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1. Since the objectives of ePROs are to effectively monitor the outcomes of treatment reported by patients, a study was conducted where rheumatologists completed a survey to investigate the acceptance, usage, and barriers to using ePROs. The results showed that not many rheumatologists currently use ePROs, and less than half are planning to use them, with various reasons investigated for this lack of adoption. I believe this application can be helpful in many areas that aim to measure the outcomes of treatment or the outcome of care and track the status of patients. However, the acceptance may depend significantly on how user-friendly and usefulness the application is.
Based on my experience in nursing, many hospitals in Thailand have developed applications to help patients with self-monitoring. One application used in my hospital is called the Rama Diabetes Care. This application focuses on empowering diabetes patients to effectively manage their own care (Self-Management), with the aim of improving diabetes control and reducing diabetes-related complications. It includes many functions, such as nutrition data logging, medication or insulin injection logging and alert and also the level of blood sugar. Moreover, patients will receive diabetes assessments from doctors. Patients can view their recorded data retrospectively by day, week, month, and year.
2.The important features of ePROs include automatic score calculations and display, as well as simple data transfer to medical records. When the results are available before the consultation, rheumatologists can interpret each patient’s results beforehand. This function benefits the treat-to-target approach, allowing patients to receive closer monitoring and more effective treatment.
Some barriers of the ePRO system were identified in the study. Since there is no information about the detail of software or application’s operation , I think the improvements should focus on enhancing usability and accessibility for all users. I suggest that the system should be simplified, ensuring that key functions such as automatic score calculation, data display, and transfer to medical records are easy to navigate and understand. Simplifying these features can reduce the time and effort required from users. Additionally, providing thorough training and ongoing support can help mitigate the lack of familiarity with the software. By making the interface more intuitive and user-friendly, the system can become more efficient and cost-effective, ultimately satisfying the needs of all users.
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1. Integrating environmental data with epidemiological data can significantly enhances the accuracy and timeliness of malaria outbreak predictions. Since malaria is a vertor-borne disease, environmental factors such as temperature, rainfall, and humidity play critical roles in the lifecycle of malaria vectors which is mosquitoes and the transmission dynamics of the disease. Using these variables, models can better anticipate conditions conducive to mosquito breeding and malaria transmission, enabling more precise and timely forecasts. For example, increased rainfall can lead to more breeding sites for mosquitoes. Moreover, epidemics often occur in highland areas when temperatures rise, as the cool conditions limit the development rates of both malaria parasites and mosquitoes. Relying solely on epidemiological data can causes delay intervention until after cases are reported, whereas environmental data can provide early warning signals, allowing actions to be taken to prevent outbreaks in a timely manner.
2.The key benefits of involving public health stakeholders in EPIDEMIA are that they can provide insights about local health problems and how things work in practice. This helps create a more effective system that is suited to their needs. Additionally, continuous involvement fosters a sense of ownership and commitment among users, promoting greater acceptance and sustained use of the system. However, involving public health stakeholders in developing the system also presents challenges such as balancing the technical requirements of the system with the needs of users can be complex. To address these challenges, it’s important to have clear communication and organized ways to collect feedback. Stakeholder input helps make the system more effective by pointing out important features, suggesting changes, and making sure the system can adapt to new conditions and user needs.
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1. In your experience, what are the biggest challenges to achieving sustainability in health information systems, and how can they be addressed?
Based on my experience, financial factors are the biggest influence on adopting an EHIS in hospitals. The initial investment is substantial, covering not just the system cost but also infrastructure upgrades, training for staff, and ongoing maintenance. To ensure the EHIS is sustainable, hospital administrators requires careful budget allocation to cover these expenses over time. Without adequate financial planning and support, the implementation and long-term viability of an EHIS can be impacted.
2: How have EHIS been designed to adapt to changing needs and technologies in your experience? If you haven’t encountered this, what features do you think are important for adaptability?
The EHIS can adapt to changing needs and technology by using a user-friendly design. For example, to ensure the new system is effective for nurses, fostering regular communication between users (nursing staff) and developers is essential so that developer know the needs of nurses. Moreover, when launching new systems or functions, users must participate in providing feedback to developers. Additionally, user requirements need to be clear to ensure developers understand the objectives, so the EHIS works effectively and sustainably.
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1. Please discuss how you think the perceived ease of use and usefulness may differ among the different demographics.
– Age: Age definitely affects how easily people use technology. From what I’ve seen in my workplace, older people often find new tech more complicated and are more hesitant to use it. When new technologies are introduced at work, they can be afraid at first and might take longer to learn how to use them. However, once they see how useful the technology can be, they usually come around and start using it more confidently.
– Gender: Some believe that men are generally better at technology than women because men have been more represented in tech fields than women. In the context of personal health records (PHRs) I think any users can use it as the application does not need the technical skill that much. They only need to know about the features and their function and I believe the developer aims to create the app that friendly for all genders.
– Education: Higher education often leads to better skills with technology. People with more education usually get more experience with tech tools and develop better technical skills. Those with less education might struggle more with using these tools due to less exposure and training.2. In your experience of using e-health applications or systems, what are some external factors or variables that should be considered to extend the proposed model for assessing the intention to use the system?
In my experience, external factors that can be considered including:
– Health status and behavior: People with health problems are usually more careful about their health compared to those who are healthy. They often have regular health check-ups and screenings. E-health systems can help them by providing easy ways to schedule appointments, get reminders, and access test results.
– Digital literacy: If people are familiar and comfortable with using digital technologies, they are more likely to use e-health systems than those who are not. -
1. From the results, What would you recommend to Tak Hospital to improve the syphilis surveillance system?
Since there is a higher number of Syphilis cases among non-Thai patients, with many cases going unreported due to gaps in the screening unit. To enhance the surveillance system I would like to suggest that before migrant workers begin employment in Thailand, they should require more comprehensive health examinations of non-Thais workers, not just accepting medical bills or receipts. This can ensure that we catch and treat Syphilis and other infections early on. Moreover, it’s crucial to improve the connection between health screening unit and the STI/HIV clinic. This will help track and manage the health of non-Thai populations more effectively, ensuring they receive the necessary surveillance and treatment.
2. Do you have experience with disease surveillance systems? What are the strengths and weaknesses of that system?
I do not have direct experience with disease surveillance systems. However, I was involved in the process when my sister was admitted to a hospital in Chumphon with dengue fever a week ago. After the doctor informed us that my sister might have dengue fever, I was asked by the hospital’s epidemiologist for disease investigation.
From my knowledge about the disease surveillance system for dengue fever, I believe the system has some strengths. The reporting structure or work flow is clear and understandable, and there are electronic tools available to support staff in reporting, such as R506 and VEP-Alert Online, which reduce the time and workload for staff. The reporting system also helps ensure the accuracy of the data.
However, there are some weaknesses, such as the possibility of reports not being completed in a timely manner or delays in reporting, as data entry depends also on staff. Nurses or assigned staff should be encouraged to play a role in enhancing the quality of the disease surveillance system. For example, incharge nurses who join the system should receive orientation or training on disease surveillance. Furthermore all involes stakeholders should understand the importance of reporting diseases ensuring that patient data is fully recorded in the reporting program. This will ensure the surveillance system’s quality and aids in quick disease control.
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1. Implementing AI technology in an epidemic surveillance system can generate many insightful information in response to disease outbreaks. AI can support the epidemic surveillance system by leveraging diverse data sources, including social media platforms like Twitter and Facebook. These platforms can help trigger alerts for further investigation when there is a sudden increase in the number of people developing similar symptoms, as they provide real-time information on public health trends. Moreover, using NLP algorithms to analyze and interpret data from various sources can help extract valuable information that might be missed by traditional methods. By integrating AI with traditional surveillance methods, health systems can benefit from early detection and timely responses to potential outbreaks.
