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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 2 | Issue 4
Page Nos. 85-115

Online since Monday, October 14, 2019

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ORIGINAL RESEARCH  

Burnout among Moroccan oncologists: A national survey p. 85
Zineb Benbrahim, Ahalli Ibtihal, Raihana Boujarnija, Mariam Atassi, Lamiaa Amaadour, Karima Oualla, Samia Arifi, Samira El Fakir, Nawfel Mellas
DOI:10.4103/JQSH.JQSH_13_19  
Introduction: Burnout is an unwanted outcome of chronic occupational stressors. Oncology staff is expected to suffer from burnout more than other health-care professionals. The aim of this survey was to determine the prevalence of burnout among Moroccan oncologists and to determine potential causal factors. Methods: We conducted a cross-sectional analytical study using an online self-administered questionnaire to oncologists in Morocco. We used the Maslach Burnout Inventory and additional questions exploring work and lifestyle factors. The questionnaire was sent in January 2018. Results: A total of 100 oncologists answered the questionnaire with predominance of women (75%), young participants (74%), and medical oncologists (60%). Eighty-five percent of the oncologists showed evidence of burnout. The rates of high scores of emotional exhaustion, depersonalization, and low scores of personal accomplishment were, respectively, 57%, 44%, and 56%.In the univariate linear analysis, age younger than 35 years (p = 0.014), being in residency training (p = 0.004), not having extra professional activities (p = 0.009), having an experience less than 10 years (p = 0.02) and estimating vacation time as not adequate (p = 0.05) were all significantly associated with increased burnout scores.In the multivariate analysis, only age <35 years (p = 0.028), being in residency training (p = 0.026), and having an experience less than 10 years (p = 0.01) were independent risk factors of burnout. Conclusion: These findings reveal that burnout in oncologists is higher than those reported internationally. Multidimensional interventions should be implemented to reduce burnout rates among Moroccan oncologists.
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Glycemic and cardiovascular risk control among patients with type 2 diabetes: A Saudi tertiary care hospital experience p. 89
Rana AlHamwy, Mona Hafiz, Yacoub Abuzied
DOI:10.4103/JQSH.JQSH_14_19  
Introduction: Data on concomitant control of both glycemia and cardiovascular risk factors among patients with type 2 diabetes (T2D) are very limited in Saudi Arabia. The aim of this study was to assess the degree of achieving glycemic control and concomitant control of cardiovascular risk factors at a primary care setting. Methods: Between February and March 2017, we retrospectively reviewed the charts and laboratory records of adult patients with T2D who received primary care services at Family Medicine clinics at King Fahad Medical City for at least a year. Outcome goals were based on 2016 American Diabetic Association (ADA) standards of diabetic care. Results: A total of 268 patients were included in the study. The mean age was 55.0 ± 10.7 years and 60% of the patients were women. Patients who achieved ADA-recommended diabetic care goals were 43.7% for glycemic control, 46.7% for blood pressure, 87.9% for total cholesterol, 52.7% for low-density lipoprotein cholesterol, 44.7% for high-density lipoprotein cholesterol, 70.8% for triglycerides, 9.4% for diet control, 1.9% for practicing exercises, 98.1% for receiving health education, and finally 38.8% for the recommended number of glycated hemoglobin testing. In addition to glycemic control, concomitant control of blood pressure, blood lipids, and both blood pressure/blood lipids were 21.3%, 9.4%, and 4.9%, respectively. In multivariate analysis, glycemic control was independently associated with the type of diabetic medications, diet control, and smoking status. Conclusion: The concomitant control of multiple diabetic care goals is alarmingly low. Further research is required to better understand the responsible system barriers and strategies to improve.
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QUALITY IMPROVEMENT PROJECT Top

