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Background Hansen's disease is a chronic, infectious and transmissible disease that is considered a public health problem in Brazil. Hansen's disease is marked by stigma and prejudice, because it carries with it a strong negative social image, reinforced by policies of social isolation in the community. Methods A qualitative study was conducted in Ribeirão Preto, an inland city of the state of São Paulo, Brazil. Eleven patients under treatment for the disease were interviewed. The interviews were audio recorded and transcribed in full, then were analyzed through the stages of transcription, transposition and reconstitution, as informed by concepts proposed by Goffman. Results The results showed that the marks of stigma are still present in the twenty-first century and were presented in two axes: 'Stigma and work for the person affected by Hansen's disease' and 'The experience of stigma in the family'. The participants refer to fears of losing their jobs and of being ridiculed, which stops them talking about the disease. Regarding their families, the participants reported episodes of discrimination, the creation of family secrets and fear of relatives' reactions. Conclusions All these aspects interfere in the follow-up and treatment of patients and need to be considered and welcomed by health professionals. It is recommended that these aspects are addressed in the initial training and continuing education of health professionals. Contexte La maladie de Hansen est une maladie chronique, infectieuse et transmissible, considérée comme un problème de santé publique au Brésil. La maladie de Hansen est marquée par la stigmatisation et les préjugés, car elle véhicule une image sociale fortement négative, renforcée par des politiques d'isolement social au sein de la communauté. Méthodes Étude qualitative menée à Ribeirão Preto, une ville intérieure de l'État de São Paulo, au Brésil. Onze patients traités pour la maladie ont été interrogés. Les entretiens ont été enregistrés et transcrits intégralement, et ont été analysés en suivant les étapes de transcription, de transposition et de reconstitution, selon les concepts proposés par Goffman. Résultats Les résultats montrent que les marques de la stigmatisation sont toujours présentes au 21ème siècle et ont été présentées selon deux axes : 'La stigmatisation et le travail pour la personne affectée par la maladie de Hansen' et 'L'expérience de la stigmatisation dans la famille'. Les participants évoquent la peur de perdre leur emploi, la peur d'être ridiculisés, ce qui les pousse à ne pas parler de la maladie. En ce qui concerne les familles, les participants ont rapporté des épisodes de discrimination, la création de secrets de famille et la peur des réactions des proches. Conclusions Tous ces aspects interfèrent dans le suivi et le traitement des patients et doivent être pris en compte et accueillis par les professionnels de la santé. Il est recommandé que ces aspects soient abordés dans la formation initiale et la formation continue des professionnels de la santé. Antecedentes La enfermedad de Hansen es una enfermedad crónica, infecciosa y transmisible, considerada un problema de salud pública en Brasil. La enfermedad de Hansen está marcada por el estigma y el prejuicio, ya que conlleva una fuerte imagen social negativa, reforzada por políticas de aislamiento social en la comunidad. Métodos Estudio cualitativo realizado en Ribeirão Preto, una ciudad del interior del estado de São Paulo, Brasil. Se entrevistaron a once pacientes en tratamiento para la enfermedad. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas a través de etapas de transcripción, transposición y reconstitución, según los conceptos propuestos por Goffman. Resultados Los resultados muestran que las marcas del estigma siguen presentes en el siglo XXI y se presentaron en dos ejes: 'Estigma y trabajo para la persona afectada por la enfermedad de Hansen' y 'La experiencia del estigma en la familia'. Los participantes mencionan el miedo a perder sus trabajos, el temor a ser ridiculizados, lo que les impide comentar sobre la enfermedad. En cuanto a las familias, los participantes reportaron episodios de discriminación, la creación de secretos familiares y el miedo a las reacciones de los familiares. Conclusiones Todos estos aspectos interfieren en el seguimiento y tratamiento de los pacientes y deben ser considerados y acogidos por los profesionales sanitarios. Se recomienda abordar estos aspectos en la formación inicial y la educación continua de los profesionales sanitarios. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor disorders are common and associated with impaired sexual function in women. Aim: To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. Methods: A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Outcomes: Pelvic Organ Prolapse Incontinence Sexual Questionnaire–IUGA Revised. Results: Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1 year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1 year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1 year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = –0.36; 95% CI, –0.02 to –0.005), partner related (ß = –0.28; 95% CI, –0.01 to –0.002), condition specific (ß = –0.39; 95% CI, –0.002 to –0.009), global quality (ß = –0.23; 95% CI, –0.02 to –0.002), and condition impact (ß = –0.34; 95% CI, –0.02 to –0.006). Clinical Implications: Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. Strengths and Limitations: The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Conclusion: Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women. [ABSTRACT FROM AUTHOR]

Background Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation. Methods An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals' preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools. Results A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals' discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals. Conclusion There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making. [ABSTRACT FROM AUTHOR]