2. There are many benefits to utilizing AI for public preparedness. For example, it can help with decision-making in a timely fashion, as AI can process and analyze large volumes of data quickly. This capability enables real-time surveillance of disease trends, allowing public health officers to track the spread of infectious diseases more accurately and rapidly. Apart from surveillance, AI can generate predictive models using machine learning algorithms by incorporating real-time data and learning from previous disease outbreaks. Since AI can provide early warnings and improve surveillance systems, it will support effective public preparedness and intervention in the future.
However, there are some challenges regarding the use of AI in public preparedness such as data quality and reliability. It is crucial to consider data quality and reliability, especially when dealing with data from social media. Social media data can be inconsistent, incomplete, or misleading due to the spread of misinformation and the variability in how people report symptoms. For all data sources used to train AI, ensuring the accuracy and reliability of the data is essential for making informed decisions and avoiding false alarms, which could lead to unnecessary panic or misallocation of resources.
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Thanks for sharing Myatt. This is very interesting topic.
1.In my opinion, environmental factors such as stigma and discrimination can significantly impact young people’s willingness to seek health care. Societal attitudes towards HIV/STIs, sexual minorities, and sex work can create a climate of fear and shame, deterring young people from seeking information and care. Additionally, the quality and content of sexuality education in schools and other educational settings can influence young people’s knowledge and attitudes. This knowledge empowers young people to make informed decisions. If they understand the risks associated with unprotected sex, young people can make choices that reduce their likelihood of contracting STIs or RH. Furthermore, once they have the disease, they are more likely to seek treatment without hesitation.
2.When considering the highest group of HIV patients in Thailand, MSM (men who have sex with men) represent the largest proportion among all HIV patients (source:DDC https://hivhub.ddc.moph.go.th/Download/RRTTR/Factsheet_HIV_2564_TH_V2.pdf). Therefore, the most vulnerable group, in my opinion, can be LGBTQ+ individuals, particularly MSM. Discrimination and a lack of understanding of their specific health needs can prevent LGBTQ+ individuals from accessing relevant health information.
To effectively reach these populations and measure the impact of health information on health-seeking behaviors, we should consider community engagement strategies such as collaborating with LGBTQ+ organizations and community leaders to build trust and establish effective communication channels. Additionally, developing culturally competent health services that respect the diversity of LGBTQ+ experiences and identities is crucial. Health education is also important for gaining their understanding. If the problem is their fear, online resources such as websites and mobile applications with health information can be very helpful to support them in health education.
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1. I have very little experience using or observing electronic-based clinical decision support systems for NSD patients in rural area. However, in Thailand, there are many mobile applications that support the self-management of NCD patients. For example, the DMThai Diary application is a collaboration between the Queen Sirikit National Institute of Child Health and the National Electronics and Computer Technology Center (NECTEC) to help patients with type 1 diabetes record, monitor, and track their blood sugar levels.
The application assists in calculating the carbohydrates in the food consumed and the recommended insulin dosage to be injected. It provides alerts for abnormal blood sugar levels and offers preliminary corrective measures specifically for patients with type 1 diabetes, facilitating intensive insulin therapy. Moreover, the DMThai Diary application is designed to display statistical results and compile data for analysis by doctors.
These technologies can enhance patient engagement, improve data collection, and facilitate personalized care. For instance,they can provide real-time feedback, enabling patients to make informed decisions about their health. Additionally, the data collected can be valuable for research and improving treatment strategies. However, challenges such as ensuring data accuracy, privacy, and accessibility must be addressed. Moreover, the effectiveness of these systems may vary depending on factors like patient digital literacy, healthcare infrastructure, and the specific NCD being managed.
2. Using NCD (Non-Communicable Disease) management tools facilitated by nurses or community health workers can be very beneficial, especially in units facing severe shortages of nursing staff. However, ensuring data accuracy is crucial for the effectiveness and reliability of these tools. There are some points that need to be considered:
Nurses and community health workers should receive adequate training on how to accurately input patient data into the NCD management tools. This training should cover not only technical aspects but also emphasize the importance of data accuracy in clinical decision-making. Moreover, in implementing tools that involve patients’ health, which potentially risks their safety, regular audits and checks can help identify and correct errors in data entry so that the data used for generating prescriptions and making clinical decisions are reliable and trustworthy.
For options to support staff shortages and promote the quality of care for NCD patients, based on my experience in nursing, patients especially in rural should receive self-management education and participate in community-based support groups. Educated patients are more likely to adhere to treatment plans, adopt healthy lifestyles, and actively participate in their healthcare. Also, in dealing with insufficient staff, implementing policies that incentivize healthcare workers to practice in underserved areas, such as offering career development opportunities or fair payment, is another way to improve sustainable healthcare infrastructure development in remote regions.
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Dear Thitikan, your topic is really informatives, thank you for sharing ka.
1. When considering patient safety in using medical AI systems, in my opinion, medical doctors who use it are one of the most important factors. Their knowledge and experience are crucial in understanding AI recommendations and making decisions that fit each patient’s unique situation. To deal with this challenge in improving safety, doctors and staff who use it need comprehensive training programs to thoroughly understand how AI systems work, including their limitations and potential biases. Additionally, they need to keep up to date with the latest developments in AI technology. Also, collaboration with AI developers is needed, as it allows doctors and healthcare providers to give feedback and improve AI systems, ensuring they meet clinical needs.
2. To build trust and confidence in the medical community, medical AI systems must show high accuracy. To achieve this, we need to train AI systems on high-quality, diverse datasets. This approach reduces the risk of learning false patterns and improves the system’s ability to perform well in different clinical settings. Furthermore, regularly benchmark the AI system’s performance against established clinical standards and other AI systems to ensure it meets or exceeds efficacy expectations.
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1. To enhance the accuracy of predicting post-induction hypotension (PIH), we can consider additional features like fluid balance status and electrolyte levels. These can provide a more comprehensive baseline for predictions. Additionally, continuous real-time hemodynamic monitoring, including heart rate variability, cardiac output, and pulse pressure variations, can be extremely helpful. These dynamic measurements allow us to capture the physiological changes happening during anesthesia induction, leading to more precise predictions of PIH.
For blood pressure measurement, invasive methods such as obtaining BP from an arterial line are more accurate and reliable than non-invasive methods. However, the applicability of these methods depends on the patient’s status and may not be suitable for every case.2. To address the limitations of the current study and make the predictive model work better for different surgeries, we should consider several future research directions. First, conducting multicenter studies with diverse patient populations and healthcare settings can help check if the model works well in different environments and improve its overall reliability. Additionally, creating customized models for specific types of surgeries can make predictions more accurate, since different procedures may have unique risk factors for PIH.
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1. The stakeholders that should involves in applying machine learning in symptoms prediction can be many professionals such as physician nurses pharmacists radiologist depends on which objective that machine learning will be doing for. In the study, for example, when focusing on the cancer symptom predictions in nursing field, by utilizing model predictions, nurses can anticipate and manage symptoms, thus enhancing personalized care plans. Furthermore, continuous monitoring of patient symptoms in real-time, using ML insights, enables nurses to make timely interventions, ultimately improving patient outcomes.
2. When developing and deploying machine learning models for predicting cancer symptoms, researchers and clinicians must ensure data privacy and security, obtaining informed consent, and mitigating biases in training data are crucial to protect patient rights and ensure fairness. Models must be transparent and explainable to gain the trust of clinicians and patients, with clear accountability for their predictions. Model validation is necessary to maintain accuracy across diverse populations. When it comes to human life, if using the low accuracy ML model with poor accountability, can significantly risk patients’ lives.
