A new hospital project is always a very challenging journey (to say the least)! Experience has shown that one such critical element for the success of a new hospital project is the pre-commissioning period; and more specifically planning for this phase. Often the construction pre-commissioning planning is dealt with sufficiently. However, planning for the operational pre-commissioning activities is often underestimated and therefor neglected.

The result being: always a frustrated team, usually unnecessary delay in the opening, and, most often, over budget. One criterion for a project to be regarded as successful is the 1,000+ operational actions & activities which need to be sufficiently attended to by the operational team. An example of these activities ranges from documentation and staffing to implementing of committees and governance. “Comprehensive” and “organized” are two key characteristics of these activities. The adventure starts from the original vision of the owner and continuous up until the date-of-first-patient. Not only must we attend to these activities but we must also address them in a synchronized manner, with specific time periods allocated to them. The responsibility to manage this process lies not with the construction project team, but with the operational team. We often feel that this task is boring and tedious. Though, it can be stimulating and fulfilling, íf we keep it simple; use suitable tools; communicate well; involve the whole team; apply sufficient knowledge; (and have FUN).

The connectivity of network systems have benefited both the users and the hackers, but with very different and obvious outcomes. Amidst medical and scientific breakthroughs and continuous efforts to enhance quality, targeted treatment and speed in patient care delivery and recovery assisted by the ever changing technological landscapes, both public and private healthcare organizations have been keeping up with the trends and invested in medical devices that provide seamless connectivity between the patients and the hospitals in terms of data transfer and management. Stolen and sold patient data is disastrous and may be remedied with penalty charges due to breach of privacy and data protection laws. We must not forget that with inter-governmental and regional MOUs, Trade Agreements and Collaborations being forged at global level, transnational data transfers would be inevitable and will certainly pose higher level of security threats. Failure of operational network systems arising from cyber-attacks within a healthcare organization with IoMTs (Internet of Medical Things) installed for the purposes stated above carry far reaching damages leading to delayed treatment, disrupted treatment codes and computations, medicinal dosages or simply a mixed up of a patient’s data with another in the aftermath of an attack, could have devastating if not deadly effects. How do we then enhance patient data protection and strengthen network system security, moving forward? In my opinion, all healthcare organizations might want to revisit traditional way of patient record keeping in paper, compact discs as back up plans and to prevent data theft and work with the manufacturer to segmentalise/decentralise all IoMTs from the main network systems which is the only path through which the cyber hackers conduct criminal acts. If we need the manpower to man all these traditional activities, so be it, as the long term effects are more sustainable. 

We will start with a histological reminder of the Gastrointestinal tract (GIT) membrane and its constituents. We will then talk about the GIT as immunologic membrane = GALT. We will review the consequences of so-called diseases of civilization. (intolerances, allergies, MIC). Then we will talk about the immune response, the differentiation of lymphocytes, the secretion of IgA, auto-illunes, the interest of pre-biotics and pro-biotics, the existing relationship between pro-biotics and immunity. It is concluded as the vital importance of the good functioning of the GIT for the well-being of patients.

This QIP highlights the importance of paying attention to resolve patients and healthcare givers complaints in hospitals through medical records revisions and adverse events and specific patients' complaints with their related medical records. Gathering patients with specific complaints and professional staffs in meetings with listening to their suggestions help designing new medical approaches to satisfy them is vital. Best solutions should be preceded by conceptual frame works that acquired approval from conjoint team is crucial. Internal auditing statistical data collection, analysis and observation revealed a decline in number of patients seeking for healthcare with increasing complaints and dissatisfaction from HCGs and patients. Occupancy and bed turnover rates are decreased with impaired bed occupancy rate plan of hospital and decreased its occupational revenues. Four months of meetings and conjoint team working formed of HCGs and complaining patients the "SMART "goal was specifically "creating proper diagnosis and healthcare management for patients through multidisciplinary approaches enhancing occupation rate plane to increase revenues, preceded by approved conceptual frameworks covering cares of allergy, women health, chronic diseases, obesity, orthopaedic, rheumatology, infertility and cancer prevention. FMS department overcomes all obstacles concerning patient cycle and passage rotation. The team used "FOCUS-PDCA", practiced retrograde medical records and patient complaints revision and evaluation with data collection and analysis for decision making, through action plan formed of four phases. Transformation from traditional clinics into integral multidisciplinary centers care is recommended with changing designs of both outpatient and ER departments. It regains patients and HCGs satisfaction and more than expectations. Establishment of hospital relative competitive advantages attract patients, increasing bed occupancy and turnover rates with positive effects on operational revenues. Effective marketing for the innovative health care services restores and improves the reputation and image of the hospital in community and makes it the first destination for seeking healthcare.