Background: Since the outbreak of COVID-19 disease, the environment, families, individuals, and their ways of living have been affected. Social distancing was one of the strategies for the prevention of SARS-CoV-2 infection. It led to limited social interactions for fear of contracting the infection, which ultimately affected relationships, among which is sexual health. Aim: To determine the risk of female sexual dysfunction and the effect of the COVID-19 pandemic on sexual function and activities among women of reproductive age in Ibadan, South-West Nigeria. Methods: This cross-sectional study of 218 reproductive-age women evaluated the sexual function before, during, and after the COVID-19 disease pandemic and lockdown. Pretested semistructured self-administered questionnaires with the Female Sexual Function Index (FSFI) were used for data collection. Information collected included sociodemographic and gynecologic characteristics and COVID-19 experiences, as well as sexual history and function before, during, and after the COVID-19 pandemic lockdown. The level of significance was set at P < .05. Outcomes: Respondents were aged 20 to 50 years (95%) with a mean ± SD age of 34.82 ± 8.52 years; the majority were married (75.58%); one-fifth (21.9%) tested positive for COVID-19 infection; and participants who tested positive for COVID-19 infections were mostly health care workers. Results: An absence of sexual activity was reported in 9.18% of participants during lockdown, 7.73% before lockdown, and 4.18% after lockdown. The risk of female sexual dysfunction was prevalent among participants, especially those who tested positive for COVID-19 infection. The prevalence was worse during the pandemic lockdown (53.57%) than before (48.39%) or after (51.61%), and a similar pattern was seen among those who tested negative. There was no statistically significant difference in risk of developing sexual dysfunction during the COVID-19 pandemic between those who tested positive and negative to COVID-19. The arousal and desire domains contributed the highest proportion of low FSFI scores. Clinical Implications: Nationwide lockdowns, which may be a method of control for pandemics, may result in psychosocial complications such as female sexual dysfunction. Strength and Limitations: Most respondents had tertiary education and were able to respond to self-administered questionnaires, yet the risk of recall bias remains a concern whereas the pandemic met the world unprepared and baseline FSFI prior the pandemic was not available for participants. There are no local validation studies for the FSFI in Nigeria, which could have aided interpretation of results. Conclusion: A low FSFI score is prevalent in Ibadan, South-West Nigeria, with a higher incidence reported during the COVID-19 pandemic lockdown. [ABSTRACT FROM AUTHOR]

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Background: To determine appropriate management for individual patients, GPs are supposed to use their knowledge of the patient's socio-economic circumstances.Objective: To analyse factors associated with GPs' knowledge of these circumstances.Methods: Observational survey of GPs who were internship supervisors in the Paris metropolitan area. Each of 52 volunteer GPs completed a self-administered questionnaire about their own characteristics and randomly selected 70 patients from their patient list. Their knowledge was analysed as the agreement between the patients' and GPs' responses to questions about the patients' socio-economic characteristics in questionnaires completed by both groups. The association between agreement and the GPs' characteristics was analysed with a multilevel model adjusted for age, sex and the duration of the GP-patient relationship.Results: Agreement varied according to the socio-economic characteristics considered (from 51% to 90%) and between GPs. Globally, the GPs overestimated their patients' socio-economic level. GP characteristics associated with better agreement were sex (female), long consultations, the use of paper records or an automatic reminder system and participation in continuing medical education and in meetings to discuss difficult cases.Conclusion: Knowledge of some patient characteristics, such as their complementary health insurance coverage or perceived financial situation, should be improved because their overestimation may lead to care that is too expensive and thus result in the patients' abandonment of the treatment. Besides determining ways to help GPs to organize their work more effectively, it is important to study methods to help doctors identify their patients' social-economic circumstances more accurately in daily practice. [ABSTRACT FROM AUTHOR]

Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality. [ABSTRACT FROM AUTHOR]

Clinical and research staff who work around magnetic resonance imaging (MRI) scanners are exposed to the static magnetic stray fields of these scanners. Although the past decade has seen strong developments in the assessment of occupational exposure to electromagnetic fields from MRI scanners, there is insufficient insight into the exposure variability that characterizes routine MRI work practice. However, this is an essential component of risk assessment and epidemiological studies. This paper describes the results of a measurement survey of shift-based personal exposure to static magnetic fields (SMF) (B) and motion-induced time-varying magnetic fields (dB/dt) among workers at 15 MRI facilities in the Netherlands. With the use of portable magnetic field dosimeters, >400 full-shift and partial shift exposure measurements were collected among various jobs involved in clinical and research MRI. Various full-shift exposure metrics for B and motion-induced dB/dt exposure were calculated from the measurements, including instantaneous peak exposure and time-weighted average (TWA) exposures. We found strong correlations between levels of static (B) and time-varying (dB/dt) exposure (r = 0.88–0.92) and between different metrics (i.e. peak exposure, TWA exposure) to express full-shift exposure (r = 0.69–0.78). On average, participants were exposed to MRI-related SMFs during only 3.7% of their work shift. Average and peak B and dB/dt exposure levels during the work inside the MRI scanner room were highest among technical staff, research staff, and radiographers. Average and peak B exposure levels were lowest among cleaners, while dB/dt levels were lowest among anaesthesiology staff. Although modest exposure variability between workplaces and occupations was observed, variation between individuals of the same occupation was substantial, especially among research staff. This relatively large variability between workers with the same job suggests that exposure classification based solely on job title may not be an optimal grouping strategy for epidemiological purposes. [ABSTRACT FROM AUTHOR]

Background: The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta‐analysis compares patient‐reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision. Methods: We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient‐reported outcomes for SCP recipients versus controls were eligible for the meta‐analysis. We performed random‐effects meta‐analyses using pooled standardized mean differences for each patient‐reported outcome. Results: Eight articles were eligible for the meta‐analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self‐reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self‐efficacy or at 12 months on anxiety, cancer‐specific distress, depression, or satisfaction with follow‐up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects. Conclusion: SCPs appear feasible but do not improve survivors' patient‐reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies. Implications for Practice: Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient‐reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective. This comprehensive systematic review evaluates the effect of survivorship care plans on cancer survivors and health care professionals. [ABSTRACT FROM AUTHOR]

