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Background: Despite the constitutional right of all Russian citizens to free medical care, out-of-pocket payment is a widespread phenomenon for all types of medical treatment. The aims of this paper are twofold: To present new evidence on the use of, and payment for, outpatient and inpatient treatment in Russia; and to compare the motivations behind both official and informal payments for outpatient services provided in public medical institutions. Methods: This study uses data from a quantitative household survey conducted in April 2014. The sample comprised 1602 individuals aged ⩾ 18 years, representing the entire adult population of the Russian Federation. We studied three types of medical care: inpatient treatment, outpatient treatment and medicines. Results: Our study found that 22.2% of patients pay for outpatient services, 37.5% pay for inpatient services and 91.5% pay for outpatient medicinal treatment. The informal payments are almost equally met in both outpatient (13.4%) and inpatient (12.2%) care; while the official payments are more common in inpatient care (25.2%), compared to outpatient care (8.8%). The main reasons for informal payment include: improvements in the quality of care and gratitude for medical staff. The official payments are more frequently motivated by an inability to receive a certain treatment free of charge. Conclusions: This study demonstrates that both official and informal payments for medical treatment are widespread in Russia: Informal payments are strongly preferred over official payments for outpatient care, while official payments dominate in inpatient care. [ABSTRACT FROM AUTHOR]

Objective: We aim to describe the rationale for and spectrum of leadership development programs, highlighting experience at a large healthcare institution (Cleveland Clinic, Cleveland, Ohio, USA).Conclusions: Developing leaders is a universal priority to sustain organizational success. In health care, significant challenges of ensuring quality and access and making care affordable are widely shared internationally and demand effective physician leadership. Yet, leadership competencies differ from clinical and scientific competencies and features of selecting and training physicians-who have been called "heroic lone healers" -often conspire against physicians being effective leaders or followers. Thus, developing leadership competencies in physicians is critical.Leadership development programs have been signature features of successful organizations and various Australian organizations offer such training (e.g. The Australian Leadership Foundation and the University of South Australia), but relatively few health care organizations have adopted the practice of offering such training, both in Australia and elsewhere. As a United States example of one such integrated program, the Cleveland Clinic, a large, closed-staff physician-led group practice in Cleveland, Ohio has offered physician leadership training for over 15 years. This paper describes the rationale, structure, and some of the observed impacts associated with this program. [ABSTRACT FROM AUTHOR]

This paper focuses on two areas of innovation currently articulating the agenda of personalized medicine (PM): the discourse of empowerment in health-care reforms and the rise of molecular epigenomics. We align these two developments as discursive and technical resources, focusing on their nascent interplay in shaping alternative sociotechnical imaginaries of PM. Our work aims at inaugurating an intellectual programme on the distinct futures of policy- and identity-making that are being catalysed around epigenomic technoscience, as well as to provide an operational map of its potential synergies with pre-existing socio-political discourses of empowerment in PM. This roadmap advances our understanding of how the intersection of epigenomics with dominant policy discourses becomes a resource to shape roles and obligations of citizens, patients and health-care actors in the emergence of PM. [ABSTRACT FROM AUTHOR]

A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups. [ABSTRACT FROM AUTHOR]

For nearly 30 years, Mozambique has been facing austerity measures regulated by the IMF. These austerity measures, grounded in macroeconomic policies, were supposed to lift Mozambique out of poverty, and improve its healthcare and education systems. By taking an in-depth look at the major etiologies of Mozambique’s debt and the conditions which forced the country to accept austerity measures-despite their protests-prior to receiving IMF funding, this paper examines how IMF policies over the past 30 years have affected poverty, health, and the education system. The results of these policies have contributed to Mozambique’s enduring classification as one of the poorest countries in the world. Aside from economic outcomes, Mozambique also has abysmal health and education systems, with one of the lowest life expectancies in Sub-Saharan Africa. It is time to re-evaluate how the current IMF macroeconomic policies negatively affect, health, education and the socioeconomic status of those who live in abject poverty. As short term macroeconomic policies of PARPA have been ineffective at reducing poverty, promoting education and improving health, the IMF should consider using longer term macroeconomic policies which invest in—rather than limit—public services such as health and education. [ABSTRACT FROM AUTHOR]

