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Objectives: Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods: Qualitative data including interviews, observation and documents were collected in two health service 'transformation' programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results: Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures and programme objectives. The degree to which participants descriptively or substantively represented the wider public was limited; participants sought to 'speak for' this public but their views on what was 'acceptable' and likely to influence decision-making led them to constrain their contributions. Conclusions: Public involvement in two major service reconfiguration programmes in England was seen as important and functional, and could not be characterized as tokenistic. Yet involvement in these programmes fell short of normative ideals, and could inadvertently reduce, rather than enlarge, public influence on health service reconfiguration decisions. [ABSTRACT FROM AUTHOR]

In recent years, significant workload, high acuity, and complexity of emergency general surgery conditions have led hospitals to replace the traditional on-call model with dedicated acute care surgery (ACS) service models. A systematic search of Ovid, EMBASE, and MEDLINE was undertaken to examine the impact of ACS services on health-care delivery processes and cost, education, and provider satisfaction. From 1827 papers, reviewers identified 22 studies that met inclusion criteria and subsequently used The Evidence-Based Practice for Improving Quality method and Newcastle-Ottawa Scale to score quality and level of evidence. Most studies found an increase in daytime operating, improved patient transit from emergency department to operating room to home, and decreased length of stay. Higher and more diverse case volumes improved resident education and operative experience. ACS services enhanced the educational experience of residents on subspecialty services by offloading emergency work from those services. Finally, surgeons generally felt that ACS services improved job satisfaction, productivity, and billing. The ACS model has demonstrated improvement in timeliness of care, diversified case mix, decreased costs, improved trainee learning, and increased surgeon job satisfaction. [ABSTRACT FROM AUTHOR]

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes. [ABSTRACT FROM AUTHOR]

Background In common with other countries, Japan has an ageing population and geographical impediments to healthcare access. The role of telemedicine within the Japanese health system may be of wide interest, yet it has not been comprehensively explored and documented. Thus, the aim of this study was to systematically review the Japanese and English language literature relating to the clinical use of telemedicine in Japan. Methods For studies published in Japanese, we searched Ichushi and CiNii. For English language publications, we searched Cochrane Library, PubMed, Embase, and Web of Science. All peer-reviewed articles describing the clinical use of telemedicine and published between 2007 and 2016 were included. Data on clinical area, study type, technology used, and type of communication were extracted. Studies were categorised by prevention, screening, diagnosis, surveillance, and treatment. Results The search yielded 1476 records; 26 Japanese language and 15 English language articles were selected for review. A wide range of clinical areas were represented; however, home care and life-style related studies were dominant. More than 50% of studies were related to prevention and early diagnosis. The majority of Japanese studies involved doctor-to-doctor consultation. Smartphones and remote monitoring systems were the main types of technology used. Conclusions Most studies of telemedicine in Japan are published in the Japanese language and are thus relatively inaccessible to the rest of the world; for the first time, this study has provided an overview of the clinical use of telemedicine in Japan. The clinically related papers reflect the Japanese cultural focus on disease prevention. [ABSTRACT FROM AUTHOR]

Clinical pharmacy service delivery is currently a significant challenge in remote areas. Mount Isa Base Hospital provides clinical pharmacy support to ten remote sites across an area of over 300,000 square kilometres. These sites do not have on-site pharmacists available and, due to the vast distances and unpredictable travel conditions, the outreach pharmacist from Mount Isa Base Hospital only visits sporadically. Provision of direct patient care and advice on medication safety with this model was restricted and insufficient. Telepharmacy provides an opportunity for these services to be vastly expanded. In an attempt to increase pharmacist accessibility for remote hospital sites, the Mount Isa Base Hospital pharmacy department developed an inpatient telepharmacy service. Telehealth equipment is being used to communicate directly with patients and hospital staff, review inpatient medication charts, generate patient medication lists, identify and resolve clinical interventions and provide medication-related advice and counselling. As a result of this implementation, all patients and health professionals in remote north-west Queensland hospitals now have access to a pharmacist. The number of inpatient medication reviews, clinical interventions and patient-pharmacist/clinician-pharmacist interactions occurring at each remote hospital site has increased. Since service initiation, 106 medication-related reviews have been completed via telepharmacy, including 48 patient interactions, and 111 medication-related interventions have been made. This paper outlines the process for the development of an inpatient telepharmacy service for remote hospitals and discusses the benefits and limitations associated with implementation. [ABSTRACT FROM AUTHOR]

