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Objective: The aim of this study was to compare the 30-day emergency department (ED) return rate between patients given a Take Home Medication pack (THM) versus a standard paper prescription (SPP) prior to discharge. Methods: This was an observational, prospective cohort study in an urban, university-affiliated, level I trauma center. Patients were identified through daily pharmacy reports. Consecutive adult patients discharged from the ED with either a THM or equivalent SPP were included. For each patient, baseline characteristics including age, gender, primary care provider (PCP), primary language, ethnicity, marital status, and insurance status were recorded from the electronic medical record (EMR). Review of the EMR was used to determine whether patients returned to the ED within 30 days and whether the return visit was for all-causes or for the same complaint targeted by the THM or SPP from the index visit. Similarly, visits to other providers in the health system within 30 days were recorded. Results: A total of 711 patients were included in the study, with 268 receiving a THM and 443 receiving a SPP. In comparison with the SPP group, the THM group was more likely to have an all-cause return (Relative Risk [RR] = 1.7, P < .01). Variables associated with increased odds of returning to the ED within 30 days included study group (adjusted Odds Ratio [aOR]: 1.7), male gender (aOR: 1.6), African American ethnicity (aOR: 3.0), public insurance (aOR: 3.3), and institutional financial assistance (aOR: 5.0). The difference between study groups for index visit complaint-specific returns was not significant. Conclusions: Patients receiving a THM demonstrated a higher all-cause return rate than patients receiving a SPP. A randomized study is needed evaluating the effect of THM on return ED visits. [ABSTRACT FROM AUTHOR]

Although the potential benefits of computer-based records have been identified in different areas of the healthcare environment, in many settings paper-based records and computer-based records are still used in parallel. In this article, emergency department (ED) staff perspectives about the use of paper- or computer-based records are presented. This was a qualitative study in which data were collected using in-depth semi-structured interviews with the ED staff. The interviews were transcribed verbatim and data were analysed using framework analysis. In total, 34 interviews were undertaken. The study identified a number of factors which might encourage or discourage the use of paper-based and computer-based records in the ED. Users also expressed their concerns and expectations. Although there is a tendency towards computerizing healthcare settings, user acceptance of technology should not be underestimated. To improve user acceptance, users' concerns should be investigated and addressed appropriately. [ABSTRACT FROM AUTHOR]

The article examines abstracts of papers submitted but not included in the program of the annual meeting of the American Public Health Association, Medical Care Section, 1962. Some of these are "Experiences and Activities at a Medical Computing Center," by L.D. Cady, M.A. Woodbury, and L.J. Tich and "An Internist's Experiences With Medical Care of Welfare Patients in Proprietary Nursing Homes," by Sidney M. Greenberg. The first abstract focuses on the center that is cooperating with investigators in the area of mathematical and theoretical analysis and statistical data handling and analysis, information coding, keypunching and storage of medical data for further study and retrieval. The second abstract contains observations of the medical, nursing, and administrative practices in four nursing homes as made by an internist responsible for the medical Scare of welfare patients in these homes. In evaluating these activities the recognition and meeting of the patient's total needs was utilized as the criterion of quality of performance.

MHCA mandates monthly reporting to the MHRBs of restraints imposed on the PwMI in the MHEs (Section 97). CB-MH services must be strengthened by effectively implementing DMHP and CB-MH services for ensuring the rights of PwMI to receive treatment in the least restrictive environment. Sir, The Mental Health Care Act, 2017,[1] was implemented in the country for ensuring the rights of persons with mental illness (PwMI).[2] Since its launch, it has been critiqued by the scientific community, highlighting its shortcomings and issues with implementation.[3]-[5] However, such critiques did not explicitly highlight the issues with the implementation of the MHCA in routine clinical discourse. [Extracted from the article]