A third of patients reviewed by rapid response teams (RRT) require end-of-life care. However, little is known about the characteristics and management of these patients following RRT review. This paper presents results of a retrospective, descriptive audit that explored the dying trajectory of adult ward inpatients who died outside of the intensive care unit following RRT review. The study setting was a 430-bed tertiary New Zealand hospital during 2013. RRT, inpatient databases and hospital notes were used to identify 100 consecutive adult inpatients who died subsequent to RRT review. Outcome measures included time from RRT review to death, place of death, pre-existing comorbidities and frequency of medical review. Results demonstrated that patients were old (median 77 years, IQR 63-85years), emergency admissions (n=100) and admitted under a medical specialty (n=71). All but one of the cohort had pre-existing comorbidities (mean 3.2, SD 1.7), almost a third (n=31) had cancer and 51% had 1-4 previous inpatient admissions within the previous 12 months. The mean length of stay prior to RRT review was 4.9 days (SD 5.5) during which patients were frequently reviewed by senior medical staff (mean 6.8 times, SD 6.9, range 0-44). Twenty percent of patients died after their first RRT review with a further 40% receiving treatment limitation/palliation. Fifty-two percent of patients had a pre-existing Do Not Attempt Resuscitation (DNAR) order. Eighty percent of patients died in hospital. Whilst the RRT fulfils an unmet need in decision-making at end of life, there is a need to understand what RRT, instead of ward-based or palliative care teams, offers dying patients. [ABSTRACT FROM AUTHOR]

Long-haul truck drivers and members of their social networks in urban locales constitute a hard-to-reach population at risk for acquiring and disseminating STIs/HIV. This paper focuses on the unique logistical, methodological, and ethical challenges faced by population health scientists while studying long-haul truck drivers and members of their sexual networks in inner-city neighborhoods of a major US metropolitan center and the innovative strategies developed to overcome the challenges. Formative research and focus groups with several trucker-centered populations (N = 28) led to in-depth interviews and serologies with 60 truck drivers and 24 sexworkers. Various difficulties encountered by the research team are discussed, followed by strategies devised to overcome them. [ABSTRACT FROM AUTHOR]

Although the use of public–private partnerships is endorsed by agencies at the national and supranational levels, there is little guidance for decision-makers on what good outcomes look like and the circumstances in which such outcomes are likely to occur. Enhanced understanding of these issues can improve the governance of large-scale contracting in the health sector. Drawing on a narrative review of the available theoretical and empirical research, this paper evaluates: (1) the benefits that public–private partnerships generate compared to alternative mechanisms of delivery; (2) their additional costs; and (3) the endogenous and exogenous factors that influence these outcomes. The evidence shows that public–private partnerships hold promise for decision-makers who prioritise cost- and time-certainty. However, public–private partnerships are also associated with additional costs – notably transaction and financing costs. The key decision that policymakers and managers need to make about their use of the public–private partnership model is, therefore, how much extra they are prepared to pay to achieve predictable cost, quality and service outcomes. How much they will have to pay is a function of a set of contextual variables which are readily amenable to policy action. [ABSTRACT FROM AUTHOR]

We highlight two contemporary trends that would benefit from more focused research as they have the capacity to significantly reshape health system delivery in the coming decade. The first is digital health and big data science. The second potential landslide is the growing phenomenon of patient and citizen engagement. This paper outlines the key features and rationale for how digital health and increased engagement can reshape health services, pointing to key areas that warrant careful research by healthcare management scholars. We further point to the relationship and overlap of these two areas and suggest that examining the synergy between these two related trends is a third area of priority in health research. [ABSTRACT FROM AUTHOR]

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

Objective: Aboriginal and Torres Strait Islander individuals are overrepresented in mental health services in the state of Queensland (QLD), Australia; indicating greater prevalence and less preventative management of mental illness. This paper describes a project to enhance the model of care to improve mental health, alcohol and other drug outcomes for Aboriginal and Torres Strait Islander Community members in two metropolitan Hospital and Health Services, in Brisbane, Australia.Methods: Individual and focus group consultations were conducted with stakeholders, to determine key themes.Results: The consultative phase of the project revealed three priority areas for action: governance and supervision arrangements for the workforce in the area of Indigenous mental health, alcohol and other drugs; the cultural capability of non-Indigenous clinicians; and consumer access to services.Conclusions: The Way Forward project is a broad workforce redesign approach to address these three key areas. This approach is designed to acknowledge the strengths among the Indigenous Aboriginal and Torres Strait Islander workforce and to utilise their specialised cultural knowledge. This strategy will also include working in relationships with key Community-controlled health and other organisations. The approach will be reviewed and evaluated. [ABSTRACT FROM AUTHOR]