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Dear Ajarns and Friends,
Good afternoon! I would like to share my COVID-19 Dashboard with you all. The dashboard provides an overview of cases: confirmed, recovered, and deaths on the home page where the scorecard in three different colours show the total number in each category. At this main page, you can easily select a specific time frame to see the details from year down to a particular date. Furthermore, the homepage highlights information for all six countries at a glance, such as the number of cases in each category and the maximum daily cases at the second table, allowing you to compare the largest situation between each region. Additionally, a Google Map with bubbles displays the size of confirmed cases based on different areas.
Moreover, the time series line chart helps you see a big picture of all events, comparing each country monthly from the beginning until the end of the selected timeframe. To help you find detailed information for each country, you can navigate to a specific country’s page by selecting the flag button from the main page.
Finally, there are buttons to get link of the report, download the report and reset just in one click at the upper right corner of the homepage!!
I hope you enjoy exploring my dashboard! Thank you for sharing your amazing work!Here is the link of my Dashboard https://lookerstudio.google.com/reporting/3df0c8d0-1c2d-4906-b925-3ac5ad4c517a
and these are pictures of the main page and example of the country page Thailand. (there are 7 pages in total) Thank you!!!
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Dear Ajarns and friends..This is my screen shot of report from Looker Studio. You all did amazing works. Thanks for sharing!!!
https://snipboard.io/7E8YrW.jpg
https://snipboard.io/cU6zua.jpg
https://snipboard.io/ADEsYm.jpg
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I would like to share my selected COVID-19 dashboard from the University of Virginia https://nssac.bii.virginia.edu/covid-19/dashboard/. The last update of it was in August 2023. The dashboard theme and layout, in my opinion, is well organized and contains many interesting features such as the interactive chart, meaningful colours, animation of the data (Time slider) since the beginning until the end of data recorded. To be more specific I would like to describe what I like and dislike about this dashbord.
What I like:
– The dashboard provides the meaningful information at a glance and quite easy to follow as each charts are arranged from the big picture to the specific element. For example, when I see the dashboard I get information immediately how many cases in all stages, active, confirmed, death or recovered. The good thing is that the colour of each category is well describe the status such as confirmed case is in red and recovered is green. Not only cases that show in the dashboard, there as also contains data about vaccination as well.– There are the control date to select if we want to know only particular day as well as the region. There is Thailand in this dashboard too if you select country.
– The dashbord also presents the filled map that display the data across a geography. This map has different shade of colour that present the density of the data and let people know the data at a glance.– At the left panel, when clicking chart tap, the barchart is pop-up to show the cases in each time frame and can select the filter to fill specific time that you want to see the data.
– There is analytic tap that show the time series of top five countries using line chart. It is good to show only five countries because using too many line in the line chart can cause people confuse.
What I dislike
– Since the chart that use to show the time series of COVID-19 cases hidden in the tap and it’s quite small, so people may need more time to reach the important information and need more time to see the data inside.– Also, if you look inside the bar chart, the data of death is quite small, bar chart cannot display the data appropriately as it placed in the lowest area of the chart, to see information better, using other type of chart such as line chart and using data label in each time spot and make the chart bigger so people can see the death value.
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First of all, in my opinion, you made a really well-organized CRF, and it is quite easy to follow with all necessary parts already there. I might not have many comments for you because it is already a great work. Please find some of my suggestions for the improvement below,
Your CRF has all important IDs, including Study ID, Subject ID, and Site ID, but one thing to add is the CRF version and date. This can help track the specific version of the CRF and ensure every site uses the same version to maintain consistency.
– Instructions Part
The CRF included instructions part which I missed this in my CRF which is very important. Without this part, recorder might misunderstand how to respond, causing inconsistent data. Actually, if this part was not included, I might tick the correct sign in every box. It’s good to learn from your work! One thing that might help if it is a paper CRF, as your CRF already has instructions, you can add an item about the use of permanent media (blue or black ink).
-Screening Part
You have complete information on both inclusion and exclusion criteria. The options given for both parts are clear with yes or no. However, to add more accuracy in pregnancy tests, a “not done” option might be needed to show that the pregnancy test was intentionally not performed rather than accidentally omitted or overlooked.
– Enrollment Part
You have provided a good quality design. The demographics part is easy to follow and respond to since you have added the “unknown” or “no response” option to avoid errors. For the vital signs part, you have clear guidelines such as decimals and digits, and it is all in separate boxes. well done!!
The physical examination section is also complete, but in some parts, it may need to specify details if abnormalities are found (in the last column), such as in the skin, EENT (Eyes, Ears, Nose, and Throat), head, and some other areas. Adding blank spaces (…………) in the last column can guide recorder to fill the breif more specific information in case of abnormal.
Overall, your CRF is perfect.!! I learned a lot from reviewing your work and it gives me a great chance to know how to improve my CRF!! I hope my little comments may help and Thank you!!.
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For me, I have never conducted or seen clinical trial research collect data electronically in eCRF and using EDC software like my friends mentioned. It’s quite interesting to learn how benefit of having such technology to help manage the data. From my experience in clinics and my thesis, I simply collected data via paper-based questionnaires and then used the SPSS program for analysis. The data is only stored on my laptop and cloud drive, while hard copies of questionnaires were kept for two years and then destroyed. However, the questionnaires only had IDs assigned and didn’t contain identifiable personal data. Through the lectures in this course, I’ve gained a broader understanding of data management systems, which will be very useful for me as I planed to train to use the REDcap software in my workplace and aim to participate in more complex projects in the nearly future.
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My chosen spot for making an improvement will be “Race”. There are many human races which mainly based on geographical or biological characteristics, such as Caucasian or White, African or Black, Asian, Latin American, and others. However, the provided CRF created an open-ended question (a Blank) for race, which participants need to fill out by hand. This manual input process could lead to difficulties in reading and can cause inaccuracies in the data. Additionally, participants may provide varying responses, such as he can fill out Caucasian or White, Black or African or others.
To enhance the quality of the data, I think the form should include checkboxes for race options instead of blank. This method will help standardize responses, reducing errors and ensuring consistency in the data collection.
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Dear Ajarns and friends!! This is my summary of the last week and thank you for sharing your amazing and informative works.
https://snipboard.io/QJE6qz.jpg
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Based on my experience, I have never collected data related to patients or clients before, only studying with the hospital staff, which was less complicated than with the clients. Moreover, my project used paper-based questionnaires without the need for technical skills. However, there are several steps that I want to go back and correct.
First, the protocol discussion. Since all my documents needed to be translated into Portuguese before starting the project, even though I understood the context of my study, participants still misunderstood some questions when filling out the form. Therefore, the questionnaires might need to be revised to collect data more accurately and avoid missing data. Moreover, if I have an opportunity to have the meeting with advisor and the unit representatives (who help me gathering the questionnaires) at the same time, the respondents might understand better about the questionnaires and be able to fill out the form correctly.
Second, regarding the timing of data collection, if I had given participants more time, there would have been fewer missing responses. So, I think I need to improve the data design and work flow to collect the data.
Finally, data manipulation. I analyzed the data myself using SPSS software, even though I had been trained to use it as it was a part of the master program. It would be better to have a deeper understanding of statistical knowledge (statistician was not involve in my project), which would allow me to analyze data more quickly.
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1. Purpose of data collection: For research, for public health surveillance, or others.
I used to do the data collection as a part of my thesis project during my study (Emergency and Critical Care Nursing) in Portugal. My thesis topic is related to the quality of working life and resilience among nurses in pediatric settings during COVID-19 pandemic back in 2021.
2. Was it primary or secondary data collection?
It was a primary data collection. I used questionnaires in the paper format to collect the data from four pediatrics settings in a University hospital in Faro, Portugal
3. Methods used for data collection
A quantitative cross-sectional study design was used for my project. The total population included nurses who worked at PED (Pediatric Emergency Department), GPD (General Pediatric Department), NICU (Neonatal Intensive Care Unit) and OPD (Pediatric OPD). The paper-based questionnaires consists of three main parts, Socio-demographic, Work-related Quality of life Scale, and Measuring State Resilience Scale. The protocol and all questionnaires were translated into Portuguese. After the projects was approved by ethic committee, the questionnaires were distributed. The data collection procedure took place over one month with the assistance from the representative of nurses in each unit who can communicate English.
