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In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions. [ABSTRACT FROM AUTHOR]

Background No attempt has been made to give a systematic overview of the innovative use of unannounced or incognito standardised patients. Objective To provide a systematic overview of all published studies with incognito standardised patients assessing doctors in actual practice situations using sound reliable and valid standardised patient methodology. Methods Systematic literature search in Medline, Eric and Psyclit with piloted search terms, followed by retrieving additional papers from reference lists. All papers were scored with a predefined protocol-sheet using predefined inclusion and exclusion criteria. Results Forty papers referring to 21 projects with incognito standardised patients were found and described in detail. The majority of studies were conducted in primary care and were descriptive. Discussion There is a need for research on the additional value of the incognito standardised patient methodology and for a consensus on how to report on accuracy and consistency of standardised patients. [ABSTRACT FROM AUTHOR]

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects.Design/methodology/approach The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions.Findings The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities.Originality/value This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated. [ABSTRACT FROM AUTHOR]

Background & Objective: Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants: Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results: Participants' needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions: This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition. [ABSTRACT FROM AUTHOR]

Purpose: A growing body of research seeks to include people with dementia as both participants and co-designers. It is also increasingly recognized that dementia research must pay greater attention to informal care, provided by family and friends in non-institutional settings, because this is the situation of most people affected by dementia. Accessing these kinds of naturalistic care sites through meaningfully inclusive studies can be challenging for researchers in many fields. The paper aims to discuss this issue. Design/methodology/approach: This paper describes a methodology designed to facilitate meaningful inclusion and access to hard-to-reach dementia care networks. It describes the implementation of this methodology in the field, the problems that emerged and the lessons learned. Findings: A two-step sampling approach was used. People with dementia were sampled through organizations unrelated to dementia. Care networks were sampled through ecomapping with people with dementia. The strategy successfully accessed the desired population, but it was labour-intensive and biased the sample in several respects. Originality/value: It is hoped that this outline will encourage further reflection and discussion regarding methodological approaches to complex sampling and recruitment issues in dementia research. [ABSTRACT FROM AUTHOR]