Objective: To understand the domains of agreement and disagreement, related to person-centred care, between the patient and healthcare professional during a shared episode of care.Design: A systematic review following the PRISMA protocol searched PubMed (Medline), CINAHL, PsychInfo and Scopus using keywords for health professionals, patients and patient-centred care. A descriptive-interpretive method was used to identify domains described in the person-centred care framework.Setting: Research conducted in all healthcare settings (inpatient, outpatient, community) were included.Participants: Research which presented the contemporaneous perspectives of a health professional and the person they were providing services to were included.Intervention(s): Research regarding the delivery of any type of health service was included.Main Outcome Measure(s): The person-centred care framework which includes Structure, Process and Outcome as measures for implementing person-centred care was used to interpret and summarize the data.Results: After title and abstract screening against inclusion and exclusion criteria, 15 of 1,406 studies were critically appraised. High levels of contemporaneous agreement were identified for easily accessible, supportive and accommodating environments, where information sharing occurred. Contemporaneous agreement occurred most often between patients and healthcare professionals in the importance of sharing information across all geographical settings, with greatest disagreement of patient involvement in the European and American hospital environments.Conclusions: Greater understanding of the context of information sharing and drivers for management preferences may support shared decision-making and increase satisfaction. More information regarding contemporaneous experiences of healthcare episodes is required to further inform patient-centred care practices and optimize health outcomes. [ABSTRACT FROM AUTHOR]

Objective Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. Materials and Methods We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. Results A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. Conclusions Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis. [ABSTRACT FROM AUTHOR]

This paper establishes that there is a need to turn to virtue ethics in dealing with the COVID-19 pandemic. It argues that the virtue of solidarity can be a companion virtue to compassion for medical frontline workers and other individuals involved. Like compassion, the virtue of solidarity is a reminder that everyone is in this crisis together and that each is responsible for all. [ABSTRACT FROM AUTHOR]

Background Most patients with end-stage renal disease (ESRD) are managed with dialysis and less commonly kidney transplantation. However, not all are suitable for or desire either of these renal replacement therapies. Conservative management (CM) is an option. However, the selection of CM is often not easy for patients and clinicians. The aim of this systematic review is to identify the key factors that influence the selection of CM for ESRD. Methods Medline, Embase, PsychINFO, and CINAHL Plus were systematically searched from inception to 10 September 2021. Titles/abstracts and full texts were independently screened by two reviewers. Reference lists of included articles were searched. An update search via PubMed was conducted on 10 August 2023. A narrative synthesis of review findings was conducted. Results At the end of the screening process, 15 qualitative and 8 survey articles were selected. Reference checking yielded no additional relevant studies. Main themes were: (i) Patient-specific factors; (ii) Clinician-specific factors; (iii) Organisational factors; and (iv) National and international factors. Patient-specific factors were awareness and perceptions of CM and dialysis, beliefs about survival, preferred treatment outcomes and influence of family/caregivers and clinicians. Clinician-specific factors included perceptions of CM as 'non-intervention', perceptions of clinician role in the decision-making process, and confidence and ability to initiate sensitive treatment discussions. Relationships with and involvement of other healthcare professionals, time constraints, and limited clinical guidance were also important factors. Conclusions An improvement in the provision of education regarding CM for patients, caregivers, and clinicians is essential. Robust studies are required to generate crucial evidence for the development of stronger recommendations and guidance for clinicians. [ABSTRACT FROM AUTHOR]

Background The public health impact of neglected tropical diseases (NTDs) is quite substantial. The objective of this study was to assess the knowledge and response capability of health professionals regarding NTDs in Kaduna State, Nigeria. Methods A pre-tested questionnaire with a Cronbach's α coefficient of 0.716 was administered to 350 health professionals. The questionnaire assessed the knowledge, resource availability and capacity to handle NTD cases. Results Only 38 (12.6%) respondents were familiar with the World Health Organization's definition of NTDs. Although self-reported knowledge was highest for physicians (37 [82.2%]), there was no statistically significant knowledge disparity between cadres of health professionals. Only 12 (46.2%) practitioners in private health facilities reported adequate knowledge. The tier of practice was significantly associated with management of NTDs (χ2 = 10.545; df 2; p = 0.005). Only 24 (47.1%) medical laboratory scientists and 18 (40.0%) physicians had adequate clinical resources for management of NTDs. Nearly three-quarters (211 (70.1%)] of respondents had never been trained in the management of NTDs. More than half (177 [58.8%]) of facilities lacked pharmaceuticals or standard operating procedures for management of NTDs. Conclusions Self-reported knowledge of NTDs was suboptimal. Physical and clinical resources for the diagnosis and treatment of NTDs were inadequate. Targeted training, increased funding and provision of adequate resources are needed in order to ameliorate the situation. [ABSTRACT FROM AUTHOR]