4. Were there any problems that occurred regarding data collection?
– I found language barrier was my main problem. Not every nurses can speak English and I also cannot understand Portuguese, therefore I had the difficulty in communication especially in contacting Ethic committee and contacting participants for collecting the data. However, I received kind support from my advisor and from nurses in each unit who could speak English. They were assigned by my advisor to help explain the project to participants.
Moreover, since the questionnaires and answers were all in Portuguese, and some parts needed to be filled out by hand, I initially struggled with deciphering them. However, as I read through more of them, I became used to it.
– Due to the busy period during the pandemic, I felt my project may have inconvenienced the staff, despite requiring only 10 to 15 minutes of their time to respond. But, I fully understood their situation because I have witnessed how much workload they had.
– Not every questionnaire was returned, resulting in a 25% missing response rate for my project, and some parts of the data were incomplete due to self-administration. In our opinion, they might have misunderstood some questions.
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Dear Ajarns and friends,
Here is my summary of week3…link >> https://snipboard.io/AnmZ4l.jpg
Thank you for sharing your wonderful works!!!!
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Dear Ajarns and friends, here is my infographic!!! and thanks for sharing yours!!
https://snipboard.io/3iDfj6.jpg
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*What intervention(s) you are considering in your modelling and how it will be added to the model structure?
Since I chose dengue as my topic, I would like to describe about vaccine that I chose for the intervention of my modelling.
Providing dengue vaccine to the susceptible individual will help induce immunity against the dengue virus in those who receive it. This immune can prevents or reduces the severity of dengue infection in vaccinated people. Therefore it can lower the incidence of the disease, decrease its spread within communities, and reduce the burden of dengue-related illness and complications.
The model structure that I discuss in the previous assignment was SEIR. Providing vaccine will add the intervention to the susceptible population. When the intervention added, it can either slowdown or stop the transition from S to E which means that the vaccine can finally helps protect people to be infected and also can help infected people to recover faster and decrease by severity of the disease.
*What are the characteristics of the intervention(s) (e.g. coverage, efficacy etc.)?
From the CDC, the Dengvaxia dengue vaccine requires three doses administered subcutaneously and given 6 months apart for full protection.
The characteristic of the intervention in my opinion can be vaccine efficacy (the effectiveness of a vaccine in preventing disease or how much transmissibility can be reduced), coverage rates (the proportion of the target population that receives the vaccine), and cost-effectiveness (Cost-effectiveness typically assess by weighing the costs of vaccination against the benefits gained in terms of prevented illnesses, hospitalizations, deaths, and associated economic losses.)*Reference:
https://www.cdc.gov/dengue/vaccine/hcp/schedule-dosing.html -
*What model structure would the disease you are interested be and please start adjusting the R code to that structure.
My interested disease discussed in the previous session was Dengue Fever. The model structure that I would like to develop for my topic is SEIR (Susceptible-Exposure-Infected-Recovered). I would like to use this model to describe the transmission prediction of Dengue in Thailand.
The reason to use the SEIR model is because the virus included incubation or latency period which occur just before infection. In the case of Dengue, the exposure time is approximately 8-9 days before manifestation of the disease once It is transmitted by an infected mosquito. Therefore, take the exposured population into account reflects the realistic disease dynamic and enhances the model’s ability to predict the transmission of dengue used for work towards in reducing the burden of this mosquito-borne disease in the future.
*R Code:
# Define the SEIR dynamics function
SEIR.dyn <- function(t, var, par) {
S <- var[1]
E <- var[2]
I <- var[3]
R <- var[4]
N <- S + E + I + R
beta <- par[1]
gamma <- par[2]
sigma <- par[3]dS <- -(beta * S * I) / N
dE <- (beta * S * I) / N – sigma * E
dI <- sigma * E – gamma * I
dR <- gamma * I# Return the rates of change as a list
return(list(c(dS,dE, dI, dR)))
}
install.packages(“deSolve”)
library(deSolve)# Define initial conditions, time points, and parameters
R0<-3.42 # Basic Reproduction Number (Liu et al., 2020)
gamma <- 1/7 # Infectious period of 7 days, infectious period (7days)= 1/gamma (CDC:
https://www.cdc.gov/dengue/training/cme/ccm/page47478.html)
beta <- R0*gamma # 3.42/7
sigma <- 1/7 # incubation period of dengue 5-7 days
SEIR.par <- c(beta,sigma,gamma)
SEIR.init <- c(5000,1000,50,50) # Assume total population of 5000,Exposed 1000, Infected 50, recovery 50)
SEIR.t <- seq(0,365,by=1) # 0-365 days,increase every 1 daySEIR.sol <- lsoda(SEIR.init, SEIR.t, SEIR.dyn, SEIR.par) # Solve the SIR model using lsoda
TIME <- SEIR.sol[,1]
S <- SEIR.sol[,2]
E <- SEIR.sol[,3]
I <- SEIR.sol[,4]
R <- SEIR.sol[,5]
N <- S + E + I + R# Plot the results
plot(TIME, S, type = “l”, col = “blue”, lwd = 2, ylim = c(0, 5000), xlab = “Time”, ylab = “Population”, main = “SEIR model for Degnue “)
lines(TIME, E, type = “l”, col = “yellow”, lwd = 2)
lines(TIME, I, type = “l”, col = “red”, lwd = 2)
lines(TIME, R, type = “l”, col = “green”, lwd = 2)
legend(“right”, legend = c(“Susceptible”, “Exposure”, “Infected”, “Recovered”), col = c(“blue”,”yellow”, “red”, “green”), lty = 1, cex = 0.8)# I am not able to upload the Plot picture ka Ajarn, I will submit by email na ka.
• Incubation period refers to the time between exposure to a pathogen and the onset of symptoms of the disease it causes. The incubation period of the dengue virus is 3–14 days, with an average of 4–7 days.
Source: https://www.ecdc.europa.eu/en/dengue-fever/facts
• Viremic period is known as the “period of infectivity”. In sick persons, viremia typically coincides with the presence of fever. Both symptomatic and asymptomatic persons are viremic and can transmit DENV to mosquitoes that bite them during this approximately 7-day period.
Source:https://www.cdc.gov/dengue/training/cme/ccm/page45915.html#:~:text=Intrinsic%20Incubation%20Period%20(3%2D14,the%20human%20can%20become%20ill.*Reference:
Liu, Y., Lillepold, K., Semenza, J. C., Tozan, Y., Quam, M. B. M., & Rocklov, J. (2020, Mar). Reviewing estimates of the basic reproduction number for dengue, Zika and chikungunya across global climate zones. Environ Res, 182, 109114. https://doi.org/10.1016/j.envres.2020.109114 -
– The disease topic: Dengue Fever
– Scope of the research: Country level, Thailand
– Research Question: What are the specific climate factors such as temperature, humidity and rainfall that influence the transmission dynamic of Dengue fever in Thailand.
– Rationale: Per the WHO, Dengue as one of the top ten threats to public health and the disease is associated with significant societal and economic burdens.The Incidence of dengue virus has soared in 2023 to near historically high levels, reported by WHO, more than 5 million cases worldwide and 5,000 deaths from the virus that still lacks an effective treatment or vaccine.