Participation by people of color in research studies is important for generalizability and to mitigate health disparities. Barriers to recruitment are well documented, but less well known is how to succeed. This paper describes successful strategies for recruitment and retention of pregnant Black women for a multisite study of preterm birth. Recruiters provided input on strategies. Participant level strategies include: commitment to being respectful, friendly, and reliable; addressing concerns regarding confidentiality; acknowledging competing priorities; and when possible, matching recruiters by gender and race. Clinical level strategies include: the formation of a good working relationship with the clinical staff; prioritizing clinical care above research activities; and obtaining access to the electronic medical record systems. Protocol level strategies include: a wide enrollment window; coordinating biospecimen collection with the clinical laboratory tests; collecting survey data on an electronic tablet; text messaging; and providing compensation for the time needed to complete study activities. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: The Pediatric Trauma Society (PTS) is a multidisciplinary organization, with scientific presentations at its annual meeting addressing trauma care from prehospital through rehabilitation. Objective: The purpose of this study was to identify and describe the scholarly areas of focus of presentations at the annual meeting over the society's first 5 years and evaluate research dissemination. Methods: Data were collected on abstracts presented between 2014 and 2018, including titles, authors, and abstract classification. PubMed and Google Scholar searches identified abstracts that resulted in publications. Journal impact factors were identified. Results: Over 5 years, 491 of 635 (77.3%) abstracts were accepted. The number of submitted and accepted abstracts increased, but the acceptance rate was stable (range = 72.1%–81.2%, p = NS [nonsignificant]). The most frequently accepted categories included "Epidemiology," "Abdominal or Thoracic Trauma," and "Neurosurgery or Traumatic Brain Injury (TBI)," whereas "Trauma Nursing" and "Quality Improvement" were less common. Among the 2014–2016 abstracts, 55.4% of podium and 24.3% of poster presentations were published. Abstracts categorized as "Epidemiology," "Education & Injury Prevention," and "Neurosurgery or TBI" were commonly presented but uncommonly published. The median journal impact factor of publications was 2.1 and 2.0 for podium and poster presentations, respectively (ranging from 0.11 to 10.25). Conclusion: Most of the scholarly effort presented at the PTS remains unpublished. Published work is mainly in low-impact factor journals. Mentorship in the publication process and encouragement of multidisciplinary collaboration within the society are needed to address limitations in the number and potential impact of the scientific content of the annual meeting. This type of analysis is relevant not only to the PTS but also to any professional society seeking to improve its impact. JTRAN Journal of Trauma Nursing 1078-7496 Wolters Kluwer Health, Inc. 10.1097/JTN.0000000000000605 00008 3 RESEARCH The Pediatric Trauma Society Annual Meeting: An Analysis of Scholarly Output From the First 5 Years Knaus Maria E. MD Maria.Knaus@nationwidechildrens.org Berg Gina M. PhD, MBA gberg@kumc.edu Vogel Adam M. MD adamv@bcm.edu Prince Jose M. MD Jprince@northwell.edu Burd Randall S. MD, PhD rburd@childrensnational.org Gosain Ankush MD, PhD agosain@uthsc.edu Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis (Drs Knaus and Gosain); Department of Family and Community Medicine, University of Kansas School of Medicine–Wichita (Dr Berg); Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston (Dr Vogel); Cohen Children's Medical Center and Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York (Dr Prince); Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, District of Columbia (Dr Burd); and Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee (Dr Gosain). Correspondence: Gina M. Berg, PhD, MBA, University of Kansas School of Medicine–Wichita, 1010 N. Kansas, Wichita, KS 67214 (gberg@kumc.edu). This study was presented at the 2019 Pediatric Trauma Society Annual Meeting in November 2019 in San Diego, CA. Author Contributions: conception and design of the study: G.M.B., A.G.; acquisition of data: M.E.K., A.G.; analysis and interpretation of data: all authors; drafting/revision the manuscript: all authors; final approval: all authors; accountability: all authors. The authors have no conflicts of interest or funding to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.journaloftraumanursing.com). September/October 2021 28 5 316 322 © 2021 Society of Trauma Nurses 2021 Supplemental Digital Content is Available in the Text. Background: The Pediatric Trauma Society (PTS) is a multidisciplinary organization, with scientific presentations at its annual meeting addressing trauma care from prehospital through rehabilitation. Objective: The purpose of this study was to identify and describe the scholarly areas of focus of presentations at the annual meeting over the society's first 5 years and evaluate research dissemination. Methods: Data were collected on abstracts presented between 2014 and 2018, including titles, authors, and abstract classification. PubMed and Google Scholar searches identified abstracts that resulted in publications. Journal impact factors were identified. Results: Over 5 years, 491 of 635 (77.3%) abstracts were accepted. The number of submitted and accepted abstracts increased, but the acceptance rate was stable (range = 72.1%–81.2%, p = NS [nonsignificant]). The most frequently accepted categories included "Epidemiology," "Abdominal or Thoracic Trauma," and "Neurosurgery or Traumatic Brain Injury (TBI)," whereas "Trauma Nursing" and "Quality Improvement" were less common. Among the 2014–2016 abstracts, 55.4% of podium and 24.3% of poster presentations were published. Abstracts categorized as "Epidemiology," "Education & Injury Prevention," and "Neurosurgery or TBI" were commonly presented but uncommonly published. The median journal impact factor of publications was 2.1 and 2.0 for podium and poster presentations, respectively (ranging from 0.11 to 10.25). Conclusion: Most of the scholarly effort presented at the PTS remains unpublished. Published work is mainly in low-impact factor journals. Mentorship in the publication process and encouragement of multidisciplinary collaboration within the society are needed to address limitations in the number and potential impact of the scientific content of the annual meeting. This type of analysis is relevant not only to the PTS but also to any professional society seeking to improve its impact. Bibliometrics Conferences Pediatric Research Scholarly activity Trauma SDC T Presentation of research findings as an abstract and the subsequent publication of the associated manuscript are necessary steps of the scientific research process (National Research Council, 2003). Without presentation and publication, methods cannot be disseminated, research findings cannot be validated, and patient care cannot be advanced. Bibliometrics, defined as the statistical analysis of written publications to determine research output and its impact, can serve as a marker of the quality of scientific output from an organization (Desai, Veras, & Gosain, 2018). The Pediatric Trauma Society (PTS) is a relatively young organization founded in 2011 after leaders in pediatric trauma sought to create a group dedicated to the prevention, advocacy, and data-guided care for injured children (PTS, 2011). In 2014, the PTS held its first annual conference in Chicago, IL. Since the first meeting, participation within the organization and at the annual meetings has substantially grown. In recognition of the high-level content presented at the annual meeting, the American College of Surgeon's Trauma Center Verification Program has included the PTS on the list of acceptable organizations in which trauma medical directors can seek membership and active participation to satisfy the requirement of national organization involvement (American College of Surgeons, 2019). The PTS is a multispecialty society, with membership that includes physicians, residents, nurses, advanced practice providers, students, prehospital providers, and other (such as psychologists, physical, occupational, respiratory therapists) specialists. Presentations at the annual meeting address pediatric trauma care over the entire continuum, from prehospital through rehabilitation, and include randomized controlled trials, systematic reviews and meta-analyses, clinical outcomes studies, and process or quality improvement studies. OBJECTIVE: The purpose of the current study was to describe scholarly activity presented in the first 5 years of PTS annual meetings, identify topical areas of focus of presentations, and evaluate research dissemination of the findings of these presentations. METHODS: We obtained abstracts submitted for presentation to the PTS annual meetings from 2014 to 2018. Abstracts chosen for presentation were classified on the basis of whether they were podium or poster presentations. Author names and institutions were collected. Abstracts were grouped into one of 21 categories (as selected by authors at submission): basic or translational science, outcomes, clinical or surgical care, critical care, emergency medicine, education and prevention, epidemiology, innovation, guidelines, prehospital care, quality improvement, trauma nursing, trauma systems, rehab or psych or social work, firearms, abdominal or thoracic, vascular, thermal or burn, spine, neurosurgery or traumatic brain injury (TBI), and orthopedics. To best capture related publications, PubMed and Google Scholar searches were performed using abstract titles, key words, one or more of the authors, and author institutions. Only abstracts from 2014 to 2016 were included to allow a 2-year window for each abstract to be submitted as a manuscript and published. If a study had been published before the PTS annual meeting, it was not considered in the final count. After each publication was identified, the journal's impact factor for the year of publication was obtained using Journal Citation Reports. If an impact factor could not be found for a given year, the impact factor from the prior year was used. If a manuscript was not published in an indexed journal, the manuscript was still considered as a publication in the final count. Descriptive results are presented in frequencies (percentages) and medians (interquartile ranges) where appropriate. RESULTS: Over 5 years, 635 abstracts were submitted and 491 (77.3%) were accepted. Of those, most (69.7%) were podium presentations and the remaining (30.3%) were poster presentations (Table 1). Each PTS annual meeting had between 61 and 77 podium presentations over 4 days, but poster presentations increased from 11 in 2014 to 35 in 2018 (range = 11–44). Abstract submission increased from 98 (2014) to 149 (2018). Although the number of submitted and accepted abstracts has increased, the acceptance rate has remained stable (range = 72.1%–81.2%, p = NS [nonsignificant]; Figure 1). TABLE 1 Category 2014 2015 2016 2017 2018 Total Abstracts submitted, n 98 111 139 138 149 635 Abstracts accepted, n (%) 75 (76.5) 80 (72.1) 112 (80.6) 112 (81.2) 112 (75.2) 491 (77.3) Podium, n (%) 64 (85.3) 61 (76.3) 68 (60.7) 72 (64.3) 77 (68.8) 342 (69.7) Poster, n (%) 11 (14.7) 19 (23.8) 44 (39.3) 40 (35.7) 35 (31.3) 149 (30.3) Podium publication, n (%) 30 (46.9) 38 (62.3) 39 (57.4) 25 (34.7) n/a 107 (55.4)a Median impact factor, median  (IQR) 2.1 (1.6–2.8) 2.2 (1.2–3.4) 2.2 (1.4–3.7) 2.1 (1.1–2.2) n/a 2.1 (1.4–3.4)a Published in JTACS, n (%) 9 (30) 9 (23.7) 12 (30.8) 4 (16) n/a 30 (28)a Published in non-JTACS, n (%) 20 (66.7) 31 (51.6) 23 (59) 21 (84) n/a 74 (69.2)a Published in nonindexed journal, n (%) 1 (3.3) 0 (0) 3 (7.7) 0 (0) n/a 4 (3.7)a Poster publication, n (%) 0 (0) 7 (36.8) 11 (25) 5 (12.5) n/a 18 (24.3)a Median impact factor, median (IQR) n/a 1.1 (0.76–1.6) 2.1 (1.4–3.0) 2.5 (1.9–4.8) n/a 2.0 (1.1–2.4)a Published in JTACS, n (%) 0 (0) 0 (0) 1 (9.1) 0 (0) n/a 1 (5.6)a Published in non-JTACS, n (%) 0 (0) 5 (71.4) 8 (72.7) 4 (80) n/a 13 (72.2)a Published in nonindexed journal, n (%) 0 (0) 2 (28.6) 2 (18.2) 1 (20) n/a 4 (22.2)aNote. JTACS = Journal of Trauma and Acute Care Surgery; IQR = interquartile range; n/a = not available. aPublication metrics for 2014–2016 only. Figure 1. Abstract submissions to the Pediatric Trauma Society over time. The number of abstract submissions to the Pediatric Trauma Society has steadily increased over time, whereas the acceptance rate for podium presentation has been relatively flat. "Epidemiology" was the most common abstract category (Table 2). This category was followed by "Abdominal or thoracic trauma" and then "Neurosurgery or TBI." The number of "Epidemiology" podium presentations stayed consistent each year (range = 7–13). The category with the most yearly variation was "Abdominal or thoracic trauma" (range = 3–14). Topical areas that were less represented included "Trauma nursing" and "Quality improvement." "Guidelines" and "Critical care" were the two categories with the lowest number of abstracts. Among the 342 podium