Objective: Mental illness is a major contributor to disease burden in China. Guangdong province has a population of over 104 million. This province's health information system is inadequate, especially the mental health workforce and service response. This paper describes a field survey to assess the existing mental health workforce and service capacity in Guangdong.Method: A total of 125 major service providers in Guangdong were identified with the capacity to treat serious mental illness at all levels of the health system. These services were approached to complete a standardised survey based on the WHO Assessment Instrument for Mental Health Systems.Results: The survey identified 8498 mental health workers with 72.5% working in psychiatric hospitals. Service providers reported a treatment rate of 68.8% of a total of 430,000 people registered for treatment of severe mental illness, and only 28.4% of over a million people estimated to be experiencing severe mental illness. An inadequate mental health workforce was cited as a common barrier to treatment access.Conclusion: Guangdong province has a significant treatment gap for severe mental illness and a shortage in the mental health workforce. The distribution of the mental health workforce and facilities is imbalanced towards hospital care rather than community care. [ABSTRACT FROM AUTHOR]

This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care. [ABSTRACT FROM AUTHOR]

This paper highlights current activities with regard to telemedicine activities in and for developing countries. The paper reviews: the preparation of a telemedicine report by a study group of the International Telecommunication Union ITU , the aim of which is to provide recommendations and guidelines for developing countries; the formation of the European Telemedicine Collaboration Group ETCG , which is undertaking telemedicine pilot projects in developing countries; and telemedicine delivery via Inmarsat, which is coordinating production of the ITU report and is a participant in the ETCG. [ABSTRACT FROM AUTHOR]

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health. [ABSTRACT FROM AUTHOR]

The threat of emerging infectious diseases including Ebola hemorrhagic fever, pandemic influenza, avian influenza, Hepatitis B, Hepatitis C, and SARS has highlighted the need for effective personal protective equipment (PPE) to protect healthcare workers (HCWs), patients, and visitors. PPE is a critical component in the hierarchy of controls used to protect HCWs from infectious hazards. HCW PPE may include gowns, respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings. Important research has been conducted in certain areas, such as respirators and protective masks, but studies in other areas, particularly gowns, are scarce. Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Prevention's Guideline for Isolation Precautions, isolation gowns should be worn to protect HCWs' arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. Isolation gowns currently available on the marketplace offer varying resistance to blood and other bodily fluids depending on the type of the material, its impermeability, and wear and tear. While some studies show no benefit of the routine use of isolation gowns, others demonstrate that its use is associated with a reduced infection rate. This paper reviews isolation gowns in healthcare settings, including the fabrics used, gown design and interfaces, as well as critical parameters that affect microorganism and liquid transmission through fabrics. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate the technological feasibility of integrating e-health solutions as an aid to the health monitoring of patients in their own homes. The approach taken to this task is based on system engineering from which models are produced to indicate how home-based health care may be envisaged. The model outputs indicate that electronic health methods and its associated technologies offer a future where health care remains affordable. [ABSTRACT FROM AUTHOR]

Even after 43 years of independence, Bangladesh—one of the poor and densely populated countries of the world—is suffering from inadequate healthcare systems and facilities for the nation. Although there have been few noteworthy achievements from public and public sector initiatives, a significant proportion of the rural population is still deprived of required medical care. Under such prevailing paradoxical development, the non-governmental organizations (NGOs) in Bangladesh have played a vital role in alleviating the poor healthcare condition in Bangladesh. While private sector healthcare comes at high cost, it is only accessible to high income groups. Whereas public sector healthcare though comparatively much less expensive, the quality of service provided is highly questionable. In such a situation, NGOs have aided the country's need for basic healthcare. The NGOs have reached the grassroots in order to spread awareness and information and to provide quality healthcare to the underprivileged. The paper focuses on one such NGO, Impact Foundation1 ‘Jibon Tari’ floating hospital, which aims to serve the poverty stricken people of Bangladesh. This case study focuses on the current changes, challenges, and attributions of a dynamic NGO with a unique concept, known as Jibon Tari that assists in aiding the healthcare deficit in Bangladesh. [ABSTRACT FROM AUTHOR]