Scholars and practitioners share a significant concern about rising healthcare costs. Health literacy is widely presented as a solution to this momentous issue, paving the way for a more appropriate access to care and therefore, for cost savings. However, to date little is still known about the ultimate effects of better health literacy on healthcare costs. Drawing from the findings of a systematic literature review which ultimately involved 29 papers retrieved from Scopus-Elsevier and PubMed. This manuscript is aimed at shedding light on the relationship between health literacy and healthcare costs. The inadequate ability of patients to understand health information and to navigate the healthcare system was found to be an important predictor of inappropriateness in the access to health care. In addition, people living with problematic health literacy are discouraged to be engaged in the provision of health services and are expected to show poor self-efficacy in dealing with their health-related conditions. From this point of view, poor health literate patients are assumed to be at high risk of exacerbation of their health problems, which in turn contributes in rising healthcare costs. In spite of these findings, both policy makers and practitioners seem to overlook the importance of health literacy. Eventually, the joint intervention on laws, policies, organizational strategies, and practices is crucial to handle the challenges related to limited health literacy. [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]

This paper draws on data from a small-scale ethnographic study of the delivery of maternity care to South Asian descent women in a hospital in Southern England during 1988. Stereotyped views of these women which related to their customs and culture as well as their typification as patients were commonly expressed by staff, particularly midwives. The paper examines the role of medical records and record making in stereotyping Asian women: the ways in which stereotyped views of women may affect the record making process; and how that process itself may reinforce and create stereotypes. The utility of records for `rate production' purposes is also discussed. The focus of the paper is the creation of a woman's maternity records which occurs in the antenatal clinic. The transformation of stigmatised views of a client into `facts' about a client is common among bureaucrats, in this setting health service staff. This process affects the client's future encounters with the bureaucracy. In medical settings records (i.e. the case notes) help to create, transmit and reify negative stereotypes of health service users. These stereotypes can affect the kind of care given to individual patients. [ABSTRACT FROM AUTHOR]

This paper examines the logic of evaluation of health care services, calling into question the possibility of assessing the extent to which medicine and health care systems are 'rational' or 'irrational'. The paper analyses and rejects claims to rationality made in discourses on evaluation and in particular economic evaluation, by recourse to Weber's distinction between formal and substantive rationalities. The rationality claimed by evaluation is a value-laden and therefore substantive rationality. Similarly, the claims of the rational actor model are seen to over-simplify the ways actors interact in the market. [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]

Drug treatment in the United States has been fragmented, underfunded, less than comprehensive, and poorly planned and integrated. To bring about a significant improvement in the number of drug abusers who receive treatment and in the effectiveness of the treatment they receive, the current fragmented approach needs to be replaced with an integrated, coherent system of drug treatment. This paper discusses the characteristics of a drug treatment system and focuses on two elements of such a system: the use of the health care and criminal justice systems as locations to identify persons in need of drug treatment, and matching clients with appropriate services to improve treatment effectiveness. The paper also discusses several issues that will need to be addressed in developing a drug treatment system, offers examples at the federal, state, and local levels indicative of trends in the direction of a systems approach to drug treatment, and emphasizes the importance of federal leadership in systems development. [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 discusses American health care and health care reform. This paper explains the USA health care system. The complexities of US health care system and that of the UK system do not have the same solutions but the problems seem to have many similarities. In this paper, the problems of the American health care are presented and suggested reforms.