The Functional Resonance Analysis Method (FRAM) is a novel healthcare research methodology that has increasingly been applied in the healthcare domain. The method has an ability to map and model everyday healthcare activities and their interdependencies, as well as, demonstrate how variability can emerge and impact system outcomes. To build a FRAM model, researchers gather data from key stakeholders, such as health care workers and patients and their families using qualitative data collection methods. An important consideration for researchers using the FRAM is how they will establish trustworthiness in their study findings given the data used to build and analyze a FRAM model can be subjective. In the spirit of advancing the quality of qualitative research, the aim of this paper is to provide practical guidance to researchers on how to employ quality enhancement criteria and strategies in their qualitative research efforts so that the resulting FRAM models and insights afforded by them are trustworthy. [ABSTRACT FROM AUTHOR]

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

The military in Latin America has been extensively involved in pandemic relief operations. This paper analyses the impact of militarization of pandemic relief operations on human rights. It argues that not all militarization is equally harmful to individuals in the region. When troops assume responsibilities regarding medical care and logistical support, human rights violations do not follow. When involved in policing the stay-at-home orders, the extent of human rights violations is explained by the level of operational autonomy the military has in public security operations. The more autonomous the military, more likely abuses are to occur. Additionally, military exposure to judicial prosecution for human rights offenses contributes to the explanation. After gathering original empirical evidence from 14 Latin American democracies on military presence in pandemic relief, we draw our inferences from process tracing on four comparative case studies of Argentina, Brazil, Chile, and El Salvador. [ABSTRACT FROM AUTHOR]

The Functional Resonance Analysis Method (FRAM) is a novel healthcare research methodology that has increasingly been applied in the healthcare domain. The method has an ability to map and model everyday healthcare activities and their interdependencies, as well as, demonstrate how variability can emerge and impact system outcomes. To build a FRAM model, researchers gather data from key stakeholders, such as health care workers and patients and their families using qualitative data collection methods. An important consideration for researchers using the FRAM is how they will establish trustworthiness in their study findings given the data used to build and analyze a FRAM model can be subjective. In the spirit of advancing the quality of qualitative research, the aim of this paper is to provide practical guidance to researchers on how to employ quality enhancement criteria and strategies in their qualitative research efforts so that the resulting FRAM models and insights afforded by them are trustworthy. [ABSTRACT FROM AUTHOR]

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

Objectives: Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS. Methods: A cross-sectional design was used. A sample of 237 16–18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites. Results: Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications. Conclusions: These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that inflammation is involved in the development of late onset Alzheimer's disease (LOAD). However, it is not clear whether inflammation is a cause or consequence, or both. The aim of this paper is to review the relationship between inflammation and LOAD. We also review the effect of anti-inflammation on the risk of LOAD to further elucidate the relationship between inflammation and LOAD. [ABSTRACT FROM AUTHOR]

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course. [ABSTRACT FROM AUTHOR]

A growing body of literature suggests combining organizational ethnography and case study design as a new methodology for investigating complex organizational phenomena in health care contexts. However, the arguments supporting the potential of organizational ethnographic case studies to improve the process and increase the impact of qualitative research in health care is currently underdeveloped. In this article, we aim to explore the methodological potentialities and limitations of combining organizational ethnography and case study to conduct in-depth empirical health care research. We conducted a scoping review, systematically investigating seven bibliographic databases to search, screen, and select empirical articles that employed organizational ethnographic case study to explore organizational phenomena in health care contexts. We screened 573 papers, then completed full-text review of 74 papers identified as relevant based on title and abstract. A total of 18 papers were retained for analysis. Data were extracted and synthesized using a two-phase descriptive and inductive thematic analysis. We then developed a methodological matrix that positions how the impact, contextualization, credibility, and depth of this combined methodology interact to increase the generative power of in-depth qualitative empirical research in health care. Our review reveals that organizational ethnographic case studies have their own distinct methodological identity in the wider domain of qualitative health care research. We argue that by accelerating the research process, enabling various sources of reflexivity, and spreading the depth and contextualization possibilities of empirical investigation of complex organizational phenomena, this combined methodology may stimulate greater academic dynamism and increase the impact of research. Organizational ethnographic case studies appear as a new in-depth qualitative methodology that both challenges and improves the conventional ways we study the lives of organizations and the experiences of actors within the interconnected realms of health care. [ABSTRACT FROM AUTHOR]