There is a severe shortage of healthcare provision in Africa. e-Health, the use of Information and Communication Technologies (ICT) to support healthcare, may help to ease this problem. e-Health projects support a wide range of applications ranging from telemedicine to global research collaborations made possible via e-Infrastructures, worldwide systems of integrated advanced high performance networking and computing ICT. To try to understand the state of e-Health in Africa, this paper aims to create a picture and to present an analytical review of some of these initiatives in Africa. A review framework composed of multiple search methods is developed and applied to yield a broad coverage of e-Health projects over the African continent. Seven quantitative analyses on the projects are presented. Major observations include that there is a tendency for e-Health projects to grow in number in some African countries over time; that African countries with larger Gross National Incomes tend to attract more e-Health projects; that e-Health projects in Africa focus on telemedicine, health education and health-related research; that there is a wide range of funding bodies, some of which have a geographical focus, and that the number of m-Health projects has been rising sharply. [ABSTRACT FROM PUBLISHER]

Chronic venous disease is a common condition, bearing significant morbidity to patients. It is predicted that the population suffering from this disease will significantly increase in the coming years, with a growing demand for specialists in the field of phlebology.Training and delivery of services are highly heterogeneous in the European Union. The establishment of the European College of Phlebology marks the opportunity to address these differences from a European perspective, with the aim of providing all patients with standardised, high-quality, accessible medical care.In this paper, we review the current status of phlebology from a European and an international perspective, as well as highlighting the current and future roles of the European College of Phlebology. [ABSTRACT FROM PUBLISHER]

Global assessment of structural conditions is important for structural health monitoring system. Especially, identification of structural parameters based solely on vibration data measured from sensors has become a popular topic in the field of civil engineering. The problem becomes extremely challenging when the number of sensors installed is limited. In this paper, a newly proposed online system identification technique, referred to as the sequential nonlinear LSE (SNLSE) approach, will be studied for global parametric identification of an experimental cable-stay bridge model. A dynamic equivalent model of the bridge will be established and the finite element analysis will be carried out. Both numerical and experimental studies will be conducted and different damage scenarios and limited number of response data will be considered. The capability of the proposed SNLSE approach in identifying the structural parameters and assessing the structural conditions will be verified. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the use of adaptive equipment after a total knee replacement. Studied population include total knee replacement patients from a general hospital through the assessment from occupational therapy staff. Also evaluated are optimal functional outcomes after surgery.

In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates. [ABSTRACT FROM PUBLISHER]

The purpose of this research involves understanding individual motivations for volunteering in clinical trials and/or health-related product tests. Identifying the reasons leading to participation in clinical studies also ensures researchers are in a position to outline projects that benefit patients as well as predicting eventual barriers that might otherwise constrain their involvement. In this context, the paper seeks to reinforce the importance of marketing strategies for recruiting and retaining volunteers as well as gasping the most effective kind of approach (promotional, communicational, economic incentives, among others). This study is based on exploratory research, deploying a deductive method, bailing up statistical methods in order to identify the motivations influencing volunteers over healthcare related product test participation. The results reveal that participants attach high importance to health professional recommendations within the scope of their motivations for participating in clinical trials. The motivations related to logistical factors (such as time and location) prove relevant to helping in the process of clinical trial participation decision making as well as deciding on the preferred alternative incentives (discount coupons, vouchers, etc.). Participants consider that information provided in hospitals, clinics, and health centers encourages interest in clinical trial participation taking into account that these are studies in the health area and the information provided by these institutions, therefore, probably receives correspondingly greater credibility. [ABSTRACT FROM AUTHOR]

This paper describes the healthcare needs of victims of multiple perpetrator sexual assault (MPSA) and single perpetrator sexual assault (SPSA) presenting to the Haven sexual assault referral centre in south-east London, and aims to identify any characteristics that might be related to attendance at follow-up appointments. We reviewed standardised casenotes of 136 MPSA victims and 139 SPSA victims attending for forensic medical examination (FME) between 1 July 2005 and 31 July 2009. MPSA victims reported a higher rate of stranger assaults, higher rates of vaginal, anal and oral rapes, more rapes at multiple anatomical sites or multiple rapes and were more likely to sustain injuries, all of which put MPSA victims at higher risk of subsequent health problems. Rates of attendance at follow-up appointments were low for all (53.5%) as were rates of completion of post-exposure prophylaxis (PEP) for HIV (33.3%). Attendance at follow-up was associated with presence of anogenital injury at the time of FME. Those over the age of 30 years were less likely to attend. [ABSTRACT FROM AUTHOR]

In the last decade, trauma care has become its own speciality. The creation of major trauma centres across the UK highlighted a clear clinical need to advance services for multiple injury patients who are known to have poor prognostic outcome. The story of trauma care development goes back well before the creation of the National Health Service (NHS). Although originally grouped with emergency medicine, the two have developed into their own distinct branches. This paper highlights key milestones and relationships in the development of trauma medicine alongside emergency medicine, from ancient times to present day, as well as the factors that have made them distinct. Reviewing the past can help medicine move forward. [ABSTRACT FROM AUTHOR]