Improving the birth registration service using Kotter’s change model: A quality improvement study from Qatar p. 98
Salma K Al-Kaabi, Nagah Selim, Ayman Al-Dahshan, Mohamad Chehab
DOI:10.4103/JQSH.JQSH_10_19  
Introduction: The increased demand for birth registration (BR) services at the Birth Registration Unit (BRU), under the Ministry of Public Health in Qatar, and the negative media criticism called for an urgent quality improvement (QI) plan to be conducted. Methods: A QI project was carried out to improve the process of birth certificate registration in the country. This project depended on Kotter’s eight-stage model as a guide for the aspired transformation. Thus, strengths, weaknesses, opportunities, and threats (SWOT) analysis, “straw-man” process map, root cause analysis, political, economical, social, technological, environmental and legal (PESTLE) factor analysis, and operational analysis of the BR process were attempted through cooperation and one–one interviews with service providers and stakeholders. The baseline measurements involved in the project focused on two main outcomes: client satisfaction and the cycle time of the BR process. Results: The post-change customer satisfaction survey showed higher overall satisfaction (0.66% overall dissatisfaction) with the services compared to the pre-change client satisfaction survey (17.3% overall dissatisfaction). Moreover, the calculated cycle time of the redesigned process (6.30min) represented a substantial decrease as compared to the pre-change cycle time (almost 7 days). Conclusion: The study of the BR process revealed many facts regarding delays and wasted time. It served as a trigger for the change and made solving this problem much easier by examining the real underlying factors. In addition, the successful use of Kotter’s change model at the BRU serves as a potential source for the diffusion of such model across other health institutions.
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Analysis of vaccination rates of 23-valent pneumococcal polysaccharide vaccine after quality improvement project in hospitalized patients with diabetes mellitus p. 105
Amy Seagroves, Christina S Reh, Nathaniel Bischoff, Laura Nally, Jasjit Singh
DOI:10.4103/JQSH.JQSH_12_19  
Introduction: Since 2014, the American Academy of Pediatrics has recommended that patients over two years with diabetes mellitus (DM) receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Methods: Retrospective chart review was initiated by a quality improvement (QI) project to determine PPSV23 administration rates for inpatients with DM at Children’s Hospital of Orange County (CHOC). The QI project included education for staff and families regarding need for PPSV23 in patients with DM. Electronic medical record (EMR) order sets for DM were updated with PPSV23 vaccine. Data were collected from EMR to identify differences in subjects who were vaccinated with PPSV23 and unvaccinated from April 2015 to April 2016. Results: Before April 2015, PPSV23 was not being given to inpatients with DM. There were 199 individual subjects admitted to CHOC with DM from April 2015 to April 2016. Of those, 78 subjects (39.1%) received vaccine. Data were categorized to identify if vaccine was ordered (n = 152) or not (n = 47). Univariate logistic regression analysis performed on whether PPSV23 was ordered showed age, location (pediatric intensive care unit [PICU] vs. floor), hemoglobin A1c (HbA1c), primary DM admission, and insulin pump vs. injection usage were significant factors (P < 0.05). Multivariate logistic regression showed that those with higher HbA1c (P = 0.014), new-onset DM (P = 0.009), and those admitted for primary DM-related issues (P = 0.007) were more likely to have PPSV23 ordered. No significant subject factors identified differences in why vaccine was not administered (n = 74) once ordered. Conclusion: PPSV23 rates for pediatric inpatients with DM increased from 0% to 39% during one year following education and EMR modifications.
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HEALTH POLICY ANALYSIS AND PERSPECTIVE Top

Implementation of country-wide pharmacoeconomic principles in cancer care in developing countries: Expert-based recommendations Highly accessed article p. 109
Abdul Rahman Jazieh, Elena Pizzo, Laszlo Gulacsi, Faris Eldahiyat, Munir Abu-Helalah, Nagwa Ibrahim, Hana AlAbdulkareem, Fatma Maraiki, Aabdulaziz AlSaggabi, Paul Cornes
DOI:10.4103/JQSH.JQSH_11_19  
Introduction: Cancer care is a major challenge to health care and for optimal outcomes, health systems need to align policy across many areas of public life. The recognition that even the wealthiest nations can fail optimum outcomes indicates a need for increased efficiency in cancer control programs. Fundamental to this is the efficient direction of resources––a process that can be optimized through economic measures. This article contains expert recommendations on how decision makers can implement pharmacoeconomic principles at national level in developing countries. Methods: A multidisciplinary panel of 10 experts was formed of oncologists, clinical pharmacists, health economists, and chronic disease control and public health experts from different countries and health-care sectors. The panel developed consensus recommendations for different stakeholders using a framework analysis method. Results: Recommendations were categorized as national level, hospital level, industry level, and public-community level to support decision makers in implementing pharmacoeconomic principles in a systematic way. The recommendations included having proper well-structured, data-driven processes with a specific role for each stakeholder. We proposed required structures and processes in such a way that they can be customized based on individual country plans. Conclusion: The expert panel recommendations will serve as a guide to relevant stakeholders at a national level. Adaptation of these recommendations to each setting is important to accommodate the situation and needs of each country.
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ACKNOWLEDGMENTS Top

Acknowledgments p. 115
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