The tremendous need for comprehensive healthcare among underserved populations has been well documented. Most of the healthcare resources have been allocated to major metropolitan areas and largely populated cities. In Massachusetts alone, 500,000 people are not serviced by proper healthcare because they are unemployed or underinsured. They do not have a home base for their needs, most visit emergency rooms or minute clinics for care. They lack continuity of care. For minorities and underserved populations, there is a gap in the healthcare system. Statistics have shown that the lower your socioeconomic status, the more advanced the disease has progressed before it is diagnosed, leading to fewer treatment options and poorer outcomes. This is often due to Healthcare Deserts / Health Professions Shortage Areas in the US where there is a true lack of access to healthcare resources. One effective system for healthcare belongs to the Cuban government. Since the revolution in 1949, one of the main goals of the Cuban government was to provide primary care to all its population. The system before the revolution was centralized in the cities and was available mostly to the wealthy and urban populations while the remaining population was left with a substandard and underfunded system like many developed and undeveloped countries. In this paper, we will explore the success of the Cuban system and extrapolate some aspects of its system to use in the underserved populations that inhabit Healthcare Deserts. Implementation of systems will create an Oasis of providers that will naturally improve the well-being of populations leading to the well-being of federally funded state and local resources. The Cuban system divided the country into a grid system and each grid was subsequently divided into even smaller areas with a population of approximately one thousand. A primary care team consisting of a doctor and a nurse was assigned to each grid, including a dental component, and charged with the health and well-being of the population. This system was so successful that it was exported to other countries such as Venezuela, and it was adopted by the World Health Organization as the healthcare model standard to be followed in their world efforts. These programs have been implemented in Latin America, Africa, and Asia with different levels of success due to resource availability and financial constraints. In Venezuela during the Chavez administration, the system was implemented and achieved its highest level of success by benefiting the poor and underserved while Chavez was in power, creating thousands of clinics and improving the healthcare of the population. In Africa, Tanzania adopted the primary care approach at its new dental school and is producing strong clinicians versed with this approach. In Asia, the WHO has made progress in some areas; however, success has proven dependent on the country’s political and financial situation. The primary care approach that the system embraces, emphasizes prevention and education at a very early stage. This is key, and the data proves the success of campaigns even with limited resources provided there is the involvement of the local population. In contrast, United States resources are concentrated on the coasts and urban locations such that the rural areas have the least resources, and people in rural locations often travel long distances to access healthcare. A few states in the US have implemented programs that have been successful – Colorado, North Carolina, and New Mexico. If we successfully transplant teams of healthcare providers, including doctors, dentists, nurses, pharmacist, optometrist, obstetrics /gynecology, pediatricians, and a complete and sustainable health center into empty grids, slowly a series of Oasis will be created and access to care will improve. This change needs to happen at multiple levels, it is a task that must be taken collectively, from the teaching institutions exposing healthcare students to the need for providers in these rural and underserved areas, increasing funding to provide more scholarships and programs that funnel recent graduates into these areas with a sustainable and self-replenishing model, and most important, emphasizing education and prevention in dental school curriculum as the key to improving healthcare, and creating Oases in the current deserts.

Obesity, a condition of excess body fat, is one of the most complex problems facing health systems. Lifestyle management programs that combine diet, physical activity, and intensive behavioral therapy have been shown by research to support a degree of weight loss that produces health benefits (i.e., at least a 3-5% initial body weight). However, it has been difficult for research-developed programs to be delivered in typical practice to have a meaningful impact. Integrated research-practice partnerships that involve the coming together of academic researchers, health system administrators, and program delivery staff may help overcome this gap, especially during this transformational time in the healthcare sector. This dissertation aimed to develop an understanding of how using the integrated research-practice approach would facilitate and sustain evidence-based lifestyle management strategies across a health system to treat obesity among patients and employees. An integrated research-practice partnership with Carilion Clinic, a health system in western Virginia, served as an example for the study. From 2013-2016, the Carilion Clinic integrated research-practice partnership conducted a series of trials testing different strategies for delivering weight loss and weight loss maintenance support. An evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted to describe implementation processes and outcomes for each strategy. Lessons learned from the evaluation support the value of the integrated-research practice partnership approach as a solution for overcoming gaps in obesity care. A shared priority perspective between research and practice was identified as the powerful process for supporting facilitation and sustainability of strategies. In addition, findings from the evaluation produced evidence to inform the future development of a system for Carilion Clinic to help patients and employees lose weight and keep it off through lifestyle management. / Ph. D.