This paper is a descriptive report of transcultural nursing discoveries in China. The authors embarked on this study tour led by an experienced transcultural nurse educator which presented a challenging opportunity to discover Chinese culture, lifeways, and health care systems. The authors were challenged to learn about cultural differences and the importance for nurses to use transcultural nursing principles and the Culture Care Theory with research findings about diverse cultures. Leininger's (1991) Theory of Culture Care and Sunrise Model were the conceptual and theoretical guides used to discover the worldview, lifeways, and cultural values of the Chinese people. The Sunrise Model depicts the components of a culture which include worldview, cultural and environmental context, and seven social structure factors. Analysis of these dimensions of the Sunrise Model enabled the authors to discover the important values, beliefs, and lifeways of the Chinese people. Religious and philosophical, kinship and social, political and legal, and economic factors were most important for this culture. In addition culture care expressions, patterns, and practices for health and well being were highly valued by this culture. The Sunrise Model includes diverse health systems which offer generic, folk, and/or professional care. The Chinese culture includes a strong reliance on folk health care systems which persists today. This paper discusses the simultaneous use of folk and professional health care by the Chinese people and implications for transcultural nurses. [ABSTRACT FROM AUTHOR]

The pediatrician's job becomes frustrating when it is necessary to deal with difficult parents. Some physicians may not have the training or inclination to engage such parents in a therapeutic partnership. This paper discusses tools available to physicians which will help them develop an effective partnership that includes uncovering the hidden meaning behind a child's illness; understanding the reciprocal nature of partnerships; and the importance of determining each party's goals, roles, and expectations. Negotiating these steps enables physicians to develop a productive relationship with difficult parents of sick children. This strategy can facilitate the child's medical care and improve the parents' and physician's satisfaction with the services rendered. This paper also discusses steps to take when these attempts are not sufficient to handle the situation. [ABSTRACT FROM AUTHOR]

The National Health Service in Britain has recently undergone a major reorganization. It has moved away from being a planned system of health care delivery to a demand driven system organized on the principles of (quasi-) market competition and quality assurance. These changes are intended by government to `empower' the consumer (patient) with real choice and to incorporate the health professionals within a more effective and efficient system of hospital management. It is in this context that the paper examines the usefulness of `postmodernity' as an explanation for the emergence of new `flexible' organizational forms within the hospital service. The paper will concentrate on the ideological and organizational contradictions between state policy and local practice, especially in relation to issues of managerial vs professional autonomy and control. [ABSTRACT FROM AUTHOR]

Objective: To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system. Methods: Using prevalence data for psychiatric disorders and population projections, this paper presents the iikeiy changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery. Results: Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged. including many mentally iii, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being dosed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services: users will pay for services more directly. Conclusions: Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry. [ABSTRACT FROM AUTHOR]

An editorial is presented on a call for papers for a special issue of Clinical Nursing Research focusing on the intersection of social determinants of health (SDOH) and patient care strategies. It highlights the various domains of SDOH and their impact on health outcomes and disparities. The objective of the special issue is to raise awareness, provide strategies, and explore opportunities and challenges in incorporating SDOH considerations in clinical care.

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.

This is the second of two papers which involve a "triangulation" on medical performance in an effort to test the proposition that organizational stratification is related to hospital care. The triangulation consists of the measurement of performance from the subjective, reputational, and objective points of view. The present paper presents evidence based upon the objective medical records. The evidence is organized around a conception of the hospital as an institution performing seven key functions. Criterion measures related to these seven functions are examined, and it is shown that units which differ in their degree of stratification also differ in their performance with respect to a number of these criteria (e.g., the length of patient stay, and the use of the consultation process). Taken together, the two papers show that when performance is independently measured in three fundamental ways, there is a basic congruence which supports the proposition that the degree of stratification of organizational units is related to variations in task performance. [ABSTRACT FROM AUTHOR]

Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick’s return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants’ role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education. [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]

The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use of participatory design), followed by multidisciplinary assessment, including description of the patients and the application and assessment of safety, clinical effectiveness, patient perspectives, economic aspects organisational aspects and socio-cultural, legal and ethical aspects. Twenty-two studies met the inclusion criteria and were included in the review. In this article, research design and methods used in the multidisciplinary assessment are described, strengths and weaknesses are analysed, and recommendations for future research are presented. [ABSTRACT FROM AUTHOR]