presentations over the first 5 years, only 20 were focused on firearm-related trauma. The 2018 PTS annual meeting had a higher number of firearm-related presentations (n = 7; Figure 2). TABLE 2 Category 2014 2015 2016 2017 2018 Total Epidemiology 7 10 10 13 12 52 Abdominal or Thoracic Trauma 10 9 14 6 3 42 Neurosurgery or TBI 8 6 5 7 10 36 Education & Injury Prevention 7 6 5 7 8 33 Clinical Outcomes 6 5 5 7 9 32 Firearms 3 3 4 3 7 20 Trauma Systems 2 3 4 3 6 18 Clinical or Surgical Care 2 2 4 3 3 14 Spine 5 4 1 2 2 14 Rehab or Psych or Social Work 2 1 3 3 4 13 Orthopedics 1 3 2 5 0 11 Thermal or Burn 0 2 1 4 3 10 Quality Improvement 1 2 2 0 4 9 Trauma Nursing 5 0 1 2 1 9 Innovation 2 0 3 1 1 7 Vascular Trauma 1 0 0 3 3 7 Basic or Translational Science 0 1 1 1 1 4 Emergency Medicine 2 1 0 1 0 4 Prehospital Care 0 1 1 1 1 4 Critical Care 0 2 1 0 0 3 Guidelines 0 0 1 0 1 2 Note. TBI = traumatic brain injury. Figure 2. Categories of abstract submission to the Pediatric Trauma Society. The most common categories in aggregate were Epidemiology, Abdominal or Thoracic Trauma, and Neurosurgery/TBI (Traumatic Brain Injury). In any given year, one of these three categories was the most common for accepted podium presentations. Publication Outcomes: There was a noticeable lag time between presentation and publication of 1.4 and 1.8 years (see Supplemental Digital Content Figure 1, available at: http://links.lww.com/JTN/A35). Thus, only accepted abstracts from 2014 to 2016 were analyzed for publication metrics. During that time, 193 abstracts were presented at the podium. Among these abstracts, 107 have been published as full papers (55.4%). Among the 74 posters presented, 18 were published (24.3%). Overall, 46.8% of presented abstracts from 2014 to 2016 were published as manuscripts in peer-reviewed journals. The Joseph J. Tepas Best Presentation Awards (established in 2016) recognize the best presentations at the annual PTS meeting by a physician and a nonphysician. Dr. Joseph Tepas has been memorialized as a model pediatric surgeon and researcher who built a pediatric surgery residency program dedicated to the expert care of injured and sick children. The publication outcomes associated with winners of the Tepas award are variable. For 2016, the abstracts presented by both Tepas award winners have been published as manuscripts, one in the Journal of Trauma and Acute Care Surgery (JTACS) and one in the Journal of Pediatrics. However, neither of the Tepas award-winning abstracts from 2017 has resulted in a published manuscript as of this manuscript's preparation. Publication Metrics: Published manuscripts presented on the podium had a median journal impact factor of 2.1 compared with a median impact factor of 2.0 for published manuscripts presented as a poster. The range of impact factors varied from 0.11 to 10.25 (see Supplemental Digital Content Figure 2, available at: http://links.lww.com/JTN/A36). The official journal for PTS is JTACS. A minority (28%) of accepted abstracts were published in JTACS, and the remainder (69.2%) were published in journals other than JTACS. Four (3.7%) were published in nonindexed journals. Among the 18 poster presentations, only one manuscript was published in JTACS. The remaining abstracts were published in non-JTACS (72.2%) and four (22.2%) in nonindexed journals. Most papers were published in surgical journals, followed by pediatric and emergency medicine journals. Only one of the nursing abstracts was found to be published and that was in the Journal of Trauma Nursing (JTN). Figure 3 compares rates of abstract acceptance versus rate of publication by topical categories. Those topics that were commonly presented but uncommonly published included "Epidemiology," "Education & Injury Prevention," and "Neurosurgery or TBI." We also found that projects in which a nurse or advanced practice provider was the first author were more often process or quality improvement projects and were less likely to result in publication. This could be because surgeons must publish to advance in their careers and gain professorship and other promotions, whereas nurses may not follow an academic career path. In addition, process and quality improvement projects can be difficult to publish unless they can demonstrate sustainability over time. Figure 3. Plot of abstract categories as the percentage of overall submissions versus the percentage published. TBI = traumatic brain injury. DISCUSSION: This study analyzed the scholarly output of the PTS over its first 5 years. We found that the number of abstracts submitted to the annual meeting has grown over the years and that slightly more than half of abstracts presented as podium presentations are published. Approximately a quarter of those presented as posters are published. Podium presentations were more likely to result in publication than poster presentations. Most publications were found in low-impact factor journals and published outside of the society's official journal. We have demonstrated the relationship between acceptance and publication by topical areas. Abstracts from topics with low representation (such as trauma nursing and vascular trauma) and those commonly presented but uncommonly published (such as Epidemiology, Education & Injury Prevention) may be an area of opportunity for the PTS to focus and improve dissemination of results specifically. This type of analysis is relevant not only to the PTS but also to any professional society seeking to assess and improve its impact. To our knowledge, the PTS is the youngest society to undertake this type of bibliometric review, but other societies have undertaken reviews of their scholarly output (Greig et al., 2019). Our results show that fewer abstracts make it to publication from the PTS than older and more established pediatric surgical organizations, such as the American Academy of Pediatrics Section on Surgery (AAP-SoS) and the American Pediatric Surgical Association (APSA). Seventy-two percent of abstracts from the AAP-SoS annual meetings were published from 2009 to 2013, and 68% from the APSA meetings from the same period (Greig et al., 2019). Mentorship in the publication process and continued encouragement of nonsurgeon involvement in the society may address limitations in the number of peer-reviewed publications and improve the impact of the scientific content of the PTS annual meeting. The etiology for abstracts not progressing to peer-reviewed publications is multifactorial. One prior study found that abstracts may not become published because the author did not have enough time to write a manuscript or because a study was still ongoing (Sprague et al., 2003). A certain proportion of research may not even be submitted for publication if the study yielded negative results. The scientific community should encourage the presentation and publication of negative study results because of their potential clinical impact (Ivanov et al., 2017). Among the 491 presented abstracts in this series, only four were related to basic science. The focus on clinical research rather than basic science research is consistent with other pediatric surgical associations. A review of the abstracts submitted at the annual meetings for the AAP-SoS and APSA showed similar findings in the paucity of basic science submissions (Greig et al., 2019). The category with the highest number of abstracts presented at the PTS was "Epidemiology." This is not surprising, as identifying epidemiological data and trends is critical to preventing and treating pediatric trauma. To increase publication rates and to disseminate more clinically applicable research, the PTS has employed numerous strategies. In 2018, the PTS implemented a formal Publications Committee that reviews manuscripts in advance of submission to JTACS, the official journal of the PTS. The Publications Committee aims to improve acceptance rates by suggesting revisions and edits prior to submission. Authors competing for the Tepas Award are now required to submit a manuscript for publication to JTACS, which will likely result in a higher publication rate for the award-winning manuscripts. To address the low representation of nursing-led studies or low publication rates for nurse-authored studies, the PTS has formed a partnership with the Society of Trauma Nursing (STN). This partnership aims to increase the publication of nurse-led projects, including process and quality improvement. The STN-affiliated journal is JTN, which aims to disseminate generalizable quality improvement initiatives (traumanurses.org/resources/stn-journal). Because these efforts are relatively new, it is too soon to determine the impact on publication metrics for the annual meeting. In addition, we have identified topical areas commonly presented at the meeting but infrequently result in publications. Ongoing efforts should focus on the dissemination of results from this group of abstracts. LIMITATIONS: This study has several limitations. Despite extensive searching, we may not have identified all published manuscripts, particularly in nonindexed journals. We also may have missed publications specifically found in other research databases, such as Scopus or EMBASE. In addition, we did not analyze the publication metrics for studies presented at the 2018 annual meeting because of the lag time between presentation and publication. The use of the journal impact factor as a quality metric may be misleading. Journal impact factors can represent the importance and visibility of a journal in a particular discipline but are subject to variability (Paulus, Cruz, & Krach, 2018) and do not necessarily indicate manuscript quality. Finally, we have used bibliometrics to describe and understand the impact of the scholarly works presented at the annual meeting. The true impact would be measured by improvements in patient care resulting from disseminating this work but is not readily quantifiable. This study identified the volume of presentations that progressed to publications but did not specifically identify barriers; future research should delve deeper into this, possibly by follow-up surveys with abstract presenters. CONCLUSION: The PTS is a relatively new society and has made tremendous strides in its first 5 years related to the publication of the scientific meeting content. Although the number of abstracts submitted to the annual meeting is increasing, a large percentage of the scholarly effort of PTS members presented at the annual meetings remains unpublished. The published work is mainly in surgical and low-impact factor journals. Focused efforts to increase publication of presented abstracts, including implementing a Publications Committee, requiring abstracts desiring to be considered for awards to submit a manuscript, and partnering with the STN, are in place. Efforts to identify pediatric trauma research barriers are needed to advance patient care and improve outcomes for vulnerable and injured children. Ongoing evaluation of the scholarly body of work presented at PTS annual meetings will be useful in developing society and its members. KEY POINTS: Much scholarly work remains unpublished. The PTS has partnered with the STN to increase publication of nursing-led studies. Periodic evaluation of the scholarly body of work is useful in the development of a society and its members. Identify strategies to increase publication and dissemination of scholarly work to a wider audience to improve the care of the pediatric population. Acknowledgments: The authors thank Katie Leavitt, Senior Administrator for the PTS, and Brittany Fiore, Meeting Manager for the PTS, for their assistance in gathering records for this project. REFERENCES: American College of Surgeons. (2019). VRC Standards FAQs (Vol. 2019). Retrieved from https://www.facs.org/quality-programs/trauma/tqp/center-programs/vrc/faq/standards Desai N. Veras L. V. Gosain A. (2018). Using bibliometrics to analyze the state of academic productivity in US pediatric surgery training programs. Journal of Pediatric Surgery , 53 (6), 1098 – 1104. doi:10.1016/j.jpedsurg.2018.02.063 Greig C. J. Zhang L. Armenia S. J. Park C. J. Fischer A. C. Caty M. G. Cowles R. A. (2019). The impact of pediatric surgical specialty meetings: A 5-year analysis of presented abstracts. Journal of Surgical Research , 238 , 16 – 22. doi:10.1016/j.jss.2018.11.034 Ivanov A. Kaczkowska B. A. Khan S. A. Ho J. Tavakol M. Prasad A. Heitner J. F. (2017). Review and analysis of publication trends over three decades in three high impact medicine journals. PLoS One , 12 (1), e0170056. doi:10.1371/journal.pone.0170056 National Research Council (U.S.). Committee on Responsibilities of Authorship in the Biological Sciences. (2003). Sharing publication-related data and materials: responsibilities of authorship in the life sciences. Washington, DC : National Academies Press. Paulus F. M. Cruz N. Krach S. (2018). The impact factor fallacy. Frontiers in Psychology , 9 , 1487. doi:10.3389/fpsyg.2018.01487 Pediatric Trauma Society (PTS). (2011). Home page. Retrieved from https://pediatrictraumasociety.org Sprague S. Bhandari M. Devereaux P. J. Swiontkowski M. F. Tornetta P. 3rd. Cook D. J. Guyatt G. H. (2003). Barriers to full-text publication following presentation of abstracts at annual orthopaedic meetings. The Journal of Bone and Joint Surgery , 85 (1): 158 – 163. doi:10.2106/00004623-200301000-00024 [ABSTRACT FROM AUTHOR]