Background People living with chronic kidney disease (CKD) need to be able to live well with their condition. The provision of psychosocial interventions (psychological, psychiatric and social care) and physical rehabilitation management is variable across England, as well as the rest of the UK. There is a need for clear recommendations for standards of psychosocial and physical rehabilitation care for people living with CKD, and guidance for the commissioning and measurement of these services. The National Health Service (NHS) England Renal Services Transformation Programme (RSTP) supported a programme of work and modified Delphi process to address the management of psychosocial and physical rehabilitation care as part of a larger body of work to formulate a comprehensive commissioning toolkit for renal care services across England. We sought to achieve expert consensus regarding the psychosocial and physical rehabilitation management of people living with CKD in England and the rest of the UK. Methods A Delphi consensus method was used to gather and refine expert opinions of senior members of the kidney multi-disciplinary team (MDT) and other key stakeholders in the UK. An agreement was sought on 16 statements reflecting aspects of psychosocial and physical rehabilitation management for people living with CKD. Results Twenty-six expert practitioners and other key stakeholders, including lived experience representatives, participated in the process. The consensus (>80% affirmative votes) amongst the respondents for all 16 statements was high. Nine recommendation statements were discussed and refined further to be included in the final iteration of the 'Systems' section of the NHS England RSTP commissioning toolkit. These priority recommendations reflect pragmatic solutions that can be implemented in renal care and include recommendations for a holistic wellbeing assessment for all people living with CKD who are approaching dialysis, or who are at listing for kidney transplantation, which includes the use of validated measurement tools to assess the need for further intervention in psychosocial and physical rehabilitation management. It is recommended that the scores from these measurement tools be included in the NHS England Renal Data Dashboard. There was also a recommendation for referral as appropriate to NHS Talking Therapies, psychology, counselling or psychotherapy, social work or liaison psychiatry for those with identified psychosocial needs. The use of digital resources was recommended to be used in addition to face-to-face care to provide physical rehabilitation, and all healthcare professionals should be educated to recognize psychosocial and physical rehabilitation needs and refer/sign-post people with CKD to appropriate services. Conclusion There was high consensus amongst senior members of the kidney MDT and other key stakeholders, including those with lived experience, in the UK on all aspects of the psychosocial and physical rehabilitation management of people living with CKD. The results of this process will be used by NHS England to inform the 'Systems' section of the commissioning toolkit and data dashboard and to inform the National Standards of Care for people living with CKD. [ABSTRACT FROM AUTHOR]

Objective This paper explores how medical regulatory bodies in nine European countries manage professional issues involving quality and patient safety, to build on limited existing information on procedures for regulating medical professionals in Europe. Design Twelve vignettes describing scenarios of concerns about standards of physicians were developed, covering clinical, criminal and administrative matters. Medical regulatory bodies in nine European countries were asked what action they would normally take in each situation. Their responses were related to their regulatory mandate. Results Responses varied greatly across participating countries. Regulators are always involved where patients are at risk or where a criminal offence is committed within the clinical setting. Non-criminal medical issues were generally handled by the employer, if any, at their discretion. Countries varied in the use of punitive measures, the extent to which they took an interest in issues arising outside professional activities, and whether they dealt with issues themselves or referred cases to another regulatory authority or took no action at all. Conclusions There is little consistency across Europe on the regulation of medical professionals. There is considerable diversity in the range of topics that regulatory bodies oversee, with almost all covering health care quality and safety and others encompassing issues related to reputation, respect and trust. These inconsistencies have significant implications for professional mobility, patient safety and quality of care. [ABSTRACT FROM AUTHOR]

Background The Government in England has recognized the importance of early intervention to promote positive child development and prevent maltreatment. In doing so, efforts have been made to increase the implementation of the Family Nurse Partnership (FNP) to target a greater number of families who require intensive secondary intervention. Methods This paper presents an argument that the FNP can be targeted more effectively to yield a greater return on investment. This is based on the re-analysis of data collected by the largest cohort study carried out into risk factors for child maltreatment in England. Results Currently, around 315 health visitors are estimated to be implementing this programme, projected to increase to around 585 health visitors in 2015. However, targeting the programme towards first-time, young vulnerable mothers with low socio-economic status means that around 1350 health visitors would be needed. Critically, targeting only this population is estimated to prevent only 10% of cases of child abuse and neglect. Conclusions By targeting risk factors which are less common in the general population but which are more prevalent amongst abusive families, fewer specialist health visitors would be needed to prevent a higher percentage of child maltreatment. [ABSTRACT FROM AUTHOR]

Background Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study. Methods An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism. Results Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students. Conclusions Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession. [ABSTRACT FROM PUBLISHER]

Shortages, geographic imbalances and poor performance of health workers pose major challenges for improving health service delivery in developing countries. In response, multilateral agencies have increasingly recognized the need to invest in human resources for health (HRH) to assist countries in achieving their health system goals. In this paper we analyse the HRH-related activities of three agencies: the Global Alliance for Vaccines and Immunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (the Global Fund); and the World Bank. First, we reviewed the type of HRH-related activities that are eligible for financing within each agency. Second, we reviewed the HRH-related activities that each agency is actually financing. Third, we reviewed the literature to understand the impact that GAVI, Global Fund and World Bank investments in HRH have had on the health workforce in developing countries. Our analysis found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. We also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period. Based on the analysis, we argue there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities. Existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for the three agencies to implement this improved co-ordination. [ABSTRACT FROM PUBLISHER]