The Rolando fracture is classically a Y pattern intra-articular fracture of the base of the thumb metacarpal. Due to the fracture’s inherent instability and difficultly in achieving and maintaining accurate reduction, management remains challenging. This article explores Silvio Rolando’s background, summarizes his classic paper from 1910 and reviews the current literature regarding optimal fixation techniques. [ABSTRACT FROM AUTHOR]

West Bengal, a medium performing state in terms of health indicators of India, received a big push in health infrastructure and financing of health care delivery from 2004 onwards in the form of Health Sector Development Initiative from DFID, UK, and the National Rural Health Mission from Ministry of Health & Family Welfare, India. There is no denial that these reform policies have made a positive impact in the rural health care system of the state. However, the overall success notwithstanding, there still exist major challenges, mostly at the grassroots level. On the basis of a primary survey covering 47 Gram Panchayats in five districts of West Bengal, the paper observes that even after significant improvement in infrastructure creation and utilization of health care services at the macro level, supply side bottlenecks as well as demand side barriers to access health care services dominate at the micro level, resulting in a mismatch between supply and demand. The architectural correction in infrastructure remains incomplete and unequal, with services delivery and health seeking behaviour truncated at suboptimal. Most of the crucial correlates of under utilization in maternal and childcare are embedded in household, social, and parent characteristics. The supply side factors do not appear to have any strong linkage with health care utilization, though the availability of ANM and HA(M) do play some role. The study succinctly points out that the supply side intervention alone cannot change the health care pattern in a developing setting, where the pre-existing inequalities in terms of ethnicity, education, and demographic factors dominate. Unless the issues at the grassroots level are addressed properly, such an effort is bound to end up in further inequality in access to health care facility and inefficiency in the health care delivery system. [ABSTRACT FROM AUTHOR]

This paper examines whether different approaches for estimating the technical efficiency of a primary healthcare centre --PHC-- can have significantly different results. Although effective regulation demands the development of measures for establishing good operation levels, few studies have compared results from a data envelopment analysis ?DEA? and stochastic frontier analysis ?SFA? in a PHC. Furthermore, to the best of our knowledge, no studies have used Chilean nationwide data. Efficiency refers to the relation between the number of output units per input unit. Effectiveness evaluates the outcome of medical care and can be influenced by efficiency. The data that were used in this study came from 259 Chilean municipalities. We included two outputs - medical and check-up visits - and three inputs - staff, general service and drugs expenses. For the DEA, we used a variable return to scale output-oriented model. Before applying the SFA, a principal component analysis ?PCA? combined the two outputs. The results were similar for both methods: the SFA efficiency averages were 70.89% and 65.83% and the DEA averages were 68.37% and 54.46% for the urban and rural municipalities, respectively. In addition to defining a frontier of "best practice", this study merged the PCA with the SFA to form an innovative approach to combining outputs. [ABSTRACT FROM AUTHOR]

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

Recently health care (HC) organizations have increasingly embarked on organizational climate (OC) assessment with the intent to improve their efficiency and the quality of the delivered services. This is important; however, it is even if more crucial to ensure that workers engaged in the evaluation process are aware of the importance of their fruitful engagement in this investigation as well as of its potential benefits. From the management viewpoint, this is crucial to plan and implement management initiatives able to create a great place to work. The purpose of this paper is to shed empirical light on how, in effect, HC workers perceive OC for itself and as a performance driver to assess and manage. The study was carried out through an action research (AR) project, which included the use of both qualitative and quantitative approaches. Key phases of the AR project were some focus groups and a survey. During the focus groups, several methods and approaches were adopted for getting opinions from people and animating discussion. About the survey, a total sample of 560 HC workers was investigated. The AR project has shown that even if HC workers intuitively conceive OC as an important performance driver, the meaning of the construct is not completely clear. Moreover, a good level of awareness among HC workers about how and why OC can improve individual and organizational performance represents a key issue to address in evaluating and managing OC. [ABSTRACT FROM PUBLISHER]