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course. [ABSTRACT FROM AUTHOR]

In today's online data-driven world, people constantly shed data and deposit digital footprints. When individuals access health services, governments and health providers collect and store large volumes of health information about people that can later be retrieved, linked and analysed for research purposes. This can lead to new discoveries in medicine and healthcare. In addition, when securely stored and de-identified, the privacy risks are minimal and manageable. In many jurisdictions, ethics committees routinely waive the requirement for researchers to obtain consent from data subjects before using and linking these datasets in an effort to balance respect for individuals with research efficiency. In this paper, I explore the ethical justification for using routinely collected health data for research without consent. I conclude that, not only is this morally justified but also that data subjects have a moral obligation to contribute their data to such research, which would obviate the need for ethics committees to consider consent waivers. In justifying this argument, I look to the duty of easy rescue, distributive justice and draw analogies with vaccination ethics. [ABSTRACT FROM AUTHOR]

The article looks at the various factors which should be considered for validation of results outcome given by the digital pathology systems for toxicological studies. It also highlights the advantages of digital pathology applications in health care and life sciences. The guidelines for validation of results outcome through digital pathology provided by the Digital Pathology Association have also been verified by the Society of Toxicologic Pathology.

In this paper, we describe the serious games, integrated into PROPHETIC which is an innovating personal healthcare service for a holistic remote management of Parkinson's disease (PD) patients. The main objective of the three developed serious games is to allow health professionals to remotely monitor and appraise the overall physical status of their patients. The significant benefits for the patients, making use of this platform, is the improvement of their engagement, empowerment and, consequently, the provision of education about their condition and its management. The design of the serious games was based on the clinical needs derived from the literature and their primary target is to assess and record specific physical capabilities of the patient. All the games scores and the recorded parameters are gathered and also presented to the clinicians, offering them a precise overview of the patient's motor status and the possibility to modify the therapeutic plan, if required. [ABSTRACT FROM AUTHOR]

Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts. [ABSTRACT FROM AUTHOR]

Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client's disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes. [ABSTRACT FROM AUTHOR]

Even before the word pandemic reentered the lexicon, pressures stemming from institutional and technological change challenged policymakers and provider organizations to rethink core features of the manner in which we deliver healthcare. This essay introduces a special issue devoted to the consequences of change on the healthcare sector's varied stakeholders. It does so in the context of our eventual, post-coronavirus reemergence and a renewed interest in remaking the healthcare system in light of its obvious deficiencies. Towards that end, we introduce the five papers composing this special issue, each of which informs the ways that change actually transpires in healthcare organizations and systems. [ABSTRACT FROM AUTHOR]

Background: The current nursing workforce needs to be skilled, confident, and competent to address the rapid change in Primary Health Care services, to align with the National Vision of Qatar. This is emphasized in the Primary Health Care Strategy 2018-2023. This strategy outlines the need of having a skilled nursing workforce to administer and educate the public about the importance of immunizations. Primary Health Care nurses emanate from several nationalities and hence possess various level of knowledge and background related to immunization administration. Design and methods: To assess Primary Health Care nurses' knowledge before and after the delivered immunization education program in Qatar. The study was part of a Sequential mixed method research study that aimed to assess the Primary Health Care nurses' knowledge, attitude, and practice of nurses before and after the conducted training program. A self-administered survey, specifically developed for the research project was loaded in Qualtrics and sent to participants of the immunization education program before and after training. Participants were trained in two cohorts from October to December, 2018 in Qatar. For the purposes of this paper, data about the immunization knowledge was statistically analyzed using the SPSS Software version 25 and Microsoft Excel. Results: Specific areas were identified as knowledge gaps among the participants of the two cohorts. Moreover, the developed education program showed overall improvement in the participants' knowledge. Conclusions: The study results have demonstrated that the delivered immunization education program significantly increases the participants' knowledge about immunization in certain areas of the primary healthcare clinics they work, including vaccine safety, efficiency, and contraindications in the delivery of vaccines to the public. [ABSTRACT FROM AUTHOR]