Since becoming independent at the break-up of the Soviet Union in 1991, the countries of Central Asia have made profound changes to their health systems, affecting organization and governance, financing and delivery of care. The changes took place in a context of adversity, with major political transition, economic recession, and, in the case of Tajikistan, civil war, and with varying degrees of success. In this paper we review these experiences in this rarely studied part of the world to identify what has worked. This includes effective governance, the co-ordination of donor activities, linkage of health care restructuring to new economic instruments, and the importance of pilot projects as precursors to national implementation, as well as gathering support among both health workers and the public. [ABSTRACT FROM AUTHOR]

The interface between parents and child protection agencies has long been a cause of concern. This paper examines the challenge that the child protection system faces from the perspective of responsive regulation theory (Braithwaite, 2002). The analysis suggests that management of compliance, though rarely discussed in the literature, has a significant impact on investigations. An emphasis on assessment, especially formal risk assessment, places an emphasis on a particular type of compliance: ‘assessment compliance’. Research on the experiences of parents suggests that overemphasis on assessment compliance has a number of disadvantages: it risks alienating families, it focuses attention on a questionable indicator of parents' willingness to make changes, increases the degree of coercion used in interventions and disempowers families and their communities. It is argued that formalistic use of assessment undermines the effectiveness of investigations because managing compliance within assessment procedures comes to dominate the response of workers. More families could be successfully engaged if the principles of responsive regulation were applied to assessment within investigation processes. A family engagement pyramid, based on responsive regulation theory, is proposed as one way of achieving this. [ABSTRACT FROM PUBLISHER]

This paper explains how teachers in schools function as resources to buoy resilience in the face of human immunodeficiency virus/acquired immune deficiency syndrome-compounded adversities. We draw on participatory reflection and action data from a longitudinal study with teachers (n = 57, 5 males, 52 females) from six schools in three South African provinces. The study tracks the psychosocial support offered by teachers following their participation in the Supportive Teachers, Assets and Resilience project. Verbatim interview transcriptions were thematically analysed and three themes (as well as subthemes and categories) emerged: (i) Teachers use resources to promote resilience in schools [teachers use (a) systems and (b) neighbourhood health and social development services to identify and refer vulnerable cases]; (ii) Teachers form partnerships to promote resilience in schools [teacher partnerships include (a) children and families, (b) community volunteers and (c) community organizations, businesses and government] and (iii) School-based support is offered to vulnerable individuals [by means of (a) vegetable gardens, (b) emotional and health support and (c) capacity development opportunities]. We conclude that teachers can promote resilience in schools by establishing networks with service providers that function across systems to support vulnerable groups. We theorize that the core of systemic networks is relationships, that relationship-driven support networks mitigate the effects of cumulative risk and school-based networks can enable schools to function as resilience-promoting resources. [ABSTRACT FROM PUBLISHER]

There is significant public and professional interest in the non-accidental death of children where abuse and neglect are suspected of being contributory factors. Systems for reviewing these deaths have been developed in each of the four jurisdictions within the UK. The main aims are to ensure that individuals and professionals are held to account if practice falls below the expected standard, whilst also seeking to strengthen the systems for protecting children through reflecting on what lessons, if any, can be learnt from the death of a child through abuse or neglect. Recently, the benefit of such inquiries and the quality of serious case reviews have come under scrutiny. In this paper, the authors report the findings of a Delphi study that sought to explore how the process of conducting reviews following the death of a child could be improved through seeking the views of experienced professionals responsible for child protection in Northern Ireland. The authors conclude that the system does command professional support, but could be improved through greater attention to process issues and a stronger emphasis on translating learning into action. In common with research looking at other recent practice developments, there is a need to focus on process indicators as a means to ensuring that well intentioned policies are translated into workable and functioning practices. [ABSTRACT FROM PUBLISHER]

The UK Coalition Government's Big Society policy has highlighted the value of the contribution that local people can make to well-being in their own communities, and plans to increase the contribution of community groups and third sector organizations in delivering services. This paper attempts to unpick some of the challenges to delivering health improvement interventions within the Big Society framework, and offers suggestions to reduce risk and preserve the value of the unique contribution that local people can make. The challenges identified are: supporting and developing skills in social enterprise; demonstrating effectiveness to commissioners; supporting local enterprise while mindful of inequality; guarding against the third sector losing its dynamism; using volunteers to replace or complement existing services. We conclude that the drive to increase community sustainability through the involvement of individuals is laudable, and responds to potential flaws in the welfare state. In order to protect the most vulnerable, and ensure equity, any change will take time and resources. More efficient ways of meeting society's needs must be sought, but we recommend that a stepwise, supported and appropriately evaluated approach is essential, and equity of provision across communities and organizations must be a primary concern. [ABSTRACT FROM AUTHOR]

Objective Burnout is highly prevalent among clinicians but there is not much known about the association between burnout and quality of care. In this paper, burnout, perceived quality of care and medical errors among German clinicians in surgery are explored. Design Data were collected during 2008 by a cross-sectional, standardized mail survey. Participants and Setting A total of 1311 clinicians in surgery in 489 German hospitals. Measure(s) Burnout was measured by using the Copenhagen Burnout Inventory (CBI). The measurement of self-rated patient care was based on a 13 item instrument (Chirurgisches Qualitätssiegel) and two questions assessing the frequency of medical errors. Results About 48.7% of the clinicians meet the criteria for burnout according to the CBI. Moreover, in multivariate logistic regression analyses, burnout is significantly associated with perceived quality of care among male (odds ratios vary from 1.5 to 2.6) but not among female surgeons (odds ratios vary from 1.3 to 1.5). Conclusions The high prevalence of burnout in our study corresponds with former studies of burnout among physicians. Furthermore, the results of the study suggest a relationship between burnout and perceived quality of care among men. Thus, reducing burnout among surgeons could not only improve their health and well-being but also the quality of care. [ABSTRACT FROM AUTHOR]