Yes / Interoperability within different healthcare systems (clinics/hospitals/pharmacies) remains an issue of further research due to a barrier in sharing of the patient’s Electronic Health Record (EHR) information. To solve this problem, cross healthcare system collaboration is required. This paper proposes an interoperability framework that enables a pharmacist to access an electronic version of the patient’s prescription from the doctor using a RESTFul API with ease. Semantic technology standards like Web Ontology Language (OWL), RDF (Resource Description Framework) and SPARQL (SPARQL Protocol and RDF Query Language) were used to implement the framework using JENA semantic framework tool to demonstrate how interoperability is achieved between a pharmacy and a clinic JENA was used to generate the ontology models for the pharmacy called pharmacy.rdf and clinic called clinic.rdf. The two models contain all the information from the two isolated systems. The JENA reasoner was used to merge the two ontology models into a single model.rdf file for easy querying with SPARQL. The model.rdf file was uploaded into a triple store database created using FUSEKI server. SPARQL Endpoint generated from FUSEKI was used to query the triple store database using a RESTFul API. The system was able to query the triple store database and output the results containing the prescription name and its details in JSON and XML formats which can be read by both machines and humans. / Supported by a Institutional Links grant, ID 261865161, under the Newton-Ristekdikti Fund partnership. The grant is funded by the UK Department for Business, Energy and Industrial Strategy and Indonesia Ministry of Research, Technology and Higher Education and delivered by the British Council.

As mudanças ocorridas no Sistema Único de Saúde nos últimos anos, associadas às mudanças nas políticas educacionais, forçaram uma modificação na atuação do profissional farmacêutico. Nesse sentido, o farmacêutico necessita adquirir capacitação para atuar em conjunto com a Equipe Multiprofissional de Saúde. O objetivo deste trabalho foi avaliar se o ensino superior em Farmácia no Brasil capacita o farmacêutico a atuar em colaboração com a Equipe Multiprofissional de Saúde dentro dos preceitos do Sistema Único de Saúde. Com base em metodologia quanti-qualitativa, este trabalho analisou projetos político-pedagógicos e o cenário clínico de hospitais universitários de cinco instituições de ensino superior brasileiras, e estudou, a partir de questionários qualitativos, aplicados a diversos profissionais de saúde, as necessidades da equipe em relação à atividade do farmacêutico. Verificou-se inserção ainda modesta do farmacêutico, muitas vezes causada pela falta de conhecimento da equipe sobre sua função ou por uma sensação de falta de preparo do próprio profissional. Também, a análise dos documentos oriundos dos cursos permitiu a constatação da falta de um olhar direcionado para o Sistema Único de Saúde e para a formação clínica. Poucas iniciativas curriculares tem surgido nesse sentido. Por fim, são apresentadas propostas, por meio de mapeamento conceitual, para se pensar um currículo em que coexistam a formação técnica, já tradicional, e a formação clínica, permitindo abarcar essa última, deixada de lado a partir de meados do século XX, que retorna hoje como uma demanda social. / Recent modification in the Brazilian\'s Public Health System, associated with changes in educational policies for higher education, forced a change in the pharmacist\'s professional performance area. Accordingly, the pharmacist needs to acquire capacity to act in conjunction with the Health Multidisciplinary Team. The objective of this thesis was to evaluate whether higher education in Brazil Pharmacy Schools enables the professional to work in collaboration with the Health Multidisciplinary Team within the precepts of National Public Health System. Based on quantitative and qualitative methodology, this study analyzed political-pedagogical projects and the clinical setting of university hospitals of five Brazilian higher education institutions, and studied from qualitative questionnaires applied to various health professionals the needs of the Multidisciplinary Health Team in having as a team member the pharmacist. There was verified a still modest insertion of the pharmacist in health teams, often caused by lack of staff knowledge about their function or by a sense of lack of readiness of the professional himself. Also, the analysis of documents from Pharmacy courses led to confirmation of the lack of educational policies directed to the National Public Health System and clinical training. Few curriculum initiatives have arisen in this regard. Finally, proposals are developed through conceptual mapping, to think of a Pharmacy course curriculum that can coexist in both the technical training as clinical training, allowing embrace this professional area of actuation that was set aside from the mid-twentieth century and returns today as a social demand.