Planning a research strategy and formulating the right research questions at various stages of developing a telehealth intervention are essential for producing scientific evidence. The aim of research at each stage should correspond to the maturity of the intervention and will require a variety of study designs. Although there are several published evaluation frameworks for telemedicine or telehealth as a subset of broader eHealth domain, there is currently no simple model to guide research planning. In this paper we propose a five-stage model as a framework for planning a comprehensive telehealth research program for a new intervention or service system. The stages are: (1) Concept development, (2) Service design, (3) Pre-implementation, (4) Implementation, (5) Post-implementation, and at each stage a number of studies are considered. Robust evaluation is important for the widespread acceptance and implementation of telehealth. We hope this framework enables researchers, service administrators and clinicians to conceptualise, undertake and appraise telehealth research from the point of view of being able to assess how applicable and valid the research is for their particular circumstances. [ABSTRACT FROM AUTHOR]

For many people across the world, experiences of depression include features that extend beyond the biopsychiatric model, which predominates in research on the relationship between religious and spiritual coping and depressive symptoms. How does attending to these diverse experiences of depression challenge our understanding of the dynamic between religiosity and depression? This paper presents thirteen qualitative interviews among economically marginalized mothers in the metro-Boston area. Analyzing these narratives presents a complex picture of the way chronic situational stress lies beneath their experiences of depression. From this expanded view of depressive experiences, we analyze the religious coping strategies of social support and meaning making to reveal the holistic, yet often ambiguous, ways these mothers engaged religious and spiritual resources to forge hope amidst chronic stress. [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]

Background For some time now, integrated care has been put forward to create a more demand-driven, patient-centred and cost-effective care system. Various conceptual frameworks have been developed to shed light on the complex concept. However, they lack insight into the mechanisms driving integrated care in practice. The aim of this paper is to gain insight into how integrated care is realised in practice. Methods Six cooperation projects in Flanders were compared on five integration mechanisms. A content analysis of secondary sources on each of the cases and semi-structured interviews with representatives of these cases was conducted. The data were analysed using comparison tables. Results Six cases representing five cooperation models in the Flemish health and social care were analysed for the presence of integrated care mechanisms. Six of the 22 mechanisms are present in all case examples. Half of the identified mechanisms concern the integration of professionals. Integrated care in these Flemish cases refers mainly to organising a case meeting, appointing a case manager and dividing the tasks between care professionals. Integration of support is less developed. Conclusions The bottom-up approach to study the practical implementation of mechanisms is a fruitful approach, since it brings into light the complex realities and practicalities of the mechanisms of integration and how they are shaped by local actors in local contexts. The approach shows how Flemish and Belgian policy makers are struggling to scaling up these integration models, whilst at the same time responding to local conditions and needs. [ABSTRACT FROM AUTHOR]

The increasing burden of chronic diseases is one of the greatest challenges healthcare systems globally are facing. Across the world, compelling demands can be found for a fundamental shift in the organisation of health and social care to meet the needs of chronic patients. Integrated care has gathered momentum to overcome fragmentation of care in order to create care systems which are demand-driven, client-centred and cost-conscious. Health information technology – often referred to as eHealth – is usually considered to be an essential building brick of integrated care. Moreover, health information technology is said to hold potential for improving patient safety in chronic care settings. The current perspective paper explores the role of health information technology in integrating and safeguarding care. We argue that health information technology – which supports integrated care – may create optimal conditions to improve patient safety, but only when well-implemented, state-of-the-art technologies are used. [ABSTRACT FROM AUTHOR]