Background Within the decentralization framework of Government, the Ministry of Health (MoH) Nepal initiated the decentralization of primary care services closer to citizens. This paper aims to examine and understand the effect of decentralization at the district health service from the perspectives of service users and providers. Methods Using non-probability purposive sampling, we conducted a series of in-depth interviews and focus group discussions in four primary health care institutions with service users, providers and other stakeholders. QSR(C)NVivo7 software was used to analyse and categorize the data under emerging themes. Results Decentralization was positively associated with increased service access and utilization and improved service delivery. The study also revealed areas of concern and possible improvement and identified the barriers to implementing these improvements. Problems described included three main areas: functions, functionaries and funding. Conclusion Both service users and providers convey a generally positive message about the health sector decentralization. The active involvement of service users, providers, policy-makers in the process of decentralization and clear national and local policy agendas may bring positive changes in district health services. [ABSTRACT FROM AUTHOR]

Interviewer effects can have a substantial impact on survey data and may be particularly operant in public health surveys, where respondents are likely to be queried about racial attitudes, sensitive behaviors and other topics prone to socially desirable responding. This paper defines interviewer effects, argues for the importance of measuring and controlling for interviewer effects in health surveys, provides advice about how to interpret research on interviewer effects and summarizes research to date on race, ethnicity and gender effects. Interviewer effects appear to be most likely to occur when survey items query attitudes about sociodemographic characteristics or respondents’ engagement in sensitive behaviors such as substance use. However, there is surprisingly little evidence to indicate whether sociodemographic interviewer–respondent matching improves survey response rates or data validity, and the use of a matched design introduces possible measurement bias across studies. Additional research is needed to elucidate many issues, including the influence of interviewers’ sociodemographic characteristics on health-related topics, the role of within-group interviewer variability on survey data and the simultaneous impact of multiple interviewer characteristics. The findings of such research would provide much-needed guidance to public health professionals on whether or not to match interviewers and respondents on key sociodemographic characteristics. [ABSTRACT FROM PUBLISHER]

Cancer patients with venous thromboembolism (VTE) pose particular management challenges since they have an increased risk of bleeding and recurrent thrombosis compared to the non-cancer population. Also, as the disease progresses so do the hazards of anticoagulation, and patients in the palliative stages of their cancer could be viewed as a separate disease group with respect to diagnosis and management. As the focus from curative treatment moves towards symptom control, physicians face several challenges in providing the most appropriate care. Palliative care patients have rarely been included in research on VTE and the supporting evidence needs to be extrapolated cautiously. Quality of life aspects of VIE and their management may be a more appropriate outcome measure in this stage of disease than radiological end points. This paper looks at the challenges facing professionals in the management of VTE in the advanced cancer patient. [ABSTRACT FROM AUTHOR]

Positivity rates were also higher in staff working in COVID-19-facing areas and among BAME staff. Unfortunately, HCW infection data disaggregated by occupational group are unavailable on a national level at the time of writing. Data recording disease severity and disease progression from onset among HCWs remain somewhat scarce. These data imply an increased risk of disease transmission due to occupational and workplace exposures, especially as PPE was introduced to care homes relatively late in the pandemic [3]. [Extracted from the article]

American physicians are increasingly concerned that they are losing professional control. Other analysts of medical power argue that physicians have too much power. This essay argues that current analyses are grounded in a structuralist reading of power. Deploying Michel Foucault's "care of the self" and rhetorician Raymie McKerrow's "critical rhetoric," this essay claims that medical power is better understood as a way that medical actors take on power through rhetoric rather than a force that has power over medical actors. Through a close reading of an essay by Senator Bill Frist, this paper argues that physicians experience a process of "subjection" wherein they are both agents of and objects of medical power as it is combined with state and corporate power in the American "war on terror." This alternative mode of analyzing medical power has implications for our collective understanding of its operations and the means by which we propose alternative enactments of medical power. [ABSTRACT FROM AUTHOR]

Background: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. Methods: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. Results: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. Conclusions: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers. [ABSTRACT FROM AUTHOR]

Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as 'Up to me' and 'Down to them') are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals. [ABSTRACT FROM AUTHOR]

Schools are important settings in which to promote children's and young people's physical and emotional health. An evaluation of the National Healthy School Standard in England showed that education and health professionals have implemented a range of projects and activities to improve pupils' health. Although these were generally well received by parents and pupils, they were not uncritical of them. Perceptions of the value of health-related work were influenced by the contextual characteristics of schools—whether primary or secondary, the quality of social relationships, the quality of teaching, and the extent of pupil and parental involvement in the life of the school. With local responsibilities for children's services in England being reorganized in response to the Green Paper, Every Child Matters: Next Steps, there are new opportunities to develop a coherent set of outcome measures that pay due regard to pupils' and parents' views, and which inform collaborative reviews of healthy school programmes, in particular, and local services, more generally. [ABSTRACT FROM AUTHOR]