Surgery is a highly competitive specialty that offers a wide range of subspecialties. The presence of surgical education and rotations in the medical school curriculum is often lacking, and for this reason many medical students have little experience of surgery during their time in medical school. This paper presents twelve tips for medical students who are interested in pursuing a career in surgery, offering different ways of exposure into activities related to surgical care. Understanding the practice of surgery and self-reflecting on one's personality and suitability for a career in surgery are key. Moreover, surgical care is not only limited to the surgeon's table–other opportunities to learn more about surgery exist outside of the operating room. Extra-curricular activities in research and leadership are also vital in developing an interest in surgery and competitive edge in medical students. [ABSTRACT FROM AUTHOR]

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

Background:The Mental Health Act Commission (MHAC) is a body which monitors the care and treatment of patients compulsorily detained in hospital in England and Wales. It does this through listening to their views and by observing the conditions in which they are held; this direct exposure to the experience of service users contrasts with other models of quality assurance which rely mainly on secondary data. Aims: This paper reviews the work of the Commission, focusing on its visiting role and methodology. Methods: The paper is based on published and unpublished literature, drawing also on personal experience as a member of the MHAC. Results: It argues that textual data tend to be privileged over talk because of the need for evidence-based recommendations and that patients' views are for this reason relatively neglected in Commission reports. The paper highlights ambiguities in the role of the Commission and identifies two divergent goals, firstly protection of legal rights, secondly audit and inspection. Conclusions: The paper finds that it has been difficult for the MHAC to reconcile these goals. While it has successfully raised standards of compliance with the Mental Health Act, it has been less successful in tackling wider issues of quality of care. There is a risk that its user-centred approach may be lost as a result of changes in regulatory structures. [ABSTRACT FROM AUTHOR]

The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. Immediate antibiotic treatment is lifesaving for some patients, but a substantial fraction of patients initially diagnosed with sepsis have noninfectious conditions. Aggressive time-to-antibiotic targets risk promoting antibiotic overuse and antibiotic-associated harms for this subset of the population. An accurate understanding of the precise relationship between time-to-antibiotics and mortality for patients with possible sepsis is therefore critical to finding the best balance between assuring immediate antibiotics for those patients who truly need them versus allowing clinicians some time for rapid investigation to minimize the risk of overtreatment and antibiotic-associated harms for patients who are not infected. More than 30 papers have been published assessing the relationship between time-to-antibiotics and outcomes, almost all of which are observational cohort studies. Most report significant associations but all have important limitations. Key limitations include focusing just on the sickest subset of patients (only patients requiring intensive care and/or patients with septic shock), blending together mortality estimates from patients with very long intervals until antibiotics with patients with shorter intervals and reporting a single blended (and thus inflated) estimate for the average increase in mortality associated with each hour until antibiotics, and failure to control for large potential confounders including patients' presenting signs and symptoms and granular measures of comorbidities and severity of illness. In this study, we elaborate on these potential sources of bias and try to distill a better understanding of what the true relationship between time-to-antibiotics and mortality may be for patients with suspected sepsis or septic shock. [ABSTRACT FROM AUTHOR]

Background: Clinical pharmacy services started in 2009 at the National Center for Cancer Care and Research, Qatar. Clinical pharmacy services was established to provide comprehensive prescription of drug management and support, and consulting services to build clinically efficient and cost-effective pharmacy program. Aim: To determine perceptions and expectations of healthcare providers toward the clinical pharmacy services at the National Center for Cancer Care and Research. Methods: A cross-sectional survey of healthcare providers was conducted from January to May 2018. A self-administered electronic/paper survey containing four domains assessing healthcare providers' perceptions and expectations towards clinical pharmacy services, perceived barriers to clinical pharmacist role and suggested area for improvement was sent to 375 healthcare providers including physicians, operational pharmacists, nurses and dietitians. Results: The response rate was 112/375. Most of the healthcare providers (74%) perceived the increasing interest in clinical pharmacy services. Also, they expected (1) providing consultations regarding appropriate medication choices (82%); (2) providing information about medication availability and shortages (82%); (3) assisting in the prescribing of cost-effective drugs by providing pharmacogenomics information routinely (75%) and (4) Participating actively in research activities (74%). Overall, healthcare providers have a high level of trust in the clinical pharmacists' abilities (P < 0.01). Nurses were less appreciative (P < 0.002) of the positive role of clinical pharmacists in direct patient care as compared to both physicians and pharmacists (64.2%, 90% and 95.7%, respectively). Conclusion: This study revealed a positive attitude towards the role of clinical pharmacists by healthcare providers at National Center for Cancer Care and Research. However, there is an area of improvement by empowering with privilege and staffing, elevating the awareness and expansion in the ambulatory care settings. [ABSTRACT FROM AUTHOR]