The biopsychosocial model outlined in Engel’s classic Science paper four decades ago emerged from dissatisfaction with the biomedical model of illness, which remains the dominant healthcare model. Engel’s call to arms for a biopsychosocial model has been taken up in several healthcare fields, but it has not been accepted in the more economically dominant and politically powerful acute medical and surgical domains. It is widely used in research into complex healthcare interventions, it is the basis of the World Health Organisation’s International Classification of Functioning (WHO ICF), it is used clinically, and it is used to structure clinical guidelines. Critically, it is now generally accepted that illness and health are the result of an interaction between biological, psychological, and social factors. Despite the evidence supporting its validity and utility, the biopsychosocial model has had little influence on the larger scale organization and funding of healthcare provision. With chronic diseases now accounting for most morbidity and many deaths in Western countries, healthcare systems designed around acute biomedical care models are struggling to improve patient-reported outcomes and reduce healthcare costs. Consequently, there is now a greater need to apply the biopsychological model to healthcare management. The increasing proportion of healthcare resource devoted to chronic disorders and the accompanying need to improve patient outcomes requires action; better understanding and employment of the biopsychosocial model by those charged with healthcare funding could help improve healthcare outcome while also controlling costs. [ABSTRACT FROM AUTHOR]

This paper presents a quasi-conditional likelihood method for the consistent estimation of both continuous and count data models with excess zeros and unobserved individual heterogeneity when the true data generating process is unknown. Monte Carlo simulation studies show that our zero-inflated quasi-conditional maximum likelihood (ZI-QCML) estimator outperforms other methods and is robust to distributional misspecifications. We apply the ZI-QCML estimator to analyze the frequency of doctor visits. [ABSTRACT FROM AUTHOR]

A UK doctor was recently acquitted of charges of reinstating a variety of female genital mutilation after delivering a child. In this paper, I contend that this incident reflects a broader confusion concerning the ethico-legal status of non-therapeutic genital surgeries for children and adults, which are not derivable from tenets of medical ethics, but rather violate them. I argue that medical professionals have an obligation to announce and address this confusion in order to motivate legislative reform, since the inconsistency of the current law entrenches the underlying sexism and ethnocentrism upon which its sense depends. Without convincing arguments for (a) condoning male circumcision and female cosmetic genital surgery and for (b) treating adult women of colour as lacking the capacity to consent, the current legislation stands in need of urgent revision. [ABSTRACT FROM AUTHOR]

In humanitarian operations, the amount of funding received and the timing and predictability of funding strongly influence program performance. In this paper, we study the problem of allocating inventory procured using donor funding to patients in different health states over a finite horizon with the objective of minimizing the number of disease-adjusted life periods lost. The funding received and the number of new patients of different health states entering the program in every period could be unpredictable and hence, resource allocation and rationing assume significance in this setting. We use a stochastic dynamic programming model with financial constraints to analyze the inventory allocation problem. We demonstrate that the optimal allocation policy is state dependent, provide analytical results regarding the impact of funding timing and funding variability in our problem context, and develop two heuristics for the inventory allocation problem. Our computational study indicates that the two heuristics perform reasonably well against the full information lower bound (roughly 5% gap on average) and in many instances, they offer significant benefits over the first-come-first-serve heuristic frequently used in practice. We also provide computational insights regarding the impact of funding timing and funding level on program performance. Our analysis indicates that for short planning horizons (up to 4 periods), receiving additional funding is beneficial even if the funding is delayed while for medium to long planning horizons, there exist situations where receiving less overall funding in a timely manner might be better than receiving more total funding in a delayed fashion. [ABSTRACT FROM AUTHOR]

Objectives: This paper reviews the importance of transition to adult services for young people with ADHD.Method: Different models are described and evidence sought for their effectiveness in clinical practice.Results: Models of care for children with ADHD include specialised mental health services, individual paediatricians and child and adolescent psychiatrists. Although it might be expected that transition would be to equivalent adult teams or specialists, studies have shown that transition may not run smoothly, and the adult services are frequently inadequate. This may result in attrition from treatment or discharge to the general practitioner.Conclusions: Adult mental health services for transitioning young people with ADHD are under-resourced. The way forward may be a generic ADHD specialist or service, treating ADHD across the lifespan and avoiding the need for transition. [ABSTRACT FROM AUTHOR]