Objective: The primary role of the patient bedside observation chart is to make clinicians aware of the deteriorating patient. Despite this, its performance has not been scrutinised. Many versions exist with different styles of data entry but the optimal format remains elusive. This paper hypothesised that chart design measurably influences function and that redesign and standardisation would improve the detection of physiological decline by clinical staff. Design: Objective evaluation of existing charts (n = 5), evidence based redesign, and re-evaluation of new chart. Selling: 250 bed district general hospital. Results: Design of existing observation charts had a significant effect on the ability of clinical staff to detect patient deterioration, with detection rates of parameters indicating physiological decline ranging from 0% to 100%. Graphical plots portrayed information better than written values for all parameters being measured except tachypnoea. No single existing chart was best for all variables. A new chart was designed, implemented with training in its use, and re-evaluated. The new chart also incorporated an early warning scoring system. There were significant improvements in the average detection rates of parameters poorly identified on existing charts: detection rates of tachypnoea and hypoxia increased by 41% (p<0.05) and 45% (p<0.05) respectively. There were also significant improvements in detection rates of tachycardia and fever by 29% (p<0.05) and 16% (p<0.05) respectively. Conclusion: Evidence based redesign of the patient bedside observation chart coupled with specific training in its use significantly improves the detection of patient physiological deterioration. [ABSTRACT FROM AUTHOR]

In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy- and decision-makers need to make within given resources limitations. After presenting an overview of the various methods for planning human resources for health, with their advantages and limitations, this paper proposes a methodological approach to estimating the requirements of human resources to achieve the goals set forth by the Millennium Declaration. The method builds on the service-target approach and functional job analysis. [ABSTRACT FROM AUTHOR]

Background Advising on ill-health retirement is an important role of most practising occupational physicians. In recent years, the eligibility criteria and process for gaining early retirement benefits have changed in many pension schemes in the UK.Aim To investigate the variation in rates of retirement due to ill-health in National Health Service (NHS) Trusts and Local Authorities and to update previously published guidance on ill-health retirement with specific reference to pension schemes with eligibility criteria that include permanence of incapacity due to ill-health.Methods Rates of retirement were calculated for 222 NHS Trusts and 132 Local Authorities with more than 1500 employees. Literature searches and consensus statements by the authors.Results Rates of retirement were widely distributed in the NHS Trusts and Local Authorities. The median rates of retirement were 2.11 (IQR 1.372.91)/1000 active members and 4.10 (IQR 3.016.10)/1000 employees, respectively (P<0.001). Difficulties in the doctorpatient relationship and in ascertaining the true functional ability of some patients were identified.Conclusion There continues to be marked variation in rates of early retirement due to ill-health within and between organizations that warrants further investigation. The general and specific guidance that appears as an appendix in Supplementary data to this paper should help occupational physicians to make equitable recommendations when assessing applications for early retirement benefits and fitness to work. [ABSTRACT FROM AUTHOR]

This paper reviews the research evidence on access to health care by ethnic minority populations, and discusses what might need to be done to improve access to services. Research on the process of care, and the quality of care received, is considered as well as studies examining uptake of services. Changes in legal context are increasing the pressure on healthcare organisations to examine and adapt their services to ensure equitable access. Examples presented include a new UK population cancer screening programme. The main challenges for clinicians, managers, and policy makers in ensuring equitable access are discussed. [ABSTRACT FROM AUTHOR]

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as well as the nature and limits of the authority they exercise over them. [ABSTRACT FROM AUTHOR]

This paper reports the results of a comparative case study that examines factors influencing changes in implementation of heart health promotion activities in Ontario public health units. The study compared two cases that experienced large changes in implementation from 1994 to 1996, but in opposite directions. Multiple data sources were used, with an emphasis on secondary analyses of quantitative surveys of health units and other community agencies, and in-depth interviews of public health staff, collected as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, changes in implementation were explained by examining changes in (1) organizational predisposition to undertake heart health promotion activities, (2) organizational practices to undertake these activities, (3) other internal organizational factors and (4) external system factors. Findings show that in communities with diverse characteristics, implementation change was most strongly influenced by an interplay of changes in internal features of public health agencies; notably, leadership, structure and staff skills. Findings support a social ecological approach to health promotion by demonstrating the importance of the institutional context in the implementation change process, the interaction of individual (skills) and organizational (structure) levels in explaining implementation change, and community context in shaping the change process. Findings also reinforce the value of strengthening capacity within public health agencies and suggest further research on the implementation change process, especially in different systems and over longer periods of time. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods. Methods. (i) Systematic review of published Internet-based surveys of health professionals focusing on criteria of external validity, specifically sample representativeness and response bias. (ii) Internet-based survey of GPs, exploring attitudes about using an Internet-based decision support system for the management of familial cancer. Results. The systematic review identified 17 Internet-based surveys of health professionals. Whilst most studies sampled from professional e-directories, some studies drew on unknown denominator populations by placing survey questionnaires on open web sites or electronic discussion groups. Twelve studies reported response rates, which ranged from nine to 94%. Sending follow-up reminders resulted in a substantial increase in response rates. In our own survey of GPs, a total of 268 GPs participated (adjusted response rate = 52.4%) after five e-mail reminders. A further 72 GPs responded to a brief telephone survey of non-respondents. Respondents to the Internet survey were more likely to be male and had significantly greater intentions to use Internet-based decision support than non-respondents. Conclusions. Internet-based surveys provide an attractive alternative to postal and telephone surveys of health professionals, but they raise important technical and methodological issues which should be carefully considered before widespread implementation. The major obstacle is external validity, and specifically how to obtain a representative sample and adequate response rate. Controlled access to a national list of NHSnet e-mail addresses of health professionals could provide a solution. [ABSTRACT FROM AUTHOR]