The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) is a comprehensive and highly adaptable framework that provides a universal language and shared health concepts to articulate human functioning across the lifespan and from individual to population health settings. It provides a global, biopsychosocial, and holistic structure for conceptualising the human experience of health and health service provision. Consequently, the ICF framework offers hope for a universal map for health service providers that bridges professional, cultural, economic, and geographical variations. While the use of the ICF is typically mandated by health professions accreditation bodies, integration of the ICF in medical and health professional education programmes has been slow. In addition, its potential for scaffolding interprofessional education for collaborative practice has not been maximised. In this Perspective paper, we draw on our extensive experience in developing curricula and teaching within a range of health professions programmes (medicine, occupational therapy, physiotherapy, and speech-language pathology) to provide advice on conceptual, theoretical, and practical dimensions of embedding the ICF framework within curricula to support interprofessional education and collaborative practice. [ABSTRACT FROM AUTHOR]

Even before the word pandemic reentered the lexicon, pressures stemming from institutional and technological change challenged policymakers and provider organizations to rethink core features of the manner in which we deliver healthcare. This essay introduces a special issue devoted to the consequences of change on the healthcare sector's varied stakeholders. It does so in the context of our eventual, post-coronavirus reemergence and a renewed interest in remaking the healthcare system in light of its obvious deficiencies. Towards that end, we introduce the five papers composing this special issue, each of which informs the ways that change actually transpires in healthcare organizations and systems. [ABSTRACT FROM AUTHOR]

As the demands and nature of caregiving work in the health-care sector become more varied and challenging, our research and theories need to match this evolving reality. This editorial introduces theories of caregiving work and then uses each of the four papers featured in the special issue to advance a more nuanced and social approach to theorizing and studying the emotional experience of caregiving work. The articles and editorial explore the implications of whole person organizational and social supports, (un)shared social location between caregivers and patients, the complexity and consequences of emotional experience, and novel measurement and analytic tools to study them. [ABSTRACT FROM AUTHOR]

The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) is a comprehensive and highly adaptable framework that provides a universal language and shared health concepts to articulate human functioning across the lifespan and from individual to population health settings. It provides a global, biopsychosocial, and holistic structure for conceptualising the human experience of health and health service provision. Consequently, the ICF framework offers hope for a universal map for health service providers that bridges professional, cultural, economic, and geographical variations. While the use of the ICF is typically mandated by health professions accreditation bodies, integration of the ICF in medical and health professional education programmes has been slow. In addition, its potential for scaffolding interprofessional education for collaborative practice has not been maximised. In this Perspective paper, we draw on our extensive experience in developing curricula and teaching within a range of health professions programmes (medicine, occupational therapy, physiotherapy, and speech-language pathology) to provide advice on conceptual, theoretical, and practical dimensions of embedding the ICF framework within curricula to support interprofessional education and collaborative practice. [ABSTRACT FROM AUTHOR]

Background. One of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e., all direct and indirect expenditure. Materials and methods. The study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households' maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern. Results. Results revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households to escape from suffering catastrophic burden due to maternity payments. Conclusions. It can be concluded that the JSY appeared to have achieved only a limited success in reducing the economic burden due to maternity. To reduce the catastrophic burden, policy makers should consider increasing the JSY reimbursement to cover not only antenatal and postnatal services but also non-medical expenditure due to maternity. The government should also take appropriate measures to curb non-medical or indirect expenditure in public health facilities. [ABSTRACT FROM AUTHOR]

Objective Attention to knowledge translation (KT) has increased in the health care field in an effort to improve uptake and implementation of potentially beneficial knowledge. We provide an overview of the current state of KT literature and discuss the relevance of KT for health care professionals working in mental health. Method: A systematic search was conducted using MEDLINE, PsycINFO, and CINAHL databases to identify review articles published in journals from 2007 to 2012. We selected articles on the basis of eligibility criteria and then added further articles deemed pertinent to the focus of our paper. Results: After removing duplicates, we scanned 214 review articles for relevance and, subsequently, we added 46 articles identified through hand searches of reference lists or from other sources. A total of 61 papers were retained for full review. Qualitative synthesis identified 5 main themes: defining KT and development of KT science; effective KT strategies; factors influencing the effectiveness of KT; KT frameworks and guides; and relevance of KT to health care providers. Conclusions: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental health care providers. Understanding of, and familiarity with, effective approaches to KT holds the potential to enhance providers' treatment approaches and to promote the use of new knowledge in practice to enhance outcomes. [ABSTRACT FROM AUTHOR]