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.

As mudanças ocorridas no Sistema Único de Saúde nos últimos anos, associadas às mudanças nas políticas educacionais, forçaram uma modificação na atuação do profissional farmacêutico. Nesse sentido, o farmacêutico necessita adquirir capacitação para atuar em conjunto com a Equipe Multiprofissional de Saúde. O objetivo deste trabalho foi avaliar se o ensino superior em Farmácia no Brasil capacita o farmacêutico a atuar em colaboração com a Equipe Multiprofissional de Saúde dentro dos preceitos do Sistema Único de Saúde. Com base em metodologia quanti-qualitativa, este trabalho analisou projetos político-pedagógicos e o cenário clínico de hospitais universitários de cinco instituições de ensino superior brasileiras, e estudou, a partir de questionários qualitativos, aplicados a diversos profissionais de saúde, as necessidades da equipe em relação à atividade do farmacêutico. Verificou-se inserção ainda modesta do farmacêutico, muitas vezes causada pela falta de conhecimento da equipe sobre sua função ou por uma sensação de falta de preparo do próprio profissional. Também, a análise dos documentos oriundos dos cursos permitiu a constatação da falta de um olhar direcionado para o Sistema Único de Saúde e para a formação clínica. Poucas iniciativas curriculares tem surgido nesse sentido. Por fim, são apresentadas propostas, por meio de mapeamento conceitual, para se pensar um currículo em que coexistam a formação técnica, já tradicional, e a formação clínica, permitindo abarcar essa última, deixada de lado a partir de meados do século XX, que retorna hoje como uma demanda social. / Recent modification in the Brazilian\'s Public Health System, associated with changes in educational policies for higher education, forced a change in the pharmacist\'s professional performance area. Accordingly, the pharmacist needs to acquire capacity to act in conjunction with the Health Multidisciplinary Team. The objective of this thesis was to evaluate whether higher education in Brazil Pharmacy Schools enables the professional to work in collaboration with the Health Multidisciplinary Team within the precepts of National Public Health System. Based on quantitative and qualitative methodology, this study analyzed political-pedagogical projects and the clinical setting of university hospitals of five Brazilian higher education institutions, and studied from qualitative questionnaires applied to various health professionals the needs of the Multidisciplinary Health Team in having as a team member the pharmacist. There was verified a still modest insertion of the pharmacist in health teams, often caused by lack of staff knowledge about their function or by a sense of lack of readiness of the professional himself. Also, the analysis of documents from Pharmacy courses led to confirmation of the lack of educational policies directed to the National Public Health System and clinical training. Few curriculum initiatives have arisen in this regard. Finally, proposals are developed through conceptual mapping, to think of a Pharmacy course curriculum that can coexist in both the technical training as clinical training, allowing embrace this professional area of actuation that was set aside from the mid-twentieth century and returns today as a social demand.

