industry and are profit-oriented. Strategic management skills will become more critical as pressure increases to find future revenue and growth opportunities. These opportunities will come through various combinations of new healthcare products and services, increasing penetration into high-priority market segments, or accessing new markets that are not serving currently.

Analisis Faktor yang Mempengaruhi Keberhasilan Sistem Informasi Pendaftaran Online di Rumah Sakit Nasional Diponegoro Kota Semarang

The development of online-based information technology in the health sector can improve the quality of hospital services. Currently, Diponegoro National Hospital has implemented outpatient registration based on the "RSND-Ku" android application, and 70% of patients use the application. This study aims to describe the effectiveness and factors that influence the implementation of online registration services for outpatients at the Diponegoro National Hospital Semarang by applying a quantitative method with a descriptive analytic approach to 100 patients who use online registration services aged 20-40 years. The results showed that there is a relationship between the factors that influence the implementation of outpatient online registration services, namely the p-value of system quality of 0.000, the correlation coefficient of 0.460, the p-value of the information quality value of 0.000 and the correlation of 0.472, the p-value of service quality of 0.000 and the correlation of 0.498, and use with a p value of 0.000 and a correlation of 0.441. As for further research, the researcher suggests improvements to optimize the smoothness of the system, completeness of information, updating services, and socializing the flow of online registration services.

Can inpatient pharmacists move the needle on smoking cessation? Evaluating reach and representativeness of a pharmacist-led opt-out smoking cessation intervention protocol for hospital settings

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hospitalization affords an opportunity to reduce smoking, but fewer than half of patients who smoke receive evidence-based cessation treatment during inpatient stays. This study evaluated a pharmacist-led, electronic health record (EHR)-facilitated opt-out smoking cessation intervention designed to address this need. Methods Analyses of EHR records for adult patients who smoked in the past 30 days admitted to an academic medical center in the upper Midwest were conducted using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. The reach of a pharmacist-led, EHR-facilitated protocol for smoking cessation treatment was assessed by comparing patients’ receipt of nicotine replacement therapy (NRT) and tobacco quitline referral before and after implementation. χ 2 tests, t tests, and multiple logistic regression models were used to compare reach across patient demographic groups to assess treatment disparities and the representativeness of reach. Adoption of the program by hospital services was also assessed. Results Of the 70 hospital services invited to implement the program, 88.6% adopted it and 78.6% had eligible admissions. Treatment reach increased as rates of delivering NRT rose from 43.6% of eligible patients before implementation to 50.4% after implementation (P &lt; 0.0001) and quitline referral rates rose from 0.9% to 11.9% (P &lt; 0.0001). Representativeness of reach by sex and ethnicity improved after implementation, although disparities by race and age persisted after adjustment for demographics, insurance, and primary diagnosis. Pharmacists addressed tobacco use for eligible patients in 62.5% of cases after protocol implementation. Conclusion Smoking cessation treatment reach and representativeness of reach improved after implementation of a proactive, pharmacist-led, EHR-facilitated opt-out smoking cessation treatment protocol in adult inpatient services.

Magnetic Resonance Imaging Evaluation of Closed-Mouth TMJ Disc-Condyle Relationship in a Population of Patients Seeking for Temporomandibular Disorders Advice

Objective. To characterize the closed-mouth temporomandibular joint (TMJ) disc-condyle relationship in a population of individuals who sought hospital services for temporomandibular disorders (TMD). Methods. Two hundred and twenty-four TMJ magnetic resonance images (MRIs) of 112 patients were assessed in all spatial planes to classify disc position with respect to the condyle in a closed-mouth position. Results. Disc displacement (DD) was present in 62.1% and superior disc position in 29.9% of the patients. Position could not be determined in 8% of the cases. Among DD, pure anteriorized position was the most common condition (34.4%), with different combined translational and rotational displacements in all the other joints (27.7%). Conclusion. There is a wide biological variability in disc position in closed mouth among patients seeking for TMD advice. Getting deeper into the correlation with clinical symptoms is recommended to refine the potential relevance of any diagnostic and management strategies based on the imaging evaluation of TMJ disc position.