Role theory is utilized to detail a six-step process for developing balanced coping through role negotiation. As applied in this paper, the role theory framework provides health educators with a useful tool for helping employed parents cope with a child's chronic illness. The emphasis is on partnering with parents or primary care- givers to identify, understand and manage the multiple role demands of working parents with chronically ill children. Role theory suggests ways health educators can support balanced coping by educating families about the demands of a child's illness, and helping to reduce those demands, helping to increase family resources, supporting parents and facilitating role negotiation. The ultimate goal is the development of balanced coping strategies that (1) meet the medical and emotional needs of the ill child, (2) allow parents to maintain their physical and mental health, and (3) enable parents to meet the demands of their other roles (e.g. paid employment). [ABSTRACT FROM AUTHOR]

This paper examines whether an understanding of the concept of social capital and its local measurement can help to tackle inequalities in health within and across communities. The paper concludes that the concept of social capital offers a valuable opportunity to help public health professionals understand how to approach inequalities in health with a greater awareness of the social processes affecting the health of communities. The measurement of social capital has been problematic. However, new guidance from the Health Development Agency (HDA) provides a useful tool for developing social capital research. A greater understanding of whether, and how social capital relates to health will help to improve strategies to reduce health inequalities at the community level. Public health professionals contributing to community development strategies such as Neighbourhood Renewal Projects, Community Safety Partnerships, Health Action Zones and Health Improvement Programmes (HImPs) should encourage thought to be given about the role that an understanding of social capital could play in making these strategies more effective. Using the HDA measurement tool locally could be one way of doing this. [ABSTRACT FROM PUBLISHER]

This paper discusses the work of Raymond J. Donaldson, who served as Medical Officer of Health (MOH) on Teesside in the North-East of England, 1968-1974, and the professional strategy that he adopted during this period is characterized. It is shown that Donaldson effectively withdrew from areas where the local authority public health department and general practitioners offered the same services, and consciously sought the complete attachment of some grades of staff to general practice. This approach, which was based on the view that in the long term the local authority could not compete successfully with general practitioners, allowed him to develop other activities, notably in the area of action research. 'Progressive realism' will be suggested as a suitable description for Donaldson's professional strategy during his time in Teesside. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review the methods used to measure quality of stroke care. Relevant articles were searched for on Medline using the following key words: stroke, quality, outcome of care, process of care, structure of care. Articles that examined how to measure the quality of stroke care and that examined difficulties in the measurement of care outcomes, processes, and structures were selected. Selected articles were reviewed to summarise methods used to measure quality of stroke care and the primary outcome measures of the studies were extracted. Conclusions were drawn about the best ways to measure the quality of stroke care. Practical problems in using outcome measures to monitor quality of care include the consequences of case mix and difficulties in risk adjustment. Clinicians may use process measures to understand differences in outcome. Once a process of care has been linked to an outcome measure, this care process should be measured. The national sentinel audit for stroke is an audit tool used to examine the quality of the processes of stroke care. [ABSTRACT FROM AUTHOR]

Background: Surgical coaching programmes are a means of improving surgeon performance. Embedded audiovisual technology has the potential to further enhance participant benefit and scalability of coaching. The objective of this systematic review was to evaluate how audiovisual technology has augmented coaching in the acute-care hospital setting and to characterize its impact on outcomes. Methods: A systematic review was conducted, searching PubMed, Ovid MEDLINE, Embase, PsycInfo, and CINAHL databases using PRISMA. Eligible studies described a coaching programme that utilized audiovisual technology, involved at least one coach–coachee interaction, and included healthcare professionals from the acute-care hospital environment. The risk of bias 2 tool and grading of recommendations, assessment, development, and evaluations (GRADE) framework were used to evaluate studies. Synthesis without meta-analysis was performed, creating harvest plots of three coaching outcomes: technical skills, self-assessment/feedback, and non-technical skills. Results: Of 10 458 abstracts screened, 135 full texts were reviewed, and 21 studies identified for inclusion. Seventeen studies were conducted within surgical specialties and six classes of audiovisual technology were utilized. An overall positive direction of effect was demonstrated for studies measuring improvement of either technical skills or non-technical skills. Direction of effect for self-assessment/feedback was weakly positive. Conclusion: Audiovisual technology has been used successfully in coaching programmes within acute-care hospital settings to facilitate or assess coaching, with a positive impact on outcome measures. Future studies may address the additive benefits of video over in-person observation and enhance the certainty of evidence that coaching impacts on surgeon performance, surgeon well-being, and patient outcomes. Surgical coaching programmes have become a feasible means of improving surgeon performance. Embedding audiovisual technology into such programmes has the potential to further enhance participant benefit. This systematic review evaluates how audiovisual technology has been utilized within coaching programmes for healthcare professionals in acute-care hospital settings. [ABSTRACT FROM AUTHOR]