Background The present study aimed to conduct a systematic review of self-administered shoulder-disability functional assessment questionnaires adapted to Spanish, analyzing the quality of the transcultural adaptation and the clinimetric properties of the new version. Methods A search of the main biomedical databases was conducted to locate Spanish shoulder function assessment scales. The authors reviewed the papers and considered whether the process of adaptation of the questionnaire had followed international recommendations, and whether its psychometric properties had been appropriately assessed. Results The search identified nine shoulder function assessment scales adapted to Spanish: Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Upper Limb Functional Index (ULFI), Simple Shoulder Test (SST), Shoulder Pain and Disability Index (SPADI), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), Western Ontario Rotator Cuff index (WORC), Western Ontario Shoulder Instability index (WOSI) and Wheelchair Users Shoulder Pain Index (WUSPI). The DASH was adapted on three occasions and the SPADI on two. The transcultural adaptation procedure was generally satisfactory, albeit somewhat less rigorous for the SDQ and WUSPI. Reliability was analyzed in all cases. Validity was not measured for one of the adaptations of the DASH, nor was it measured for the SDQ. Conclusions The transcultural adaptation was satisfactory and the psychometric properties analyzed were similar to both the original version and other versions adapted to other languages. [ABSTRACT FROM AUTHOR]

Reverse innovation, defined as the flow of ideas from low- to high-income settings, is gaining traction in healthcare. With an increasing focus on value, investing in low-cost but effective and innovative solutions can be of mutual benefit to both high- and low-income countries. Reverse innovation has a role in addressing maternal health challenges in high-income countries by harnessing these innovative solutions for vulnerable populations especially in rural and remote regions. In this paper, we present three examples of 'reverse innovation' for maternal health: a low-cost, easy-to-use blood pressure device (CRADLE), a diagnostic algorithm (mini PIERS) and accompanying mobile app (PIERS on the Move), and a novel method for mapping maternal outcomes (MOM). [ABSTRACT FROM AUTHOR]

There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. [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]

Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

P-wave dispersion is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different-surface ECG leads. It has been known that increased P-wave duration and P-wave dispersion reflect prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. Extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for atrial fibrillation in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. In this paper, we aimed to summarize the measurement methods, current use in different clinical situations, strengths and limitations of the of P-wave dispersion. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

This paper is concerned with the socio-medical organisation of psychiatric disorder. The main line of analysis demonstrates how different psychiatric ideologies produce different objects of professional focus arid, consequently, radically different forms of therapy and therapeutic environment. By way of empirical evidence, the paper examines in some detail three contrasting contexts in which psychiatric disorder has been described and organised. The first is represented in Freud and Breuer's Studies on Hysteria, the second in the case books of a turn of the century asylum, and the third in the activities and practices of a modem psychiatric ward. By drawing on these sources of data, it is argued that an understanding of large scale changes in the organisation of psychiatric health care (such as is evident, for example, in modem trends from hospital to community care), firmly depends upon a study of the inner structure of psychiatric ideologies. Furthermore, and as a corollary of this it is claimed that appeals to extra-psychiatric (economic) interests and/or scientific (pharmacological) advances as key factors for explaining processes or organisational change (especially the process of deinstitutionalisation), are essentially misleading. [ABSTRACT FROM AUTHOR]