One major pathogenesis of obesity is the unbalanced hormones, too much stress hormone steroid and/or not enough “anti-obese” happy hormones, endorphin, serotonin, dopamine, and oxytocin, too much estrogen and/or too less testosterone. Any sexual orientation is normal. Sexual orientation is X-linked and Y-linked traits, inherited by the next generations. It is like this, female homosexual XAXA, female bisexual XAXa, female straight XaXa, male bisexual XAYA, male homosexual (manly type) XAYa, male homosexual (girlish type) XaYA, male straight XaYa. The presentation and degree of homosexuality vary in many ways, and at different stages of the lifespan, as these hormones and our genetic makeup change. So is a fat deposition. More estrogen and/or less testosterone are associated with fat ass. A fat ass may be an easy way to identify stronger homosexuality. If everybody loves his/her love, it may be better balanced. Yet, the reality is the reality. LGBT healthcare remains far behind. As an unresolved frustration, closeted homosexuality causes a series of health problems, obesity, tobacco/alcohol/substance abuse, and mental/psychiatric disorders. The incautious sexual practice causes sexual transmitted diseases (STDs) like AIDS. Social problems like inequality opportunities among minorities happen often. It brought a huge challenge for management. Better acceptance and recognition from learning in a variety way, information merged into clinical visits through smartphone apps and electronic medical record system (ERMS), barrier protection in sexual practice, positive attitude in daily life, team network of physicians, psychiatrists, psychologists, pharmacists, activists, and communities, with loving hearts. Start local, go global, and don’t ever shut the door.  

Background: Burnout syndrome is an occupational mental health problem that affects human service professionals, including physicians, due to chronic job stress. It is a syndrome of three dimensions: Emotional Exhaustion (EE), Depersonalization (DP), and reduced Personal Accomplishment (PA), that can occur among individuals who work with people. Physicians are placed under stresses as they are required to provide quality services despite the weakness of infrastructure, shortage of staff, and increased number of patients. In addition, physicians are required to continuously update their knowledge, improve their skills and at the same time take care of themselves and their families. All these stresses may eventually lead physicians to “burnout”. Despite the importance of this occupational mental health problem, there is a dearth of literature about job burnout among physicians in Saudi Arabia.

Objectives: This study was conducted to estimate the prevalence of burnout among physicians working in KFHU and to determine the factors associated with burnout among physicians working in KFHU at eastern province of Saudi Arabia.

Methodology: This was a cross-sectional survey targeting all eligible physicians working in KFHU. A total of 390 physicians were targeted and contacted. A self-administered questionnaire consisting of two sections was used. The first section was constructed by the researcher to include background information on determinant of burnout. The second section was the Maslach Burnout Inventory-Human Services Survey. The prevalence of burnout levels and each dimension were  calculated. The SPSS program was used for data entry and analysis.

Results: A total of 265 instruments were analyzed .The response rate for this survey was 67.9%. The prevalence of the different dimensions of burnout are the following: 111 (41.9%) experienced average to high emotional exhaustion, 72 (27.2%) experienced high depersonalization and 102 (38.5%) experienced low personal accomplishment. Of all respondents, 28 (10.6%) had burnout as identified by the combination of high EE, high DP and low PA.

Introduction: The Social Health Security Program(SHSP) is a social protection program which aims to  access quality health care services and been in implementation  from 2016/17 fiscal year in Nepal. SHSP  prevent people from catastrophic expenditures for health in an equitable manner, accountability and quality in health care services.

Purposes: This research was intended to identify the barriers to SHI and to know the frequency of people practising the SHI policy.

Methodology: This was a descriptive, cross sectional study, conducted in seven districts hospitals of eastern Nepal among the people selected randomly irrespective of the gender, religion and cast. The study was conducted from December 2017-January 2018 for the data collection and analysis.

Results: Only 23.68% had knowledge about SHSP run by government and 75.26 % unaware of  SHSP run by government. Only few, 6.30% had received the SHI issued by government and 93.70 % had not received SHI policies till date. Most of them 14.5% paid themselves for their health scheme, 15.78% knew about the advantage of obtaining SHI while 84.22% people were unaware of various benefits of health insurance policies for the quality health care only 13.15% people had obtained social health security insurance policies from private company and 4.21% people had obtained policies from government.

Conclusion: There were less coverage on this health policy. The movement towards full SHI coverage is an incremental process, with systematic expansion over the transition period. Barriers affecting to meet the universal coverages need to be addressed.

This QIP highlights the importance commitment of "continuous education and training" in hospitals, and raised the knowledge and the scientific level of staff with different categories in the basics and principles of "TQM, Patient safety, IPC and Environmental safety" to "create one team for one goal speaks the same language and thinks the same thinking". Additionally inevitability of involving staff in finding the solution and listening to their opinions to satisfy them. Selecting the best team to study and proposes appropriate solution and implement it through a clear action plan is vital. Internal auditing revealed a false sensation of security and appearance of informal groups. The spirit of quality and patient safety with implementation of policies and procedures become far away from daily workload of hospital categories. Among six months with sharing of 789 out of 814 hospital staff and a team of 15 members chosen by "GRPI" model, the "SMART" goal was specifically "innovating Simple move to improve continuous education and training of quality and patient safety among hospital staff using a new method instead of lectures proved to be not suitable time workload and work shifts as well as to create one team for one goal, the hospital overcome all obstacles and achieved success. The team used "FOCUS-PDCA", practiced team, data collection and analysis quality tools, for decision making, through action plan formed of four phases, putting in mind results of preliminary and final staff questionnaires and exams. Neutralization of informal groups, elimination lack of commitment and resolving the false sensation of security to prepare the hospital for reaccreditation occurred in conjunction with improving staff skill development and morale. Usage the new method in departmental education is recommended. It can help patient education and new employee orientation. Enhancing the internal marketing and celebrating the annual WHO awareness days and sharing in exhibitions get benefits from it.