Objective: Recently, Indigenous academics have evolved an Indigenist discourse that centralises Indigenous 'ways of knowing, being and doing'. Through this dialogue, Indigenous 'ways of knowing and being' augment Western biopsychosocial treatments.Methods: This paper outlines the authors' clinical encounters with young people from the Koori community and ongoing consultation with Koori community Elders in Victoria that led to engaging young people and their families in an Indigenist dialogue.Results: The Indigenist dialogue facilitates deeper engagement in the therapeutic process, opportunities to mirror and reflect on young people's experiences, and drawing parallels between Western health interventions and Aboriginal cultural ways of doing health and being healthy.Conclusions: The young people and their families evince greater faith in the management process and a deeper focus, centred awareness and knowledge of their Cultural rights and responsibilities. Future developments should include a systematic database with qualitative and quantitative data to support its evaluation and iterative development and improved community engagement to ensure holistic health gains are maintained. [ABSTRACT FROM AUTHOR]

Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care. To this end, Basic Life Support paramedics and nurses were taught interventions outside of their field of expertise. Prehospital electrocardiograms were used to remotely diagnose ST segment elevation myocardial infarction and to monitor patients who were en route by ambulance to the nearest catheterization facility or emergency department. Basic Life Support paramedics received extended medical authorization that allowed them to provide opioid analgesia via telemedicine physician orders. Nurses from community health centres without physician coverage were able to request medical assistance via a video telemedicine system. The second objective is to optimize medical resources. To this end, remote death certifications were implemented to avoid unnecessary transport of deceased persons to hospitals. This paper presents the telemedicine program and some results. [ABSTRACT FROM AUTHOR]

Ukraine has one of Europe's fastest growing HIV rates and in 2003–2012 was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). Doctoral research recently completed by the author investigates the conduct and practice of international and national nongovernmental organisations (NGOs) as Principal Recipients (PRs) of GF grants in Ukraine from 2003 to 2012. An ethnographic enquiry including 50 participant interviews was conducted in three oblasts in Ukraine, and in its capital, Kyiv. The paper presents some of the findings that emerged from the analysis. Discussing the PR NGOs roles and practices in delivering HIV prevention programmes funded by GF, the author argues that the anticipated benefits of NGO partnerships between PR NGOs and their Sub-Recipients (SRs) have not been achieved. Rather, PRs acted as donors and ran highly discretionary policies in channelling GF funding to SRs that installed competition and vertical relations between NGO-grantors and NGO-grantees. The outcome was a servile civil society that is dependent on external funding and is unable to genuinely represent their communities. With an anticipated GF phasing out from Ukraine, there is a critical lack of advocacy potential of the civil society to articulate and defend the needs of PLHIV when transferring HIV services into state funding. [ABSTRACT FROM AUTHOR]

There is an increasing use of statistical methods, such as funnel plots, to identify poorly performing healthcare providers. Funnel plots comprise the construction of control limits around a benchmark and providers with outcomes falling outside the limits are investigated as potential outliers. The benchmark is usually estimated from observed data but uncertainty in this estimate is usually ignored when constructing control limits. In this paper, the use of funnel plots in the presence of uncertainty in the value of the benchmark is reviewed for outcomes from a Binomial distribution. Two methods to derive the control limits are shown: (i) prediction intervals; (ii) tolerance intervals Tolerance intervals formally include the uncertainty in the value of the benchmark while prediction intervals do not. The probability properties of 95% control limits derived using each method were investigated through hypothesised scenarios. Neither prediction intervals nor tolerance intervals produce funnel plot control limits that satisfy the nominal probability characteristics when there is uncertainty in the value of the benchmark. This is not necessarily to say that funnel plots have no role to play in healthcare, but that without the development of intervals satisfying the nominal probability characteristics they must be interpreted with care. [ABSTRACT FROM AUTHOR]