Aim: Long-term invasively ventilated patients exhibit exceptional and resource-intensive healthcare needs. However, major knowledge gaps in Germany complicate appropriate approaches to best address these demands. This paper evaluates available information on the patient group and their healthcare needs from German data sources and derives implications for healthcare planning and regulation by national/federal self-governing bodies, political decision-makers, and specialized providers. Methods: Based on the concept of needs, we addressed the normative dimension typically characterized by epidemiological data. Based on existing German health system data resources, an explorative approach was utilized to identify and characterize available databases providing information on the patient group and/or their healthcare. Results: To date, no available database provides information on the healthcare needs of this patient group. As of the reporting year 2017, the diagnosis-related groups (DRG) statistics will provide hospital-specific data on home invasive ventilation interventions, but the data do not provide information on long-term care. Claims data may be a promising source for cross-sectoral evaluation of healthcare needs but feature methodological challenges. These results call for efforts to address limited data eligibility, adopt a broader understanding of healthcare needs, and identify actions needed to evidence informed and needs-oriented healthcare. Conclusion: Future approaches on needs-oriented specialized healthcare should close the existing knowledge gap based on reliable data. In addition to normative information, they should consider subjective dimensions on a life course perspective and quantitative and qualitative service performance characteristics across multiple sectors and professions. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Humour is a complex, dynamic phenomenon that mainly occurs in social situations between two or more people. Most humour research reviews rehearsed as opposed to spontaneous humour and rarely review the patients' perspective. Aim We explore patients' perspectives on the use of humour in health care. We discuss the asymmetrical and divergent humour use between patients and clinical nurse specialists and posit nurses' approaches to risk as a contributing factor. Design A constructivist grounded theory collated researcher-provoked (interviews, observation, field notes, pre-and post-interaction audio diaries) and non-researcher-provoked data (naturally occurring interactions) over 18 months. This paper is based upon four patient focus groups. A constant comparison approach to data collection and analyses was applied using interpretative and illustrative frameworks that balanced what was 'known' and 'unknown' about humour. Setting and participants Patients were recruited from four patient-peer groups. Three audio-taped ( n = 20) and one observed focus group interactions ( n = 12) were undertaken at the groups' regular meeting places. Results Patients hold a broad appreciation of humour and recognize it as being evident in subtle and nuanced forms. Patients wish health-care staff to initiate and reciprocate humour. Conclusion A chasm exists between what patients apparently want with regard to humour use in health-care interactions and what actually transpires. Initiating humour involves risk, and risk-taking requires a degree of self-esteem and confidence. Nurses are, arguably, risk-averse and have low self-esteem. Future research could review confidence and self-esteem markers with observed humour use in nurses and their interactions across a range of specialities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. Background: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. Design: Exploratory nonparticipant observational study. Methods: Three hundred and fifty‐one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper‐based observation grids between December 2013 and March 2014. Results: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One‐third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re‐entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double‐checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. Conclusions: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. Relevance to clinical practice: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds. [ABSTRACT FROM AUTHOR]

Purpose Since 1990, the Cleveland Clinic has trained physicians in team skills through various iterations of a program called Leading in Healthcare (LHC). In the present study, the authors utilize a case study approach to gain insight into the LHC curriculum, and more specifically, the team project. The purpose of this paper is to better understand the Cleveland Clinic’s position on the issue and its approach to education – specifically among physicians.Design/methodology/approach The authors utilized a case study approach with four key program architects.Findings The results of this exploratory research yielded three themes: There is a lack of formal physician education in teamwork, there is a growing trend of inter-disciplinary teams and the team project was an important component of teambuilding in LHC.Research limitations/implications A breakdown in team function adversely impacts patient care. While formal and informal participation in teams is imbedded in the role, physicians are rarely trained in leadership or teambuilding in their formal medical education – much of it is learned on the job in hidden curricula. In addition to the adverse effects of dysfunctional teams on patient care, the authors have explored another area that will be affected by a lack of education – the team experience at the administrative level. As more and more physicians take on leadership roles in healthcare, there is an additional need to build competencies around teams (e.g. team theory, cross-functional team participation and leading teams) from an administrative perspective.Originality/value This is one of only a few studies which have specifically examined the impact of a teamwork education for physicians. [ABSTRACT FROM AUTHOR]

Conflicts of interest ( COIs) are common in the practice of emergency medicine and may be present in the areas of clinical practice, relations with industry, expert witness testimony, medical education, research, and organizations. A COI occurs when there is dissonance between a primary interest and another interest. The concept of professionalism in medicine places the patient as the primary interest in any interaction with a physician. We contend that patient welfare is the ultimate interest in the entire enterprise of medicine. Recognition and management of potential, real, and perceived COIs is essential to the ethical practice of emergency medicine. This paper discusses how to recognize, address, and manage them. [ABSTRACT FROM AUTHOR]

Although the 'Greater Involvement of People Living with or Affected by HIV/AIDS' (GIPA) principle was first articulated over a decade ago (UNAIDS, 1999), relatively few studies have examined the extent to which it is being implemented. A study was undertaken in three areas of England to establish the types of user involvement mechanisms in place for HIV-positive people to influence service and policy development. Drawing on group discussions with 38 people living with HIV and six HIV professionals across the three geographical research sites, as well as interviews with eight professionals with expertise in this area, this paper illustrates variability in opportunities for involvement. Also identified are a range of (innovative) methods for facilitating HIV-positive people's greater participation in service planning and delivery, as well as some of the challenges encountered by people living with HIV and service providers when implementing GIPA. The paper concludes by identifying some specific strategies for improving user involvement in HIV service provision. [ABSTRACT FROM AUTHOR]

Widespread health service goals to improve consistency and safety in patient care have prompted considerable investment in the development of evidence-based clinical guidelines. Computerised decision support (CDS) systems have been proposed as a means to implement guidelines in practice. This paper discusses the general concept in oncology and presents an evaluation of a CDS system to support triple assessment (TA) in breast cancer care. Balanced-block crossover experiment and questionnaire study. One stop clinic for symptomatic breast patients. Twenty-four practising breast clinicians from United Kingdom National Health Service hospitals. A web-based CDS system. Clinicians made significantly more deviations from guideline recommendations without decision support (60 out of 120 errors without CDS; 16 out of 120 errors with CDS, P < 0.001). Ignoring minor deviations, 16 potentially critical errors arose in the no-decision-support arm of the trial compared with just one (P = 0.001) when decision support was available. Opinions of participating clinicians towards the CDS tool became more positive after they had used it (P < 0.025). The use of decision support capabilities in TA may yield significant measurable benefits for quality and safety of patient care. This is an important option for improving compliance with evidence-based practice guidelines. [ABSTRACT FROM AUTHOR]

Most health care intervention models for intimate partner violence (IPV) are crisis driven and targeted to survivors of injury following episodes of physical violence. Knowledge about anticipatory and preventive approaches with women who are at risk for abuse is scarce, limiting professionals' ability to respond fully and effectively to this problem. This paper describes a retrospective, practice-based research study of social work interventions in two hospital-based primary care practices. A total of 431 female patients completed a self-administered questionnaire developed for the early detection of IPV risk factors during routine health care visits. The study showed surprisingly high rates of multiple risk markers in an urban primary care population whose medical presentations ordinarily would not raise provider suspicion about abuse. Findings confirmed the willingness of primary care populations to freely partake in routine screening and support the value of early identification and intervention with populations at risk. Practice implications are discussed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to analyse the utilization of formal and informal home care among older patients with cancer (OCP) and to compare this with middle-aged patients with cancer (MCP) and older patients without cancer (ONC). Additionally, we examined predictors of transitions towards formal care one year after a cancer diagnosis.Methods: OCP and MCP had to be recruited within three months after a cancer diagnosis and have an estimated life expectancy over six months. ONC consisted of patients without known cancer, seen by the general practitioner. Formal and informal care were compared between the patient groups at baseline, i.e. shortly after a cancer diagnosis and changes in care were studied after one year.Results: A total of 844 patients were evaluable for formal care at baseline and 469 patients (56%) at follow-up. At baseline, about half of older adults and 18% of MCP used formal care, while about 85% of cancer patients and 57% ONC used informal care. Formal care increased for all groups after one year though not significantly in OCP. The amount of informal care only changed in MCP which decreased after one year. Cancer-related factors and changes in need factors predict a transition towards formal care after a cancer diagnosis.Conclusions: A cancer diagnosis has a different impact on the use of formal and informal care than ageing as such. The first year after a cancer diagnosis is an important time to follow-up on the patients' needs for home care. [ABSTRACT FROM AUTHOR]