In South and Southeast Asia there is a significant rise in dengue cases, with indications that global warming may contribute to a potential record-breaking number of infections worldwide. In Malaysia, for instance, reported a staggering surge in dengue cases, recording 56,721 cases up to July 20,2023 compared to 23,183 cases during the same period the previous year—an alarming increase of 144.7% while the number of deaths more than doubled compared to 2022, reaching 39. Similarly, Thailand’s Department of Disease Control noted a sharp increase in dengue cases, with 46,855 cases and 41 fatalities registered as of July 19,2023. This marks a significant rise from the 16,542 cases reported throughout the entirety of the previous year, representing the highest rate since 2020. The surge in infections has also been observed in other countries such as Cambodia, the Philippines, and Sri Lanka.
Given the high burden of dengue with the absence of effective vaccine, the primary method to prevent dengue transmission remains vector control. Mathematical models have long been used to describe the dengue transmission and it serves as a guiding tool for decision-making. Investigating the climate factors influencing the dynamic transmission of Dengue fever can contribute to public health authorities’ capacity for implementing intervention measures for disease control.
* References:
– https://healthpolicy-watch.news/dengue-cases-approach-historic-highs-local-transmission-seen-in-europe/
– https://www.benarnews.org/english/news/bengali/dengue-asia-record-infections-08072023151754.ht*Citations on other previous work that you may use to guide your study (if there are any):
– Aguiar, M., Anam, V., Blyuss, K. B., Estadilla, C. D. S., Guerrero, B. V., Knopoff, D., Kooi, B. W., Srivastav, A. K., Steindorf, V., & Stollenwerk, N. (2022, Mar). Mathematical models for dengue fever epidemiology: A 10-year systematic review. Phys Life Rev, 40, 65-92. https://doi.org/10.1016/j.plrev.2022.02.001
– Chanprasopchai, P., Pongsumpun, P., & Tang, I. M. (2017). Effect of Rainfall for the Dynamical Transmission Model of the Dengue Disease in Thailand. Comput Math Methods Med, 2017, 2541862. https://doi.org/10.1155/2017/2541862
– Naish, S., Dale, P., Mackenzie, J. S., McBride, J., Mengersen, K., & Tong, S. (2014, 2014/03/26). Climate change and dengue: a critical and systematic review of quantitative modelling approaches. BMC Infectious Diseases, 14(1), 167. https://doi.org/10.1186/1471-2334-14-167
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From my experience as a clinical nurse, the ethical principles contributing to control policies during COVID-19 in my workplace are:
1. Justice: Since during the pandemic, only certain units in my hospital can admit COVID-19 patients, and some wards consistently receive heavier workloads due to having negative pressure rooms. Therefore, with the crisis situation, the equity in the distribution of resources is crucial. Many nurses are forced to place on their unfamiliar units which is stressful. But in order to provide the care with fairness to both patients and between staff themselves, we all adhered to the hospital policies.
2. Transparency: We maintain transparency by promptly sharing situations involving staff at risk of COVID-19 with the infection control department, without fear of blame. For instance, when a staff member has suspected symptoms or infected, we immediately report to the infection control so they can implement stricter policies. Additionally, we communicate openly with patients’ families, ensuring they understand the hospital’s situation and cooperate with the control policies.
3. Non-maleficence: When individuals feel unwell or suspect symptoms, we report to supervisors immediately and avoid contact with patients or coworkers to prevent transmission, thereby protecting others from infection. Also during the pandemic, despite exhaustion and discomfort from wearing tight protective equipment, we strictly adhere to policies to prevent disease spread to patients and between co-workers.
4.Beneficence: Despite the fear especially during the pandemic’s first and second wave as it had very high mortality rate worldwide, as frontline workers, we strive to help patients survive. Moreover, We also recognize the challenges faced by patients separated from their families and offer video calls as an alternative to visiting to provide holistic care. -
In Thailand, the Universal Health Coverage (UHC) scheme, commonly referred to as the “30-baht” or “gold card” scheme, requires a copayment of 30 baht per visit. It is the largest of the three healthcare programs providing universal healthcare to the country’s citizens. The scheme covers the majority of the population and is directly funded by the national budget, allocated by the National Health Security Office (NHSO). Every Thai citizen is entitled to the 30-baht scheme, but if already covered by another scheme, that coverage will be use first. Approximately 48 million out of Thailand’s total population of 69 million are insured under the 30-baht scheme, while the remaining population is covered through employers or the civil servants’ medical benefit scheme.
Thailand’s UHC provides numerous benefits for the Thai population. The strengths of the UHC scheme, in my opinion, include the following:
* Improving access to necessary medical care without financial barriers.
* Ensuring social equity by providing healthcare services to everyone regardless of their socio-economic status.
* Reducing the financial burden on individuals and families through low healthcare costs while maintaining the standard of care.
* Improving public health outcomes through increased access to healthcare services, early detection and treatment of illnesses, preventive care, and management of chronic conditions, leading to overall better health and well-being.However, Thailand’s UHC also have some weaknesses such as:
* Limited financial support: Providing healthcare for 48 million people requires substantial financial resources, particularly in the era of an aging population like today. The government need a lot of effort to ensure the sustainable financing to cover the costs of providing comprehensive healthcare to its citizens.
* Limited access to specialized services may affect the quality of care: Resource constraints can lead to long waiting times for certain procedures and inadequate access to advanced medical technologies. I often experience while working in the clinic when patients need to decide which medication they will recieve either the higher cost one with the best quality and self-paid or another medication with lower quality but cheap and reimbursable. Sometimes we upset patients with the undeniable options when this happens to the low income families.To mitigate the weaknesses of Thailand’s Universal Health Coverage (UHC) scheme, the government should prioritize increasing healthcare funding, enhancing efficiency in healthcare delivery, expanding infrastructure and workforce. These efforts are crucial for strengthening the UHC scheme and ensuring equitable access to high-quality healthcare for all citizens.
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In my opinion, Thailand’s healthcare sector is undergoing the development in digital health transformation and still lacks personnel specialised in health informatics. From my years of experience in healthcare, traditional methods of care have gradually been replaced by modern technology. Previously, many institutions made health informatics a compulsory subject in the course of undergraduate level, including in my field of nursing, to help graduates increase their knowledge in healthcare informatics before working in clinics. Recently, with digital disruption affecting every industry, including healthcare, some universities in Thailand have started offering four-year courses related to health informatics, such as Bachelor of Science in Medical Informatics. Moreover, at the postgraduate level, some institutions are opening courses to prepare future skilled health informaticians, including our program BHI, and related courses such as the Master of Science program in Digital Health. Regarding the national strategic planning in digital health transformation, I believe that a sufficient number of health informatics workforce can contribute to its achievement in the future. However, there are some limitations that pose challenges to the effective growth of health informatics workforces in the country:
* Limited educational opportunities: Although some institutions provide courses to produce future health informaticians, there are still limited formal educational programs in health informatics that offer specialized training and qualifications in this field compared to the increasing demand in health data.
* Resource constraints: Developing and implementing health informatics education and training programs requires significant resources, including funding, infrastructure, and faculty expertise, which may be limited in some settings.
* Lack of incentives: As my classmate mentioned before, IT personnel who work in healthcare might prefer to move to other industries that offer adequate payment for their skills and competencies. Therefore, to produce health informatics graduates who intend to work for their professional health informatics field and retain the current health informatics workforce, adequate and fair payment for their skills need to be considered. -
For me, if I am the person in charge of a dataset, whether to share data depends on the situation. I would definitely share the data if it provides benefits for the population’s well-being as the data can lead to new insights, discoveries, and innovations. For example, when data can help predict potential risks that induce diseases like cancer or improve treatment and care outcomes for patients. However, before sharing the data publicly, I would consider several points: I would ensure privacy and confidentiality before opening shared data, as mentioned in the session about de-identification of the participants, and keeping their confidentiality is the way to respect their rights and protect their privacy. Also, before sharing, I will ensure that the data that I will share has good enough quality since the data may be misinterpreted or used inappropriately if users are not sufficiently knowledgeable about its context, limitations, and potential biases.