Objectives: Challenges in healthcare demand great leadership. In response, leadership training programs have been developed within academic medical centers, business schools, and healthcare organizations; however, we are unaware of any well-developed programs for physicians-in-training.Methods: To address this gap, we developed a two-day leadership development course for chief residents (CRs) at the Cleveland Clinic, framed around the concept of emotional intelligence. This paper describes our five-year experience with the CRs leadership program.Results: Since inception, 105 CRs took the course; 81 (77%) completed before-and-after evaluations. Participants indicated that they had relatively little prior knowledge of the concepts that were presented and that the workshop greatly enhanced their familiarity with leadership competencies. Qualitative analysis of open-ended responses indicated that attendees valued the training, especially in conflict resolution and teamwork, and indicated specific action plans for applying these skills. Furthermore, the workshop spurred some participants to express plans to learn more about leadership competencies.Conclusions: This study extends prior experience in offering an emotional intelligence-based leadership workshop for CRs. Though the program is novel, further research is needed to more fully understand the impact of leadership training for CRs and for the institutions and patients they serve. [ABSTRACT FROM AUTHOR]

This paper examines the framework for the treatment of prisoners of war that emerged after 1945. It focuses on one of the key elements of the post-war prisoner of war (POW) regime, the role of neutral bodies – state authorities acting as ‘protecting powers’ or humanitarian agencies such as the International Committee of the Red Cross – in supervising the implementation of the 1949 POW convention. It examines the importance of neutral supervision for the POW regime, and shows how the events of the Korean War affected the willingness of states to comply with their obligations under the new convention. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Stigma Associated With Ghanaian Caregivers of AIDS Patients," by Prudence P. Mwinituo and Judy E. Mill. The paper evaluates the experiences of informal caregivers of AIDS patients in Ghana. Mwinituo and Mill identify four themes: care under cover, loneliness and isolation, lack of support and disrespect from health workers. They provide an insight into both quantitative and qualitative studies reporting on the occurrence of stigma and the negative impact of stigma on both informal caregivers and on patients with HIV and AIDS.

NHS research governance makes it almost impossible to collect certain kinds of data on the everyday life of hospitals and the experience of patients. Fortunately, those of us who get sick enough to be admitted can write about the experience without fear of regulation. This paper presents some observations on clinical ethics, ward organization and infection control that would have been difficult to obtain in any other way, but which illustrate the policy and information costs of the present system. While not personally recommending this as a research strategy, the paper identifies a growing evidence gap and comments on its implications for the delivery of humane and well-organized care. [ABSTRACT FROM AUTHOR]

The article presents a paper from John Fry, one of the giants of general practice (GP) in Great Britain, which focused on medical staffing requirements. The paper contained skill mix and work sharing across the primary health care team, the mantra about creating a national service, and independence in organizing general practice services. Additionally, it provides annual summary and figures on total consultations, daily and weekly workload totals for the practice per GP and hospital referrals.

Papers presented at the three Successes and Failures in Telehealth conferences have made a helpful contribution to what is known about the practicalities of implementing and using telehealth. Ten of the 89 papers covered general concepts, 40 described primary studies and 26 discussed telehealth programmes or networks. Common themes that emerged on determinants of success and failure included the reliability of equipment, the reliability of vendors, political and budgetary issues, the perceived need for telehealth, the involvement of stakeholders, health professionals' opinions, the stability of management structures, the turnover of personnel and cooperation between organizations. Limitations in some papers included an absence of data, weak study designs, short-term perspectives and lack of information on health outcomes. Despite these limitations, the papers have made a valuable contribution to our knowledge of what has worked and what has failed in the field of telehealth. [ABSTRACT FROM AUTHOR]

The article focuses on the paper published by author Odin Anderson concerning the significance of health services politics based on cross-national comparison. His paper provides a brief history of the development of health care. It offers a descriptive typology of different arrangements for the funding and delivery of health care. It is also considered a helpful guide to comparative analysis in medical care.