Background: Sciatica has a substantial impact on patients, and is associated with high healthcare and societal costs. Although there is variation in the clinical management of sciatica, the current model of care usually involves an initial period of 'wait and see' for most patients, with simple measures of advice and analgesia, followed by conservative and/or more invasive interventions if symptoms fail to resolve. A model of care is needed that does not over-treat those with a good prognosis yet identifies patients who do need more intensive treatment to help with symptoms, and return to everyday function including work. The aim of the SCOPiC trial (SCiatica Outcomes in Primary Care) is to establish whether stratified care based on subgrouping using a combination of prognostic and clinical information, with matched care pathways, is more effective than non-stratified care, for improving time to symptom resolution in patients consulting with sciatica in primary care. We will also assess the impact of stratified care on service delivery and evaluate its cost-effectiveness compared to non-stratified care.Methods/design: Multicentre, pragmatic, parallel arm randomised trial, with internal pilot, cost-effectiveness analysis and embedded qualitative study. We will recruit 470 adult patients with sciatica from general practices in England and Wales, over 24 months. Patients will be randomised to stratified care or non-stratified care, and treated in physiotherapy and spinal specialist services, in participating NHS services. The primary outcome is time to first resolution of sciatica symptoms, measured on a 6-point ordered categorical scale, collected using text messaging. Secondary outcomes include physical function, pain intensity, quality of life, work loss, healthcare use and satisfaction with treatment, and will be collected using postal questionnaires at 4 and 12-month follow-up. Semi-structured qualitative interviews with a subsample of participants and clinicians will explore the acceptability of stratified care.Discussion: This paper presents the details of the rationale, design and processes of the SCOPiC trial. Results from this trial will contribute to the evidence base for management of patients with sciatica consulting in primary care.Trial Registration: ISRCTN75449581 , date: 20.11.2014. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is a common complication in the critically ill patients and associated with a substantial morbidity and mortality. Severe AKI may be associated with up to 60% hospital mortality. Over the years, renal replacement therapy (RRT) has emerged as the mainstay of the treatment for AKI. However, the exact timing of initiation of RRT for better patient outcome is still debatable with conflicting data from randomized controlled trials. Thus, a systematic review and meta-analysis was performed to assess the impact of "early" versus "late" initiation of RRT.Methods: All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched from 1970 to October 2016. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the effect of "early/prophylactic" RRT versus "late/as and when required" RRT were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing early initiation of RRT or prophylactic RRT with late or as and when required RRT were included. The primary outcome measures were all cause mortality and dialysis dependence on day 90. The secondary outcome measures were: length of ICU stay, length of hospital stay, recovery of renal function and adverse events.Results: Of the 547 citation retrieved, full text of 44 articles was assessed for eligibility. Of these a total of 10 RCTs with 1,636 participants were included. All the trials were open label; six trials have unclear or high risk of bias for allocation concealment while four trials have low risk of bias for allocation concealment. There was a variable definition of early versus late in different studies. Thus, the definition of early or late was taken according to individual study definition. Compared to late RRT, there was no significant benefit of early RRT on day 30 mortality [6 studies; 1301 participants; RR, 0.92;95% CI: 0.76, 1.12); day 60 mortality [3 trials;1075 participants; RR, 0.94; 95% CI: 0.78, 1.14)]; day 90 mortality [3 trials; 555 participants; RR,0.94;95% CI: 0.67, 1.33)]; overall ICU or hospital mortality; dialysis dependence on day 90 [3 trials; (RR, 1.06; 95% CI:0.53, 2.12)]. There was no significant difference between length of ICU or hospital stay or recovery of renal functions. A subgroup analysis based on modality of RRT or mixed medical and surgical vs. surgical or based on severity of illness showed no difference in outcome measure. The trials with high or unclear risk of bias for allocation concealment showed benefit of early RRT (RR, 0.74; 95% CI: 0.59, 0.91) while the trials with low risk of bias for allocation concealment showed no difference in the mortality (RR, 1.02; 95% CI: 0.89, 1.17). Grade evidence generated for most of the outcomes was "low quality".Conclusion: This updated meta-analysis showed no added benefit of early initiation of RRT for patients with AKI. The grade evidence generated was of "low quality" and there was a high heterogeneity in the included trials.Prospero Registration Number: CRD42016043092 . [ABSTRACT FROM AUTHOR]

Although second opinion is a not a new terminology and medical fraternity mostly uses because it provide better services to their patients. Million dollar question, what is the acceptability of this term in Indian context. Is our hospital really serious for second opinion? No doubt these are a good practice and save patients life who suffering with severe ailments. Getting a second opinion from a different doctor might give a fresh perspective and new information. It may also provide you with new options for treating your condition. Today patients understand the importance of managing their health and an organization would like to promote good health through holistic approach. Medical second opinion was created with a vision to providing outstanding patient care based upon the principles of compassion, care and innovation. This paper will cover the role of second opinion and here it is a pure conclusive study where primary data will use. Apart from that there will be qualitative as well as quantitative method of data analysis will use for this research. [ABSTRACT FROM AUTHOR]

The Association of Academic Physiatrists, the home of academic physiatry, is interested in advancing industry partnerships in research among academic physiatrists. There are limited existing resources that outline opportunities for academic physiatrists in engaging the translational research continuum through industry partnerships and the skill sets that academic physiatrists need to successfully navigate these partnerships. In 2019, then President of the Association of Academic Physiatrists, John Chae, MD, ME, assembled a group of interested physician-scientists in physical medicine and rehabilitation to form the Research and Industry Partnerships Task Force to address this problem. The Task Force implemented a live educational session titled "Collaborating with industry" at Physiatry '19, the Annual Meeting of the Association of Academic Physiatrists held in Puerto Rco. To extend the reach of this valuable information, the Task Force is creating resources that can be easily distributed and accessed by all physiatrists. The goal of this white paper is to provide a roadmap to help academic physiatrists begin to navigate the field of academia-industry relationships with the ultimate goal of accelerating discovery for the benefit of physiatry and rehabilitation patients. [ABSTRACT FROM AUTHOR]

The proposition of this paper is principally that if the term 'reassurance' is used by nurses its meaning should be clearly stated and the methods by which it may be achieved should be clearly identified. The author begins by attempting to identify a workable definition of the term and by arguing a case for taking the approach that it is a nursing interpersonal skill rather than a nursing psychotherapy. Using this as the basis for the rest of the discussion he then suggests that as an interpersonal skill it is open to analysis and behaviours can be identified which help to achieve a restoration of the patient's confidence. Further to this, learning objectives are stated in the hope that the concept of reassurance can be seen as a skill which can be enhanced by educational processes. Full competence in the use of interpersonal skills is not a stable feature in all human beings; in every individual nurse there is scope for the development and training of interpersonal skills. Finally, the author attempts to achieve the major aim of the paper--stating nursing actions which may be employed in order to achieve this reassurance of the patient. [ABSTRACT FROM AUTHOR]