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I find it intersting that the challenges faced in Myanmar quite similar with the concerns voiced by nursing staff at my workplace regarding the adoption of Electronic Medical Record (EMR) systems. In my opinion, the advantages and disadvantages of implementing EMR systems can be outlined as follows:
Advantages:
– Time Efficiency and Patient Safety:
EMRs significantly save time, reduce administrative tasks, and enhance patient safety. For instance, before the implementation of the EMR system, requesting blood from the blood bank involved extensive paperwork, manual document handling, and potential errors due to the lack of decision support. With EMRs, many nursing tasks, including blood transfusion procedures, can be conducted more efficiently and safely, contributing to improved care quality and patient outcomes.
– Seamless Communication Between Departments:
EMRs promote seamless communication between hospital departments. Traditionally, acquiring paper medical records for each patient during hospital visits was burdensome, involving significant effort and time. In inter-departmental consultations, physical documents led to many of paperwork and make the process very slow. EMRs helps eliminate these challenges, facilitating efficient communication between units and departments.
– EMRs helps Keep the documentation more organised, complete, easy to retrieve, reduce redundancy and prevent physical damage .
The completeness of the documentation is crucial, as it serves as the very important evidence of patient treatment. Therefore, after the implementation of EMRs, all documents are automatically stored in the system and categorized into groups, making them much easier to retrieve. Additionally, this digital storage helps reduce the risk of physical damage to the records. Moreover, the EMR system reduces data redundancy and prevents the duplication of patient information, such as names or IDs
– Increase patient’s satisfaction. Since EMRs are linked with mobile applications in some procedures, patients have a better opportunity to manage their health right at their fingertips. At my hospital, patients can download an application, allowing them to perform various activities on their own, such as making online registrations, scheduling appointments, using telemedicine feature, processing payments online, refilling medication, and checking the list of lab tests they need to undergo. Mobile app and the EMRs system can reduce the time spent in the hospital and facilitate patients which helps increase their satisfaction.Disadvantages:
– Increased Staff Workload: Similar to the situation described in the research paper, we are currently in a transitional period, and as a result, many processes still require duplication of work, both in paper and electronic forms. Although the electronic system can reduce staff workload for some tasks, there are still numerous tasks that need to be done using both methods. For instance, the medication administration process: a doctor orders medication through the computer and also records it on a paper chart. At the same time, nurses must retrieve the doctor’s order from the computer and write it onto paper. Despite being in the middle of this transition, the system has the potential to prevent medication errors with its decision support system.
– Staff Burnout: Due to the increased workload, many staff members experience burnout and leave their profession. In my opinion, the implementation of EMRs has brought about significant changes in work processes. Traditional methods are no longer in use. Some staff, especially those who are not tech-savvy, exhibit resistance and reluctance to adapt. Because of this shift, many departments are making efforts to educate and train staff in using EMRs related to their field of work, including nursing.
– EMRs system is Costly: While these systems provide numerous benefits, the best vendors are often very expensive. Hospitals require a significant budget for the implementation of an EMR system. Higher quality implies a higher price. Therefore, some features of lower-priced systems might not be as user-friendly when compared to higher-priced systems. Systems with user-friendly and usability features can alleviate staff burden and promote the quality of care.– Data security: Although EMRs limited authorized access, they still pose a risk of patients’ personal data breaches. This vulnerability is due to potential hacking or unauthorized. The robust security protocols and continuous monitoring is needed.
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From the article, I agree with all the challenges provided about Big Health Data for improving the treatment and outcomes for cardiovascular patients. There are some suggestions based on my opinion for coping with those challenges, described as follows:
1. Missing data: Missing data can compromise data integrity and lead to misinterpretation. A common issue I have encountered in data collection is patients not answering every item on a questionnaire for various reasons, such as concerns over privacy, time constraints, or ignoring. In my experience, assuring patients of data security, explaining the use of their health data, and highlighting the research’s potential benefits to others can enhance participation. Additionally, data quality derived from Electronic Health Records (EHRs) is significantly influenced by healthcare professionals’ involvement. Implementing strong indicators to assess the completeness of data entry by healthcare professionals in EHRs, along with regular internal audits, can strengthen health data quality. This approach may require a cultural shift within the organization, emphasizing collaboration among healthcare professionals. Moreover, a robust information system can mitigate data missingness. Features such as alert messages can prompt users to complete missing data fields. If missing data cannot be resolved at the source, statistical techniques may be employed for handling large volumes of patient health data. In such cases, education and training for staff who regularly interact with health data, such as informaticians, statisticians, or healthcare professionals skillfull in data analysis, become essential.
2. Selection Bias: The results of a research that contains the selection bias can also reflect to the misguided information for doctors and it is also serious. The bias can be in various forms as mentioned in the paper; geographic, insurance, medical history. To overcome this challenge, use a diverse range of data sources to capture a more comprehensive representation of the population can help eliminate the selection bias. Incorporating data from multiple healthcare settings, regions, and demographic groups can also help mitigate bias. However, if there might have potential bias in the study, transparently report the limitations of the data set, including any potential sources of bias, clearly communicate the demographic and historical context of the study population, enabling readers to interpret findings within the appropriate context is important.
3. Data Analysis and training: As previously mentioned, skills in statistics, informatics, or analytics are essential for researchers and healthcare professionals when they are dealing with the big health data. Considering the limited availability of skilled staff in these areas, an effective alternative approach is to utilize existing organizational resources for assistance. Engaging with statisticians in the clinical research center or seeking support from staff specialized in these analytical fields can be highly beneficial.
4. Interpretation and Translational Applicability of results. It is always difficult when it involves the application to human’s life such in context of cardiovascular practice. To help reassure the results will be benefit for human, the results’ quality and reliability is needed. Collaboration between interdisciplinary and request for the expert opinion can ensure that research questions are relevant and that findings are practical and applicable. Moreover, learning from the previous outcomes can help in understanding the effectiveness of translational efforts and guide future directions.
5. Privacy and Ethical issue: It’s essential to strict data protection regulations to ensure confidentiality and security. Informed consent should be obtained from participants, clearly explaining how their data will be used, and allowing them to opt out if they wish. Furthermore, using anonymisation of data can help protect individual identities. Ethical review boards must take part in every human related research to ensure compliance with ethical standards and to address potential risks and benefits. Additionally, implementing robust cybersecurity measures can prevent data breaches and unauthorized access.
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Everyone has explained very clearly about fighting corruption. I also agree with all the points recommended in this article.
Firstly, concerning stakeholders: It is impossible to advocate for what is right without collaboration among key individuals in each system. Identifying corruption requires consensus and understanding. I also agree that speaking up is particularly challenging for those without power. Also, the need for a policy of support and protection should be considered.Secondly, prioritizing action is crucial. It’s essential to identify which corrupt practices require urgent attention, so we can focus more on those with the most significant impact on the health system. For example, corruption in the procurement of medical supplies is a high-impact area because it directly involves patient safety and can be a matter of life and death. This issue demands immediate action.
Thirdly, taking a holistic view. Research on corruption is limited, possibly due to associated risks. I agree that collaboration across multiple disciplines is vital, as it ensures that the causes of each corrupt practice are addressed from a broader perspective. This approach makes solutions more effective and sustainable.
Finally, conducting research is crucial. The benefit of research lies in its ability to gather many meaningful insights, especially when it involves various disciplines. Research can help in identifying the causes and impacts of corrupt practices, developing solutions, and creating indicators to monitor corruption. Moreover, research can highlight the transnational nature of some corrupt practices, promoting international collaboration in the development of policies and strategies to combat corruption.