The paper which follows takes the form of a dialogue between a sociological voice and an unidentified, questioning voice. The two voices explore some of the tasks involved in, and difficulties generated by, the attempt to apply social science to practical issues. The discussion focuses on the area of health economics and, particularly, on recent efforts to provide measures of the quality of life that can be used to solve administrative problems within the NHS. Beginning from close examination of a particular text, the sociological voice claims to reveal some of the background assumptions of health economics as a social practice and to identify some of the ways in which the production and application of economic knowledge are socially contingent. The sociological voice also contrasts the textual form of the present paper with the 'scientific' format normally employed by economists and most other applied social scientists. S/he may be read as asserting that the dialogic character of the present text is in some way more suited to a more collaborative use of social science expertise in the realm of practical action. [ABSTRACT FROM AUTHOR]

Drawing from theory on institutionalized organizational environments, this paper analyzes the actions of community-based service programs providing care for people with AIDS. The focus is on the interorganizational relations developed by the lead agencies in demonstration projects attempting to coordinate services in three communities. The paper identifies differential styles of organizational response to developmental and operational issues. These differences are related to the conceptual distinction between organizational responses to technical environments and those to normative, or "institutional," environmental features. Various factors are identified that appear to promote a higher degree of institutionalization in interorganizational relations. Coordination as a reform strategy is seen to have become, in itself, an institutionalized myth to which organizations must subscribe in order to gain legitimacy. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

This is a "state of the issue" paper about gender and physical health. It organizes the hypotheses proposed for male-female differences in physical health status, therapeutic health behaviors, and longevity and it summarizes empirical research, especially sociological research, on the topic over the past 10-15 years. Capsule summaries of sex differentials in health and of recent trends in health and morality are also presented for American (U.S.) men and women. The central theoretical viewpoint of this paper is that sex differences in health are principally the outcome of differential risks acquired from roles, stress, life styles, and preventive health practices. Psychosocial factors—how men and women perceive and evaluate symptoms, and their readiness and ability to take therapeutic actions—are important as well, but typically secondary to acquired risks. Other factors such as prior health care, biological risks, health reporting, and caretaker effects (for example, physician sex bias) have even smaller importance. We hypothesize that the relative weight of acquired risks and psychosocial factors varies for different types of health problems as follows: (1) Psychosocial factors have their greatest weight in responses to chronic, nonfatal, or low severity diseases and injuries and (2) gender differences are also greatest in responses to these; that is, men and women differ more in their perception, evaluation, and treatment of prolonged, mild conditions than of acute, life-threatening, or severe ones. The paper suggests some strategies for social science research on male-female health differences in the next decade or two. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various research papers published in the June 1961 issue of "Journal of Health and Human Behavior." One of the abstract discusses the relationship between and intrapsychic processes. Another abstract presents a study which attempts to ascertain, and account for, the presence of significant differences in knowledge of attitudes toward mental disease between a sample of high school boys and one from a boys' reformatory. The purpose of one of the papers on hospital-patient relationships is to clarify the precise nature of the relationship between mental hospitals and patients and to compare and contrast it with the relationship between medical hospitals and patients. Another paper on mental hospitals presents information about four types of "pathway" organizations which seek to assist in the transitional period between the discharge of a mental patient from a hospital and his re-entry into community life. The four general types considered are day hospitals, halfway houses, sheltered workshops, and ex-patient organizations.

In Italy, advance health care directives are a subject of considerable debate in both legal theory and practice. This debate focuses in particular not only on the appropriateness of approving ad hoc statutory regulations but also on the extent to which similar advance indications of a person's wishes are applicable under the existing legal system, albeit in the absence of a law regulating them. The authors of this paper consider, in particular, guidelines relating to the possible use of the mechanism of support administration (amministrazione di sostegno) (Law No. 6/2004) as a procedure to be used for the legal recognition of advance health care directives, particularly in the light of the legal provision for the possible designation in advance of a support administrator by a beneficiary in anticipation of an eventual situation of incapacity. This underlines how the concept of health does not only exist in the abstract, but must be measured in relation to the particular patient in the particular situation and how beneficence and respect for autonomy are both essential elements in the choices aimed at promoting the health and the wellbeing of its citizens. [ABSTRACT FROM AUTHOR]

Objective: As part of its ongoing effort to combat stigma against mental illness among healthcare providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes. Methods: Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program (n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients. Results: The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that Included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs. Conclusions: The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers. [ABSTRACT FROM AUTHOR]