Background The Medication Assessment Center is a faculty and student run patient care clinic located within the pharmacy school at the University of Saskatchewan (Canada). It was created as a novel experiential education site for pharmacy students and to provide clinical pharmacist services for complex patients who have trouble accessing services elsewhere. Objective To determine if the clinical services provided by faculty and students at the Medication Assessment Center are valuable to patients who are referred to the program. Setting The Medication Assessment Center, which is faculty and student run patient care clinic. Method Convergent mixed methods design comprised of a retrospective patient chart audit and a paper based patient experience survey. All patients who attended at least one appointment at the Medication Assessment Center between March 1, 2014 and July 31, 2015 were included in the chart audit. All new patients who were referred between April 1, 2015 and October 26, 2015 were included in the survey. Main outcome measures Recommendations made by the pharmacist and patient experience survey indicators. Results 173 patients were included in the chart audit, which found that patients were elderly (64.8 years), highly medically complex (13.8 medications and 6.5 diagnoses each), and had a large number of recommendations made by the pharmacist to adjust drug therapy (6.2 per patient). 121 questionnaires were mailed to patients with a response rate of 66.9 % (n = 81). The survey found high levels of support and satisfaction for the program, including more than half of patients (59.2 %) who reported that their health had improved as a result of the Medication Assessment Center. Conclusion The patient care and experiential education program offered by the Medication Assessment Center provides a valuable service to patients who are referred to the clinic. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to focus on the Integrated Care Transitions Project between the emergency department (ED) of a university hospital and primary health care (PHC) services in a large city in Southern Brazil was the focus of this study. Care transitions occurred through telephone contact for patients discharged from the ED to PHC. Design/methodology/approach – This descriptive, exploratory qualitative research collected data via semi-structured interviews (n=14) including interns of health disciplines, advisors for interns, nurses, and physicians from the ED and PHC Family Unit. A thematic analysis of the data were conducted. Findings – ED providers felt they gained increased knowledge of the care networks available for patients in the community. Connection between the providers in ED and PHC facilitated confidence in the services provided in the community and increased continuity of care for patients’ needs. The PHC providers recognized integration promoted communication and better care planning for patients discharged from ED. Integrated care made the work in the PHC easier and benefited the users. Research limitations/implications – The study evaluated a program available in one hospital. Generalizability may be limited as services in the ED were provided by professional residents and their advisors, not employees of the hospital. Practical implications – Shared information by different health services leads to better care for patients and greater job satisfaction for providers. Originality/value – Care transitions are not well-managed in health care; there is limited research focusing on care transitions from ED to community. For providers and patients, this program assisted in building capacity and networks for transitions in care. [ABSTRACT FROM AUTHOR]

Background: Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. This paper examines the effects of the ACE service on RACF residents' transfer to hospital using a controlled pre-post design.Methods: Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors.Results: Residents had a mean age of 86 years. ED presentations ranged between 16 and 211 visits/100 RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR = 1.17, p = 0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 min (p = 0.0575), and was 40 % less likely to be admitted to hospital, . The latter was highly significant (p = 0.0012).Conclusions: Transfers to ED and admission to hospital are common for residents of RACFs. This study has demonstrated that a complex multi-strategy intervention led by nursing staff can successfully reduce hospital admissions for older people living in Residential Aged Care Facilities. By defining goals of care prior to transfer to the ED, clinicians have the opportunity to better deliver care that patients require. Integrated care requires accountability from multiple stakeholders.Trial Registration: The Australian New Zealand Clinical Trials Registration number is ACTRN12616000588493 It was registered on 6(th) May 2016. [ABSTRACT FROM AUTHOR]

Background: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes.Objective: Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models.Data Sources: We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process.Results: From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors.Conclusions/implications: This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem Referência is the property of Escola Superior de Enfermagem de Coimbra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine ( SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications. [ABSTRACT FROM AUTHOR]

This paper reports on an empirical study in Sweden of how patient resources come into play in physiotherapy interventions. A qualitative analysis was conducted of five video-recorded first encounters between patients with non-specific low back pain (NSLBP) and physiotherapists in primary care, using Conservation of Resource Theory (COR) to identify and focus on how physiotherapists made use of patients' resources (objects, conditions, personal characteristics and energies). The findings reveal variations in how these resources are utilized during the intervention. Resources with implications for what happens in the examination room during the ongoing encounter and resources characterized by professional familiarity were both employed in the intervention. However, underutilized resources were featured in the broader lifeworld perspective of' lay people and of other professional frames. The findings raise questions about professional challenges that go beyond professional skills. This implies that professionals need to improve skills in understanding and integrating patient resources into interventions. [ABSTRACT FROM AUTHOR]

AimThis paper aims to explore and analyse mental healthcare staff's (MHCS) knowledge and experiences of diabetes care for persons with psychosis.BackgroundThere are a range of studies concerning the increased risk of type 2 diabetes mellitus among persons with psychosis, and the need for healthy lifestyle interventions to prevent the illness. MHCS are often trusted and have regular follow-ups with the patients, and their attitudes and actions often play an important role for the person's care behaviour. There is still little documentation of their experiences of diabetes care.MethodsA qualitative, explorative design was used, collecting data through semi-structured interviews with 12 MHCS working in psychosis outpatient care in Sweden. Data were analysed with qualitative content analysis.FindingsThree categories emerged and provide a deeper understanding of how staff were aware of the risks of type 2 diabetes among their patients and therefore performed lifestyle interventions to promote these. Nevertheless, they lacked knowledge of diabetes care and simultaneously felt a lack of training among diabetes nurses to adapt diabetes care to suit persons with cognitive dysfunctions. Patients who were overconfident in their ability to manage diabetes care reported to have experienced most difficulties. Cooperation among those involved in these persons’ health was considered necessary.ImplicationsDiabetes care for persons with psychosis could improve if knowledge of type 2 diabetes was increased among MHCS and training in how to adapt diabetes care to persons with cognitive dysfunctions was enlarged among diabetes nurses. A challenge for nurses is to see how the care of different illnesses and support given by the family and others affect the persons total life situation and health. Healthcare plans and cooperation among all those involved in these persons’ health is necessary for this. [ABSTRACT FROM PUBLISHER]

Aims: The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices. Major findings: Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power. Practice conclusion: Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection. [ABSTRACT FROM AUTHOR]

Background: Patient non-adherence to medicines represents a significant waste of health resource and lost opportunity for health gain. Medicine management services are a key health policy strategy to encourage patients to take medicines as they are prescribed. One such service is the English Medicines Use Review (MUR) which is an NHS-funded community pharmacy service involving a patient-pharmacist consultation aiming to improve patients' knowledge of medicines and their use. To date the evidence for MURs to improve patient health outcomes is equivocal and GPs are reported to be sceptical about the value of the service. This paper presents the patient's perspective of the MUR service and focuses on the importance of GP-pharmacist collaboration for patient care. Suggestions on how MURs may have value to GPs through the delivery of increased patient benefit are discussed. Method: A qualitative study involving ten weeks of ethnographic observations in two English community pharmacies. Observations were made of all pharmacy activities including patient-pharmacist MUR consultations. Subsequent interviews with these patients were conducted to explore their experience of the service. Interviews with the pharmacy staff were conducted after the period of observations. A thematic approach was used to analyse the data. Results: Fifty-four patients agreed to have their MUR observed of which thirty-four were interviewed. Seventeen pharmacy staff were also interviewed. Patients reported positive views about MURs. However, there was little evidence suggesting that pharmacists and GPs were working collaboratively or communicating outcomes resulting from MURs. MURs were conducted in isolation from other aspects of patient care. Patients considered GPs to have authority over medicines making a few wary that MURs had the potential to cause tensions between these professionals and possibly adversely affect their own relationship with their doctor. Conclusions: This study reveals the potential for effective GP-pharmacist collaboration to improve the capacity of the MUR service to support patient medicine taking. Closer collaboration between GPs and pharmacists could potentially improve patients' use of medicines and associated health care outcomes. The current lack of such collaboration constitutes a missed opportunity for pharmacists and GPs to work together with patients to improve effective prescribing and optimise patient use of medicines. [ABSTRACT FROM AUTHOR]

