Reducing the energy consumption of a hospital during the development process – An applied study on Hama National Hospital in Hama – Syria –: خفض استهلاك الطاقة لمستشفى خلال عملية التطوير – دراسة تطبيقية على مستشفى حماة الوطني بمدينة حماة - سورية –

The health system in Syria is based on the principle of free access and free care in public hospitals called national hospitals. However, most of these hospitals were built in the twentieth century and need a development process to reduce their consumption, which is of financial benefit in reducing operating costs to be used in health care support. To benefit the environment, and given that modern technology, especially nanotechnology, has provided materials with high efficiency, but it has not been taken into account so far in Syria, the research is working on developing a mechanism for developing hospitals based on nanotechnology and applying it to the Hama National Hospital located in the city of Hama to be a reference to develop the rest of the Syrian hospitals.

Challenges of Rabies Surveillance in the Eastern Amazon: The Need of a One Health Approach to Predict Rabies Spillover

Brazil has been promoting essential improvements in health indicators by implementing free-access health programs, which successfully reduced the prevalence of neglected zoonosis in urban areas, such as rabies. Despite constant efforts from the authorities to monitor and control the disease, sylvatic rabies is a current issue in Amazon's communities. The inequalities among Amazon areas challenge the expansion of high-tech services and limit the implementation of active laboratory surveillance to effectively avoid outbreaks in human and non-human hosts, which also reproduces a panorama of vulnerability in risk communities. Because rabies is a preventable disease, the prevalence in the particular context of the Amazon area highlights the failure of surveillance strategies to predict spillovers and indicates the need to adapt the public policies to a “One Health” approach. Therefore, this work assesses the distribution of free care resources and facilities among Pará's regions in the oriental Amazon; and discusses the challenges of implanting One Health in the particular context of the territory. We indicate a much-needed strengthening of the sylvatic and urban surveillance networks to achieve the “Zero by 30” goal, which is inextricable from multilateral efforts to combat the progressive biome's degradation.

The Effectiveness of the Digital Care Platform CMyLife for Patients With Chronic Myeloid Leukemia: Patient-Preference Trial (Preprint)

BACKGROUND The two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring, but both are still suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients. CMyLife aims to provide these patients with tools and knowledge to have more control over their disease process and improve medication compliance and molecular monitoring. This could eventually lead to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE The aim of this study was to explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS The effectiveness of CMyLife was explored using a patient-preference trial. Participants received a written baseline questionnaire by mail. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least six months, after which they completed the post-intervention questionnaire. The scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. After six months, 29 patients filled in the post-intervention questionnaire in the questionnaire group and 57 patients filled in the post-intervention questionnaire in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. However, self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS In the future, an iterative process of assessing patients’ needs and further adjustment of CMyLife is required, to keep care patient-centered and put patients in lead of their disease process. Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. CLINICALTRIAL ClinicalTrials.gov NCT04595955

Abstract P162: Racial and Gender Disparities in a Stroke Clinical Network

Introduction: Earlier studies have suggested that disparities in stroke care exist for racial and gender groups. Our objective was to examine compliance with defect free care for these groups in a stroke clinical network. Defect free care gauges compliance with the delivery of selected core metrics reflecting best practices. The stroke clinical network providers and stakeholders have been meeting for over 5 years to share best practices and perform improvement projects. The Stroke Clinical Network consists of nine stroke centers located in rural, suburban and urban geographical regions. Methods: Stroke coordinators at nine stroke centers (8 PSCs and 1 CSC) used the GWTG registry to obtain Defect-Free reports using the filters: male, female, African American and white. Populations included patients with a diagnosis of stroke, ICH and SAH. Data was collected for Jan 2016-December 2019. The proportion of defect free compliance was calculated for these subgroups: African American, white, male and female. Results: There was not a difference in defect free care compliance between African American and white stroke populations (AA defect free 90% 2355/2583; white defect free 89% 4176/4685). The range for defect free compliance for AA was 70-98%. The lowest score of 70% was in an urban hospital. The range for defect free compliance for whites was 82-97%. There was not a difference in defect free care between male and female patients (female defect free 92% 5311/5771; male defect free 90% 4646/5211). The range for defect free compliance for females was 78-98%. The range for defect free compliance for males was 70-98%. For all patients in the stroke clinical network defect free care compliance was 91% (9957/10982). Conclusions: In a geographically diverse Stroke Clinical Network there were no disparities in defect care compliance due to gender or race. Future plans include performing a deep dive of the individual care measures to identify opportunities for improvement. The results indicate having an effective Stroke Clinical Network in which best practices and standardization of care are achieved provides an effective strategy to improve defect-care compliance across a network of hospitals.

Quality of Labor and Delivery Services: Maternal Satisfaction Study from a Tertiary Hospital

Introduction: Maternal satisfaction is an important indicator for any hospital to measure the quality of labor and delivery services. Satisfaction with the care received during labor and childbirth process influences the decision of institutional delivery for future utilisation. This study aims to identify the satisfaction of postnatal mothers towards labor and delivery service in a selected hospital. Methods: It is a descriptive cross-sectional study. Non-probabilistic purposive sampling technique was used to select a sample. A total of 54 postnatal mothers were interviewed using a semi-structured interview schedule. It was adapted from Donabedian Model and Respectful Maternity Care (RMC) Scale focusing on four aspects i.e. health institution related aspect, interpersonal aspects of care, abuse free care and informative aspects of care in five-point Likert scales. Data were coded, entered and analyzed using Statistical Package for Social Science (SPSS) version 16 for windows. Results: In this study, 79.6% of the postnatal mothers were satisfied with the overall aspects of the labor and delivery services. The component wise results show that 94.4% were satisfied in health institution related aspects while in the interpersonal aspect, 92.6% were satisfied. Similarly, all sampled mothers were satisfied with the abuse-free care system of the health institution. In informative aspects of care, 87% were satisfied and the rest (13%) were dissatisfied. Conclusions: Although the majority of mothers were satisfied, there were dissatisfaction in regards to availability of drinking water, the behaviour of staffs and the health education provided to them. By improving these aspects, quality of service will improve and thus increase women's satisfaction with care received.