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety. [ABSTRACT FROM AUTHOR]

The chronic medical conditions in the paediatric population pose a range of potential psychosocial challenges not only to the child, but also to the family members and health care providers. This paper comprehensively reviews the psychosocial issues of children infected with HIV and AIDS and offer some of the strategies to address the issues comprehensively by multidisciplinary team. [ABSTRACT FROM AUTHOR]

The state of the nation's health and healthcare disparities looms large and is currently at crisis proportions, so much so, that these issues have been advanced as a national priority. These disparities are known to disproportionately afflict minorities and disadvantaged groups who become predisposed to certain risks. However, in light of the ever increasing racial and ethnic diversity of the American population, the visible absence of underrepresented minorities (URMs) in the health professions needed to meet these growing needs continues to fuel these crises. The purpose of this paper is thus fourfold. First, to examine the reason (s) for the persistent shortage of underrepresented minorities in the health professions and the associated barriers they encounter in pursuing opportunities in these professions. Second, to determine the degree to which the shortage of URMs contributes to the current state of health and healthcare disparities among certain groups. Third, to identify nontraditional mechanisms like the military as a medium to help increase the number of URMs in the health professions pipeline. Finally, the authors discuss the role of cultural competence as an essential skill set in rendering quality healthcare to minority patients; the strengths and limitations of their findings; and the implications of these findings for future research. [ABSTRACT FROM AUTHOR]

Visual methods are accepted tools for qualitative research and are increasingly used in a wide range of disciplines, such as sociology, psychology, geography, and health care. A literature review was undertaken with the aims of understanding why visual methods are chosen for use in research, reviewing any evidence regarding outcomes arising from those choices, and reflecting on the role of visual methods in these outcomes. Searches conducted from 2000-2010 across multiple bibliographic databases yielded 109 research papers that cited reasons for their choice of visual method. These were reviewed using a method tailored to the review's purpose but also informed by a narrative synthesis approach. The reasons given were collated and analysed inductively, with two categories of reasons emerging: those principally related to enrichment of data collection or presentation and those concerning the relationship between participants and researchers. Support for these reasons is reviewed and the ethical implications regarding choice of method are discussed. This article concludes that support for the use of visual methods to enhance data richness is strong, but more research is needed to facilitate a better-informed choice of method. There is some support for using visual methods for purposes connected with relational aspects between researcher and participants, but the visual media's contribution derives mainly from the ability of images to facilitate and enrich communication thus enhancing the data. The enrichment of data and an approach to participants that is affirming and empowering are intricately connected in the attainment of relationship-focused outcomes. [ABSTRACT FROM AUTHOR]

The Coalition government’s plans for reform are meant to transform the NHS into a more privately run, competitive system, raising the question as to whether or not the NHS is likely to resemble the US capitalist healthcare industry. The US system will be examined for comparative purposes, followed by an analysis of how far earlier reforms under Conservative and New Labour governments have moved the NHS in that direction. The implications of the White Paper proposals are analysed to determine the degree to which the NHS is destined to become a commodity-producing industry. The tentative conclusion is that while secondary care will be similar in many ways to the US hospital industry, state funding remains a barrier to complete transformation, and what is likely to emerge is a hybrid system in which competition, consolidation, and pressure on the workforce all increase. [ABSTRACT FROM PUBLISHER]

In this paper one aspect of the transition that must be made by experienced clinicians who become involved in conducting qualitative health research is examined, specifically, the differences between clinical and research interviewing. A clinician who is skillful and comfortable carrying out a clinical interview may not initially apprehend the important differences between these categories and contexts of interviewing. This situation can lead to difficulties and diminished quality of data collection because the purpose, techniques and orientation of a qualitative research interview are distinct from those of the clinical interview. Appreciation of these differences between interview contexts and genres, and strategies for addressing challenges associated with these differences, can help clinician researchers to become successful qualitative interviewers. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative. Method: Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. A Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel. Results: Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration. Conclusions: Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery. [ABSTRACT FROM AUTHOR]