The Kidney Research and Education Initiative (KREI) was established to develop collaborative working for renal education and research between renal patients, carers, lecturers, researchers and practitioners at City University London.This article will describe the background to KREI and considers the motivation for its establishment in addition to outlining the achievements to date and plans for the future. Narratives from patient and carer members of the KREI are presented, in which KREI members reflect upon their experiences of being involved in the initiative. This paper addresses the benefits and challenges of patient and carer involvement and also outline the initiative's future plans. [ABSTRACT FROM AUTHOR]

The focus of this paper is the experiences and needs of family carers of people with end-stage dementia. The project involved in-depth, qualitative interviews with 15 carers. The major themes emerging from the accounts of participants’ experiences were: getting support; having to trust others with care; managing the loneliness of being a carer; witnessing a loved one fade away; anticipating and experiencing death; and re-establishing life after the funeral. Carers expressed a range of instrumental and psychosocial needs. The study has provided a more personal account of the caring experience than much of the related literature. It has emphasized the need of carers for genuine understanding and connection — from family and friends as well as healthcare staff. The study highlights the amount of support carers can provide to each other through support groups and associated friendships, and stresses the importance of healthcare staff acknowledging and respecting this capacity of carers. [ABSTRACT FROM PUBLISHER]

Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients' independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals' autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients' treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients' autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy. [ABSTRACT FROM AUTHOR]

Background: Vocational services offered to people with severe mental illness represent a cornerstone for their social integration. Differences in terminology and the adaptations or modifications in vocational services make it difficult for stakeholders to have a clear understanding of the goals and content of the vocational services offered to people with severe mental illness. Aims: To facilitate comparisons of vocational services worldwide; this paper describes the most common types of vocational services identified in the literature. Conclusion: An empirical investigation of the effectiveness of specific vocational services components is warranted in order to determine which types or combinations of services work best for which individuals with severe mental illness. [ABSTRACT FROM AUTHOR]

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires researchers to: • Understand the context – as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks – identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks – deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks – decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk – evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult – use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem – get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. [ABSTRACT FROM AUTHOR]

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed. [ABSTRACT FROM AUTHOR]

Evidence-based practice (EBP) has been heralded as the most appropriate way of ensuring that patients receive the most effective care possible. It does, however, have several limitations. It is also not enough just to locate and evaluate the evidence without implementing it. This paper discusses EBP and its limitations and potential barriers; it also suggests strategies for changing current practices to more evidence-based ones according to an accurate understanding of the concept of EBP. [ABSTRACT FROM AUTHOR]

Aims: Little is known about the extent to which quit attempts are planned ahead or initiated immediately following a sudden decision to quit. This is important because if most smokers quit abruptly, rather than plan ahead, this could impact heavily upon recommendations to health care professionals on the kind of smoking cessation advice they deliver to patients. This paper aims to address this gap in knowledge by examining detailed smoking histories taken from smoking and ex-smoking patients. Design: Face-to-face in depth semi-structured interviews. Participants: 146 smoking and ex-smoking patients within a family medicine practice were recruited by means of screening 700 consecutive patients (14 years of age and older) and inviting eligible patients to participate. To be eligible, patients had to have smoked a minimum of five cigarettes per day for at least six months in their lives and made at least one serious quit attempt that lasted at least 24 hours. There were no refusals. Ex-smokers (n = 67) were defined as those who had not smoked for six months. The remainder were classified as smokers (n = 79). Measurements: Participants were asked to describe, in their own words, their most recent quit attempt and whether they had planned the quit attempt in advance, what were the triggers, and how long they abstained. A quit attempt was defined as planned if smokers set a quit date at some future time point. An unplanned quit attempt was defined as a sudden decision not to smoke any more cigarettes including those that might be remaining in the current pack. Information was also collected on methods used to quit and reasons for quilting. Results: A majority (51.6%) of quit attempts were reported as being unplanned. The figure was higher for ex-smokers than for smokers (67.1 % v 36.7%, p « 0.001). Most quit attempts were unaided (64%) and made for reasons of health (64%). Conclusions: The finding that so many quit attempts are unprepared suggests that models of smoking cessation should place greater emphasis on the dynamic nature of motivation to quit. This is an area that requires further investigation. [ABSTRACT FROM AUTHOR]

General practices in the UK are increasingly hosting welfare advice services on their premises to address patients’ social and economic needs. In this paper, the authors present the outcomes of a service providing welfare advice across 30 general practices in inner-city Bradford. A retrospective study of all patients referred for advice during the initial 24 months of the project was conducted. The following information was collected: patient demographics, source of referrals, advice issues raised and income generated through benefit claims. The advice workers saw 2484 patients dealing with over 4000 welfare advice issues. Demand for the service varied widely across practices, reflecting practice list size and engagement with the service by practice staff. The main source of referrals was general practitioners (28%), and disability-related welfare benefits constituted the largest category of advice issues. Sixty-nine per cent of patients seen for advice were of south Asian ethnic origin. The advice workers raised£2 389 255 in welfare benefit claims for patients, primarily through disability-related benefits. Approximately one in four patients referred for advice benefited financially. It is concluded that the service is an excellent strategy by which primary care organisations address the social, economic and environmental influences on the health of their population. [ABSTRACT FROM AUTHOR]

The continued growth in the economic evaluation of healthcare over the past 25 years has led to a shortage of trained health economists globally, leading to a number of universities and/or national governments developing specialised health economics programmes to train more health economists. One of the common problems with many of these training programmes is that they only educate new health economists to the Masters level, and as such they are unable to cover the many skills needed by a successful health economist. Furthermore, government and industry interests have ensured that economic evaluation is a heavily regulated environment that gives little incentive to seek further education. These two related factors (under-education and over-regulation) have lead to a situation where economic evaluation methods may adversely limit innovation of therapeutics and devices in clinical areas that perform badly when evaluated on the cost per QALY scale. The good news, however, is that the tide is turning and theoretically sound adjustments (such as risk adjustments and stated preferences) to the current paradigm are now being considered. This, of cause, is just the tip of the iceberg with other important issues such as time preference and the endogeneity of preference remaining very much under-researched areas in health. This paper concludes that many of these real-world issues, such as patient preferences, can be avoided by using artificial objective functions such as cost per QALY, but this comes at the cost of irrelevance and the misallocation of resources. If we are to meet all of the future challenges in economic evaluation in healthcare then we must focus more on advanced education and far less on the regulation of health economists. [ABSTRACT FROM AUTHOR]

The prevalence of fluctuating demand is increasingly seen as a serious and ongoing issue facing the health services industry. Volume flexibility in a health care setting represents a means to improve service delivery and it allows organizations to leverage their scarce resources for optimal utilization in response to fluctuations in patient demand. This paper develops a research framework that describes four volume flexible strategies based on literature reviews and structured field interviews of health care administrators at a Carnegie I research and teaching hospital. This prescriptive framework and the propositions that are developed create a foundation to help guide future research on the important relationships between demand uncertainty, volume flexible strategies, and organizational performance. [ABSTRACT FROM AUTHOR]