Like many others, I believe that transparency in governance is a crucial tool for fighting corruption in healthcare, as it reduces opportunities for corrupt practices to go unnoticed. Furthermore, with increased transparency, the misuse of power becomes much more challenging. For my setting, apart from the strategies previously described, I think since corruption starts with individuals, educating about morality is also vital and can be instilled from a young age. When people have a consciousness of right and wrong, they are less likely to engage in improper and harmful actions towards others. Moreover, in healthcare, raising awareness of corruption through education and training that focuses on ethics and legal issues can be beneficial. It can help individuals to act ethically and recognize corruption.
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I would like to discuss the introduction of the 30-Baht Plus Universal Health Scheme in Thailand, recently launched in some provinces under the concept of “One Card for All.” While the previous 30-Baht scheme or the gold card scheme is the largest of the three Thai healthcare programs providing universal health care, it has limitations. Gold card holders are exempt from paying hospital fees only at registered public facilities, necessitating a referral letter for services elsewhere, except in emergency cases.
The new initiative, the 30-Baht Plus universal health scheme, allows the Thai population to access medical care at any state hospitals, private hospitals, clinics, and pharmacies that join the program, with only an ID card needed. The pilot project has already launched in the first four provinces, and the second phase is set to start in eight more provinces by March, with the goal of nationwide coverage by the end of the year.
Last week, the nursing director of my organization announced that nurses should also prepare for the significant impact. In my opinion, this health system improvement offers many benefits to the Thai people, such as reducing crowds in large hospitals, as individuals may prefer seeking medical care at the health facilities near to their accommodations while receiving the same healthcare benefits as the previous gold card universal coverage. Moreover, the initiative’s uniqueness lies in the digital connectivity between medical facilities, so it facilitate the sharing of patient health records across the healthcare providers. For patients, this can reduce waiting times and the time spent during hospital visits. Lastly, with this universal coverage, individuals facing financial constraints can access medical treatment and quality healthcare without worrying about bills.
The 30-Baht Plus project aligns with three goals of the health system—health, responsiveness, and fair financial contribution—however,there are some potential barriers in this new scheme. First is financing. As people can access various health facilities, from hospitals and pharmacies to dentistry or community nursing clinics, the government needs to invest more resorces to meet the increased demand. The failure in allocating finance means the quality of the services people will receive might be compromised. Furthermore, this may increase the workload for staff, considering the existing shortage of medical doctors, nurses, and other health professionals. Some people might choose to only access large hospitals, tertiary care, or university hospitals, believing in the quality of care regardless of the treatment indication. Therefore, each setting needs to prepare a sufficient number of staff to handle the patient influx. Insufficient staff can also affect the effectiveness of the service. Lastly, the new system involves the development of Electronic Health Records (EHRs) and the seamless connectivity, which require a robust information system and enough IT personnel for maintenance and support. Therefore, each hospital needs to make sure the readiness of IT system, otherwise the quality of care and services will be impacted.
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For me, I have made several of my new year resolutions, but the top one that I really want to achieve is to lose 8 kgs that I gained from last year. Here are my 12 steps of this project.
1.Define the Project:
Since my objective is to lose 8 kgs within 6 months, I have titled my project the “8 Kilos in 6 months, No More Belly Fat Challenge.”2.List the Tasks:
This challenge focuses on three main tasks: nutrition, exercise, and stress management. The breakdown of these tasks are as follows:
– Nutrition: I will create a weekly meal plan for each working day that aligns with my calorie goals. From Monday to Friday for example breakfast will be 2 boiled eggs and 1 cup of low-fat yogurt, and 1 cup of no sugar added Americano. Dinner will consistently be a salad. Lunch will depend on what is available in the cafeteria, but I must be mindful of it and careful about the calories. On weekend’s breakfast and lunch I can choose my favourite with the limited calories. Moreover, I will track my intake regularly using digital meal tracker that I bought.
-Exercise: Each week, I plan to exercise regularly for 30 minutes to 1 hour a day, at least five days a week. I love swimming, so I have scheduled swimming sessions each week.
-Stress Management: Whenever I feel stressed, I tend to eat a lot. Therefore, I will engage in more activities that reduce stress, such as regularly practicing meditation and pray.3. Get Tasks into the Right Order:
Since the challenge already has a daily plan with the specific time, organizing tasks in the right order for me will include also small wins. For example, in the first 4 weeks, I will set a goal of 30 minutes of swimming and then gradually increase it to 45 minutes by 3 months and 1 hour for last 3 months as I may build more tolerance through practice. The same approach will be applied to meditation and pray, starting from 10 minutes and increasing to 30 minutes daily.4.Add a Safety Margin:
In situations where I might not be able to strictly follow my daily meal plan, I’ll allow for some flexibility. I can skip a low carb or low fat meal but with the limitation of only 4 times cheating in a month.5.Crash the Project Plan:
If I happen to fail to complete a 1-hour swimming session, I will reduce it to 30-45 minutes. In such instances, I’ll compensate by walking more during the day instead of using a golf cart between buildings.6.Create a Gantt Chart:
Chris’s Gantt chart technique is very interesting for this project, as it allows me to track my activities using color coding through conditional formatting. Over the entire 6 months, I can have an overview of whether I’m achieving my goals or not and readjust tasks if the plan deviates.7. Assess Resources:
There are many resources I have gathered to assist me with this challenge, such as YouTube channels for choosing diet or in the Instagram, and also from the person who have successfully lost their weight.8. Think About Risk:
A major problem I’ve experienced in the past when trying to lose weight is having a peptic ulcer. This time, I will ensure that I do not skip any meals and carefully choose low-calorie foods.9. Monitor Progress:
As my objective is to lose weight, I will monitor my progress by checking my weight every Monday and recording it on a weekly basis. Simultaneously, I will track the timing of my exercise and meditation daily using a Gantt chart to observe my progress in these activities.10.Monitor Cost:
There are no extra costs associated with this project except for food. I expect that after working on this project, I will save a significant amount of money that I previously spent on sweets and buffets. Therefore, it’s a good idea to include the daily cost of food in the chart to compare with my previous meal expenses before the project.11. Readjust Plan:
In situations where I cannot go swimming, I will opt for running instead, maintaining the same duration. And for food, it can be flexible but should align with the low-calorie options I have listed. Moreover, if my time schedule is so tight and I could not go for exercise I might do planking at home for only 5-10 mins.12. Review the Project:
I will summarize the project monthly and at its end, including my weight reduction whether it meet my objectives or not, average time spent on exercise and meditation, and also the expenses spending on food. -
For me, to motivate the team member to do or to change something is not easy, but based on my experience, being the good role model, be consistent on what are we doing and show the impact if we change, then they are finally follow.
In my workplace, the traditional way of nursing care makes people more comfort with and feel difficult to do out of what they are usually do. A good example is one day I introduced something different of what they always do for more than 30 years. It is nesting style that I learned from clinical practice in Europe. (Nesting is a component of developmental care that improve neonates sleep quality through the high boundaries that support their limbs and legs into the midline similar to living in their mother’s wombs.) Many juniors followed what I suggested, but many seniors do not cooperate with the reasons that it is more complicate than what they have been doing for ages. To influence the new culture and overcome the resistence is never easy but finally when they see us do regularly and know the outcome of this change even need some more effort, they finally listen and follow. The trick that I used especially when working with senior colleagues is that show them and prove that what I want them to do is truely gives the positive results and improvements.
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A disaster recovery plan of the information system that I will use in my organization include the procedures and techniques as following:
1. Building the risk assessment. Develop a comprehensive risk assessment form to evaluate potential risks such as natural disasters, cyber attacks, hardware failures, and other disasters.
2. Specify the potential effects of each disaster scenario and determine the Recovery Point Objective (RPO) and Recovery Time Objective (RTO) to prioritize timely backup and recovery solutions.
3. Develop the incidence response plan for outline the step of disaster recovery in each specific types of disaster.
4. Use data backup and recovery technologies to help protect organization from data loss. Restoring data in the cloud services help in case of the primary data center is compromised.