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by oligomenorrhea, hyperandrogenism, and polycystic ovaries shape by ultrasound. It has an estimated prevalence of 4–21% in reproductive aged women depending on the diagnostic criteria and population examine. PCOS is associated with metabolic abnormalities including dyslipidemia, insulin resistance, and type II diabetes and is also one of the most common causes of reduced fertility. The altered metabolic and hormonal environment among women with PCOS may increase their risk of some types of cancer like: Endometrial cancer which explained by the absence of ovulation and producing estrogen, but not progesterone, which causes the endometrium (the lining of the uterus), to grow too much and undergo atypical cell changes. This is a pre-cancerous condition called endometrial hyperplasia. If the thickened endometrium is not treated, over a long period of time it can develop into endometrial cancer, and ovarian cancer: as PCOS   increased androgen exposure presence of androgen receptors on normal ovarian cells as well as benign and borderline tumors, and a doubling of androgen levels during pregnancy is associated with a 40–50% increased risk of borderline serous and invasive. Breast cancer: characteristics and consequences of PCOS have been previously associated with both increased and decreased risk of breast cancer. Increased levels of insulin in the blood can increase the risk of formation of breast cancer cells and  other kinds of cancers might linked to PCOS medications that may influence cancer risk such as: oral contraceptives, metformin, ovulation-induction therapies.

How do you create a team that not only has a great time working together, but that produces beyond your expectations and creates beyond what you had possibly and originally envisioned?  This is definitely the power of a great leader.

Whether your teams are on the front line, in management roles or in the board room, all your teams are vital to the success of your organization.  Learn how to make a huge difference in your teams from a shift in morale to a change in their productivity.  Experience what it is like when you create a new energy and excitement in your teams. When people feel valued, acknowledged and appreciated, an amazing movement of collaboration and participation begins to happen!

In this workshop, you will try on new skills and will experience the secrets of how it feels to be really seen and heard whether you are in your work environment or your community.  It is a powerful skill to hold.  Come and explore this and then take your teams to new heights!

Statement of the Problem: Negligence in the human resource planning leads to many problems, including shortages or the excessive human workforce, the unequal human workforce distribution, and inappropriate use of staff in the organization. To prevent the unequal distribution of healthcare providers, some strategies have already been employed, such as the design and implementation of norm estimation of human resource. The purpose of this study is to develop a norm for estimating the required nurses in referral hospital inpatient wards in Iran using the nurses-to-patient ratio method. 

Methodology & Theoretical Orientation: This cross-sectional study was carried out in 53 inpatient departments in 14 referral hospitals affiliated to MUMS in 2017. The specialized nominal group technique was used to determine the required nurse-to-patient ratio for the inpatient departments interview, reviewing documents and staff records were used to identify factors affecting available working time and calculation of nurses’ available working. Finally using nurse to patient ratio and nurse`s available working time was developed a norm a norm for estimating the required nurses for inpatient departments in referral hospitals. 

Findings: Eleven factors affecting the nurses’ available time were identified. The hospital inpatient departments were ranked in nine levels according to the nurse-to-patient ratio and in twelve levels by considering the nurses’ available time. In all scenarios, the highest required nurse estimation norm was for the ICU department of burns, and the lowest norm was for the psychiatric departments. 

Conclusion: The nurse-to-patient ratio and the available time of nurses are two important components in calculating a norm for estimating the required nurses in different hospital departments. Using a norm for estimating the required nurses can prevent the personalization decisions of managers on distributing nurses, and these norms can also be considered as an efficient strategy to improve the levels of employing nursing staff as well as patient care levels.

The aim of conducting the present study was to explore the relationship between medical student’s stress and time management behavior. Furthermore study determined the gender differences in medical student stress and time management behavior. The sample of medical students (N = 200; Males = 100, Females = 100), age range between 19 to 22 years were taken from different medical colleges of Rawalpindi, Islamabad and Abbottabad. The Student Stress Inventory and Time Management Behavior Scale were used. Pearson correlation and t- test were applied to test the hypotheses. The data was analyzed by SPSS version 21.  .Results indicated negative correlation between stress and time management in medical students. It was found that those students who had higher level of stress had also poor time management and vice versa. Results showed that female students displayed higher level of stress and highest scores as compared to the male students. The study concludes that stress negatively effects on time management among medical students. Female students exhibit higher level of stress as compared to the male students.