The bulk of this paper will deal with the results of a survey which we have undertaken among clinicians. However, for the lessons of that survey to be learned, we have to understand the reasons why computerized decision support systems are desirable in the first place. There is no space in this paper to discuss those reasons, but we wish to set the scene by asserting that the three major factors are: 1. The huge knowledge explosion in healthcare (the half-life of a paper is about 8 years); 2. The complexity of the decisions facing clinicians and policy-makers (simple decisions typically involve choosing one course of action from a menu of millions of courses of actions); 3. The limitations of unaided human information processing (Miller's Magical Number 7 ± 2-) [1]. There is a large literature on sub-optimal decision-making (and even serious errors) by clinicians that shows that what one would predict in theory actually occurs in practice [2] [3]. We do not assert that using computers with their large memories, powerful inferencing mechanisms, consistency and general reliability is the only way to improve health decision-making. We do, however, assert that this is currently the most likely candidate for doing so. [ABSTRACT FROM AUTHOR]

Most statistical process control programmes in healthcare focus on surveillance of outcomes at the final stage of a procedure, such as mortality or failure rates. Such an approach ignores the multi-stage nature of these procedures, in which a patient progresses through several stages prior to the final stage. In this paper, we introduce a novel approach to statistical process control programmes in healthcare. Our proposed approach is based on the regression adjustment and multi-stage control charts that have been in use in industrial applications for decades. Three advantages of the approach are: better understanding of how outcomes at different stages relate to each other, explicit monitoring of upstream stage outcomes may help curtail trends that lead to poorer end-stage outcomes and understanding the impact of each stage can help determine the most effective allocation of quality improvement resources. A test statistic for the control charts is proposed. Simulations are performed to test the control charts, and the results are summarised using an empirical probability of true detection. An illustrative example using data from a maternity unit is included. A main result from the simulation study is that taking a multi-stage approach makes it easer to explicitly identify shifts in upstream stage outcomes that might otherwise be signalled in final stage outcomes if dependence between stages is ignored. [ABSTRACT FROM AUTHOR]

Introduction To reduce the burden of chronic lung diseases, the Lung Alliance Netherlands has designed a National Action programme on Chronic Lung Diseases. It aims to improve healthcare coordination, thereby reducing the burden of chronic lung diseases, by focussing on five objectives to be achieved within five years: (1) a 25% reduction in hospitalisation days for asthma and chronic obstructive pulmonary disease; (2) a 15% reduction in working days lost due to respiratory diseases; (3) a 20% improved cost-effectiveness of inhalation medication; (4) a 25% reduction of adolescents taking up smoking; and (5) a 10% reduction of mortality due to asthma and chronic obstructive pulmonary disease. Methods/design Baseline data were collected from Dutch registries with the most recent available data from 2011, 2012 and 2013. To achieve the objectives, the Lung Alliance Netherlands presented various key activities and strategies that are described in this paper. Discussion The ambitious objectives are interconnected and their mutual reinforcement is expected to have a beneficial impact on the burden of chronic lung diseases. A strength of the Dutch national action programme is the extensive cooperation between the multiple healthcare parties that contribute to the coordination of the delivery of healthcare. A potential weakness is the relatively short time span of the programme, which may prevent observing its full potential. [ABSTRACT FROM AUTHOR]

This paper uses data from the healthcare sector to explore how clock time organization influences therapeutic performance. The case of a pediatric physiotherapist offers an important opportunity to examine how clock time, mediated by a variety of organizational and social systems, imposes limitations to the individual activity, in terms of learning, experimenting, and innovating. Social, cultural, institutional, and organizational layers have developed around this universal time reference. They impose an in-depth and taken for granted time discipline on organizational actors. The job of the physiotherapist conflicts with this clock time discipline when she has to respond to the evolving needs of her patients. Based on her expertise, the therapist decides on the necessary care, including duration and frequency of treatment. The measured time allocation imposed by the healthcare system and the time-based reward system generate pressure on, and interfere with, the unfolding activity. The study illustrates how the therapist escapes these multiple constraints and how this enables her to focus on the therapeutic acts. Taking the therapeutic process as temporal reference reveals the impact of clock time discipline on the unfolding therapeutic activity. I conclude that open-ended activities are inhibited and distorted by this socially constructed time not only because they cannot unfold but also because the temporal framing prevents deliberation and initiative. [ABSTRACT FROM AUTHOR]