5. Use the data replication technology to help the organization with fast recovery as it can reduce the RTP and RPO. Given the healthcare nature of the organization, quick recovery is crucial for maintaining patient care, administrative functions, and overall hospital operations.
6. Regularly perform testing and simulations of the disaster recovery plan. Also, regularly conduct IT staff training to ensure familiarity with all procedures, enabling efficient system restoration in the event of a disaster.
7. Keep up-to-date documentation covering all aspects of the disaster recovery plan, including procedures, contact information, and system configurations and regularly review and update documentation to ensure an effective response for IT staff if the disaster occur. -
For me, if my hospital adopted the high availability technology in its HIS, both patients and hospital will receive many advantages.
For patients, High Availability (HA) technology enhances the quality of care by supporting the continuous functioning and operation of the system, maintaining its availability for patient care at all times. When the downtime is occur if the HIS has a high availability technology, the interruption to treatment and patient care is minimized. Also, a robust HA system allows healthcare providers to perform their work more effectively, benefiting the standard of care and patient outcomes. Additionally, patients will not face the risk of time and budget waste due to unstable systems, such as the postponement of surgeries that may occur during system downtimes or delays.
For the hospital, HA technology ensures that the Hospital Information System (HIS) remains
operational consistently. This operational continuity facilitates healthcare providers in delivering patient care effectively and in a timely manner, which help improve patient outcomes. Moreover, a strong HA technology contributes to the hospital’s long-term financial management by minimizing the impact of system failures and reducing associated costs. Beyond operational and financial aspects, HA technology aligns with accreditation requirements, serving as evidence of the hospital’s commitment to patient care and data security.In summary, the implementation of High Availability technology not only ensures continuous and reliable HIS operation for patients’ benefit but also contributes to the hospital’s overall effectiveness, financial stability, and adherence to accreditation standards.
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What happened?
I personally rarely experience events related to the CIA principles of the information system in my workplace. However, I remember a situation back in mid-2021 when I received a notification from my head nurse that the organization’s email accounts had been hacked. She received a list of hacked email accounts from the hospital informatics section, which included my email address and those of some of my friends. The reason only a specific group of accounts was targeted is that the hacker executed the attack on a specific day, affecting those who had signed into their accounts on that particular day. Because of this incedent, the informatics team requested the victims to change their passwords immediately.How did it affect the system or users?
Since confidentiality was compromised, the victims’ personal information was prone to disclosure. For example, if users stored passwords or sensitive information in their emails, hackers could obtain identification or passwords and engage in credit card theft. Additionally, they could impersonate account owners and conduct fraudulent financial transactions or other cybercrimes. Moreover, affected accounts were temporarily unable to log in because the passwords might have been changed by the thief.How to prevent it?
To prevent situations like the email hacking incident, it’s crucial to enhance cybersecurity measures. Implement robust authentication protocols such as Two-factor authentication (2FA) to add an extra layer of security. Conduct employee training on cybersecurity best practices is necessary. Additionally, enforce strict password policies, using strong, unique passwords and regular changes. Monitor and audit user account activities regularly to detect unusual patterns and promptly respond to any anomalies. Lastly, it is worth to invest in the latest and strong cybersecurity technologies which will collectively fortify the information system against potential threats. -
Thanks for sharing. I just learned about the information systems like JCHIS that facilitate primary healthcare from your discussion. I hope in the future they can strengthen their interoperability features. This would greatly benefit nurses in primary units as well as patients. And of course, VHVs (Village Health Volunteers) are like heroes in situations where there is a shortage of nurses or community health workers. Well-designed tools to assist both nurses and VHVs in their works are a good idea.
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Hi Siriluk,
First of all, I love the theme color of the layout you picked. It’s super neat and soft. I find your dashboard is easy to understand with all the key metrics provided. The dashboard shows all important information at a glance, including the scorecard showing the total number of cases. You have also provided the shortened, compact number of millions of cases, which helps avoid confusion for the reader. You gave a nice contrast in color for each country when creating the comparison chart, which helps the reader easily differentiate the data. The reset button and download button are very useful and It works well!
One suggestion from me is that many-digit numbers, such as those in the table, might be clearer if you add commas to them.
Thank you for sharing your great work!!
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I do agree that IT workforce in healthcare may receive lower salaries compared to working in other sectors. That is one reason why skilled IT workforce leave the healthcare sector. Thanks for sharing, Khan Weerapat. I think as health informatician is very important in this era. Offering fair payment as well as a clear career path is a great solution to increase their career satisfaction and intention to stay in their profession.
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Hi Teerawat. Your suggestion is so meaningful. Public awareness campaign is interesting and I think it can help people understand more of health facilities and use the benefit for its service more appropriately. Also, promote the use of telemedicine for minor ailments or for initial consultations can reduce the burden of the overcrowded hospital and also will much lesson health providers workload. Thanks for sharing!!
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You have the great example N’Prize. I can relate the problems of waiting time especially in the OPDs. EHRs are used recently in the hospital where I work and it really help in shortening the time spending on taking patient history. However, because the high number of patients each day but there are limited physicians and staff, the problem is still occurs. To solve the problems, understaffing issue needs to be considered together with other resources. I hope someday the government will have the good strategies to retain healthcare professional in the health system such as offer the fair pay or invest in the infrastructure to reduce their workload. Thanks for sharing!!
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Yes!! a sense of humour is the trick that I really like and we should not forget. It helps us improve our physical and mental health. For me, no matter how hard day it is, at least if we make a joke and laugh, my feeling of tiring is lessen and I can gain more energy to move on my work. Thanks for sharing ka!!!
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I absolutely agree with your tricks. Leading by example is one of the greatest ways to motivate my colleagues based on my experience. Also, the environment can affect our inspiration as well, for me the positive environment at work helps me enjoy working and shape my attitude about the success as I feel motivated on what I am doing. Thanks for sharing ka khun Ton.
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For me, I really struggle with recalling details when listening. Many years ago, I found myself surfing on social media a lot, which always switches from one content to another so fast. And also I spend much time on the screen during the day, even when having my breakfast, lunch, or dinner. It makes me lose focus and lessens my ability to memorize things. When it comes to the situation where I have to keep track of the details of the speaker, I face trouble in remembering. Moreover, multitasking on my working style always makes it worse.
The strategies that I think will help me with this challenge are:
* Spend less time on the screen, especially on social media such as Facebook or Instagram. (I used to do my own experiment by deleting the Facebook and Instagram apps off my phone for three months while preparing for exams three years ago, and it worked well to help me remember what I read. I believe it may be useful for improving memory when listening as well.) Also, I need to limit myself from opening them.
* Engage in meditation or mindfulness. I find it useful to clear my mind when I practice it which helping me stay in the present. I think it can enhance my ability to memorize if I practice regularly. Moreover, I believe that when I do multitask, it will help me stay more focused on what I am doing right now, which might help me in the better memory recall.
* Take on daily challenges, such as listening to short stories and trying to capture as many details as I can, then writing them down. Then check it if what I wrote covers all the important details and continuously practice to see improvement.
* When my friends tell me something that contains many details, I will paraphrase what they said and ask for feedback to ensure I covered all the important details.
* Try to have as much enough sleep as I can to help my brain rest, relax and refresh, also I have to eat healthy food to boost my brain. I believe all these techniques if I practice regularly, I will have the better memory and be able to recall details when listening. -
That’s true, Prize and Pyae. Thanks for sharing! It happens to me all the time. Multitasking is so common in my work (nursing), especially on super busy days, and it is the main reason for me that reduces my memory. It is like I am not paying enough attention to listening, so I couldn’t memorize things effectively. Not only does the busy day cause me to easily forget some details, but also when my brain is tired, especially during the night shift. I often need to ask my friends to repeat their words again and again during the handover in the next morning. Thanks for sharing!
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