La recherche opérationnelle (RO) joue un rôle important dans les systèmes de santé. Au cours des dernières années, l'hospitalisation à domicile comme les hôpitaux de réhabilitation ont émergé pour pallier aux coûts du système de santé et à la qualité de vie des patients. Dans les secteurs de la réhabilitation, la gestion des soins de santé est sous-développée et la plupart des hôpitaux de réhabilitation sont gérés uniquement par l’expérience. Dans cette thèse, nous traitons d'abord le problème de la planification des traitements dans les hôpitaux de réhabilitation afin de les optimiser. Notre travail vise à réduire le temps d’attente des patients hospitalisés et ainsi améliorer leur satisfaction. Afin de résoudre efficacement ce problème de planification de traitements complexes, nous proposons une approche basée sur un algorithme de recherche hybride de coucou qui est testée et validée dans un cas réel. Nous nous intéressons ensuite à l'hospitalisation à domicile qui constitue un autre problème réel compte tenu du vieillissement de la population. Dans la plupart des régions, un nombre croissant d’organisations à but lucratif et à but non lucratif s’associent pour offrir des soins aux patients. Elles ont tendance à atteindre un niveau hospitalier tant en quantité et qu'en qualité avec une flexibilité accrue par rapport aux services hospitaliers. Nous étudions les problèmes de planification et d'acheminement des soins à domicile en tenant compte de nombreuses contraintes liées à la fois aux patients et aux soignants. Le problème est un scénario pratique motivé et vise à minimiser les coûts d'exploitation totaux. Nous utilisons le solveur commercial Gurobi pour résoudre et valider le modèle avec des données réelles. / Operations research (OR) plays an important role in healthcare system. In recent years, rehabilitation hospitals have been emerging to meet the increasing needs for rehabilitation services due to the ageing population trend. However, the healthcare management in rehabilitation sectors is undeveloped and most of the rehabilitation hospitals (departments) are managed by experience. In this thesis, we deal with a treatment scheduling problem in rehabilitation hospitals. The objective is to facilitate the scheduling process. More importantly, our work aims at reducing the waiting time of inpatients so as to improve inpatients’ satisfactions. In order to solve the complex treatment scheduling problem efficiently, we propose an approach based on a hybrid cuckoo search algorithm which is tested and validated in a real case. Moreover, home healthcare (HHC) is another real-world issue considering the aggravating trend of ageing population. In most areas, an increasing number of social-profit & non-profit organizations are joining in providing healthcare services to patients at their homes and it has a tendency to reach the hospital-level in both quantity and quality for the added flexibility than hospital's service. We investigate home healthcare scheduling and routing problem with consideration of many real-life factors, especially lunch break requirement. The problem is practical scenario motivated and aims at minimizing the total operating cost. We use the commercial solver Gurobi to solve and validate the model with real data.

Made available in DSpace on 2014-12-17T14:46:56Z (GMT). No. of bitstreams: 1 DeboraDSM.pdf: 318175 bytes, checksum: 69936c4287b18c346f645bf8926587de (MD5) Previous issue date: 2006-06-06 / This study analyzes the point of view of nurses working at a pediatric teaching hospital on their work process within the scope of the Brazilian unified healthcare system SUS, in order to identify factors that interfere with its development and find out how work relations are taking place between nurses, other nursing professionals and the multidisciplinary staff. It is a descriptive and analytical study, qualitative in nature, which starts with a consideration of a nurse s current practices and moves on to reflect on a perspective of transformation aiming at rethinking their work process pursuant to the principles of SUS. In order to attain these objectives, we decided on using the focal group as a data-collecting technique, which took place from November to December 2005, by using as instruments a questionnaire for the characterization of the persons being researched and a discussion outline. Theoretical support has approached transformations in the world of work, placing it in the context of healthcare and nursing and has tried, specifically, to understand the work process of a nurse engaged in the production of health services. Therefore, the discourse analysis of participants, in the light of theoretical support, has evinced an ambiguity inasmuch as though identified as such in their work process, nurses are also fulfilling multiple functions in health services. Through this study it has also been possible to identify several factors that interfere with the work of these professionals, including poor working conditions and excessive hiring of high school graduate interns as an attempt to make up for a meager nursing workforce, as well as reveal the possibilities brought about by the SUS in retargeting its professional practice to interdisciplinarity and integrality / Este estudo analisa a vis?o das enfermeiras de um hospital pedi?trico de ensino acerca do seu processo de trabalho no contexto do Sistema ?nico de Sa?de (SUS), com vistas a identificar os fatores que interferem na sua efetiva??o e a forma como v?m se estabelecendo as rela??es de trabalho entre estas, os demais profissionais da enfermagem e a equipe multidisciplinar. ? um estudo descritivo/anal?tico de natureza qualitativa, que parte da reflex?o da atual pr?tica das enfermeiras para a perspectiva de transforma??o, no sentido de repensar o seu processo de trabalho em conson?ncia com os princ?pios do SUS. Para atingir tais objetivos, optou-se pelo grupo focal, como t?cnica de coleta de dados, o qual se realizou entre novembro e dezembro de 2005, utilizando-se como instrumentos um question?rio de caracteriza??o dos pesquisados e o roteiro de discuss?o. O referencial te?rico abordou as transforma??es no mundo do trabalho, contextualizando o trabalho na sa?de e na enfermagem e, especificamente, buscou compreender o processo de trabalho do enfermeiro inserido na produ??o dos servi?os de sa?de. Assim, as falas das participantes, analisadas ? luz das refer?ncias te?ricas, evidenciaram ambig?idade no reconhecimento do enfermeiro acerca do seu processo de trabalho, que, apesar de identific?-lo, assume m?ltiplas fun??es nos servi?os de sa?de. Este estudo ainda permitiu a identifica??o de diversos fatores que v?m interferindo na pr?tica desses profissionais, dentre os quais, as deficientes condi??es de trabalho e a excessiva contrata??o de bolsistas de n?vel m?dio, como alternativa de recompor a insuficiente for?a de trabalho da enfermagem, al?m de revelar as possibilidades trazidas pelo SUS na reorienta??o do seu fazer profissional com vistas ? interdisciplinaridade e a integralidade

This report is about double documentation in health care. In today's healthcare, there is a problem with the staff entering the same information in several different systems. It creates more work and takes precious time for an already strained business. The healthcare professionals are feeling more stressed with the increasing workload. Double documentation is today a work problem for healthcare professionals. The purpose of the report is to make a current report on how and why duplicate documentation occurs in the health care sector in the region of Gävleborg. A descriptive case study was conducted focusing on how healthcare professionals insert patient data into multiple information systems. The case study has been conducted in cooperation with Tieto, a software company in Luleå. The study resulted in several different findings. A major reason why double documentation exist depends on the lack integration between the information systems used in today´s healthcare. It is also caused by the fragmented state Swedish healthcare is currently in. Double documentation occurs mostly in cases when healthcare personnel need register patient information in. Healthcare personnel is liable to register the same information in the information system handling medical records as well as the information system used hospital department. / Nej

There is a new trend of shifting the provision of health care from hospitals to the patient?s natural environment. We are increasingly aware of the expensive and sometimes ineffective late hospital treatment; therefore, there are stronger efforts for early diagnosis, prevention and health education from an early age. It is necessary to keep the future generations focused on their health and the health of their family members who live in the community. The initiative must originate not only in families but also in the school environment in which children find themselves almost every day. A school nurse is an expert in the field of community care working in school environment. The work load of the school nurse rests in maintaining and improving physical and mental health. The school nurse supports pupils in their responsibility for their health and she creates a system of formalized school activities, prepares and implements the school?s educational program focused on prevention. The data in the research part of the thesis was obtained through quantitative and qualitative research survey. The quantitative research was carried out using the technique of an anonymous questionnaire. The questionnaire was intended for general practitioners for children and adolescents, as well as nurses working with general practitioners for children and adolescents. The qualitative research data was collected through semi-structured interviews with the head teachers of elementary and secondary schools on the basis of which casuistries were created resulting in categorized charts. The objective of this thesis was to find out about the position of general practitioners for children and adolescents, and paediatric nurses working with general practitioners for children and adolescents on introducing the function of school nurses in the healthcare system of the Czech Republic. The research in this thesis showed a low level of awareness about the position of school nurses. The primary controversies related to the introduction of school nurses can be described as follows: the method of financing, the issues of authority of such nurses, and the way of preparing for this occupation. The main positive aspect of school nurses can be seen by the respondents in comprehensive care for pupils, prevention and better public education. School head teachers, general practitioners and nurses believe that school nurses should be placed in schools according to the number of school pupils and school head teachers assume greater use school nurses in primary schools than in secondary ones. The method of financing school nurses should be, according to the respondents, from multiple sources. This thesis may be used as a basis for further research work focused on the position of school nurses, and also as a proposal of establishing the school nurse position in the healthcare system of the Czech Republic, or as informative material for professional as well as lay public.