This article describes the technological trajectory of the Institute of Technology in Immunobiologicals (Bio-Manguinhos) of a public institution (Fiocruz) linked to the Brazilian Ministry of Health, showing how it affected the learning process and the technological capabilities accumulation. It also tackled the government policies to stimulate the local production of similar biotherapeutics through the productive development partnerships, and the regulatory framework involved in this process. Bio-Manguinhos was created in the second half of 1976 aiming to supply the Brazilian National Program of Immunizatio (NPI) created in 1973, by organizing an incipient vaccine production done in several different research laboratories of Fiocruz. Since then, through different types of technology agreements and maintaining the investments on intrinsic technological development, the Institute had an extraordinary growth. Today it is responsible for more than 60% of the vaccines distributed to the Brazilian population, supplies diagnostic kits for several public programs and became an innovative organization launching high-tech kits intrinsically developed. In 2006, Bio-Manguinhos entered the biopharmaceutical field and is becoming the vanguard production in the country for different types of treatment covered by the government. This paper also shows the public health policies that focus to induce the local biological production by stimulating partnerships between public and private companies, the impact of the local production and the changes in the regulatory environment to follow the new scenario. Through different types of technology agreements, Bio-Manguinhos today produces more than 100 million doses of vaccines, including technologically complex ones as streptococcus pneumonia 10 valent. The technological trajectory of the in vitro diagnosis tests was similar to the vaccines, whereas the institute began supplying to the ministry of health programs tests produced in old technological platforms and then became an innovative organization launching high-tech products. Through this case it is possible to realize the learning process as well as the technological capabilities accumulation of Bio-Manguinhos. [ABSTRACT FROM AUTHOR]

The procedures for structuring clinical ethics case reflections in a childhood cancer care setting are presented, including an eight-step model. Four notable characteristics of the procedures are: members of the inter-professional health care team, not external experts, taking a leading role in the reflections; patients or relatives not being directly involved; the model explicitly addressing values and moral principles instead of focussing exclusively on the interests of involved parties; using a case-based (inductive) rather than principle-based (deductive) method. By discusing the advantages and disadvantages of the proposed procedures, our paper aims to contribute to the literature on models and procedures for ethical analysis that can be used in clinical settings. It is suggested that our proposed procedures have some advantageous features when it comes to promoting health care staff’s learning to structure their thinking about ethical issues. [ABSTRACT FROM AUTHOR]

This paper aims to show that the ethical justifications and the processes for requiring consent for interventional research or treatment are different to requiring consent for the disclosure of patient or subject information. I will argue that these process and theoretical differences are sufficient to view “consent” in the two situations as different concepts and suggest that the phrase “permission to disclose” would be more appropriate in the information disclosure situations. [ABSTRACT FROM PUBLISHER]

This paper proposes the Clinical Pathway Analysis Method (CPAM) approach that enables the extraction of valuable organisational and medical information on past clinical pathway executions from the event logs of healthcare information systems. The method deals with the complexity of real-world clinical pathways by introducing a perspective-based segmentation of the date-stamped event log. CPAM enables the clinical pathway analyst to effectively and efficiently acquire a profound insight into the clinical pathways. By comparing the specific medical conditions of patients with the factors used for characterising the different clinical pathway variants, the medical expert can identify the best therapeutic option. Process mining-based analytics enables the acquisition of valuable insights into clinical pathways, based on the complete audit traces of previous clinical pathway instances. Additionally, the methodology is suited to assess guideline compliance and analyse adverse events. Finally, the methodology provides support for eliciting tacit knowledge and providing treatment selection assistance. [ABSTRACT FROM AUTHOR]

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

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. [ABSTRACT FROM AUTHOR]

In this paper, I will explore ideas advanced by Bradshaw, Pence and others who have written on compassion in healthcare. I will attempt to see how and whether their assumptions about compassion can be justified, and explore the role compassion should play in a modern healthcare system. I will justify scepticism at the idea of attempting to incentivise compassion through metrics. The Francis Report raises important questions concerning the nature of a healthcare system that harms rather than helps patients. If something is failing in modern healthcare, those in charge should naturally seek to remedy it. I will investigate whether this is due to the disappearance of compassion, and if so, what is it that is emerging to fill its place. I will consider whether we need to rehabilitate or enforce compassion in the system, or to acknowledge that our modern healthcare systems are incompatible with compassion and how we can make the best of what remains. [ABSTRACT FROM AUTHOR]

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

In this paper, we address the shortage of behavior analysts serving rural communities and outline a model of service delivery for rural students with autism spectrum disorders. The model involves the use of pre-service behavior analysts to provide behavioral intervention to students with ASD in exchange for district-supported training and supervision experiences. Specific examples are provided from the state of Texas, but the conclusions are applicable to all of rural America. [ABSTRACT FROM AUTHOR]

Australia is stepping up to the new e-health environment. With this comes new legislation and new demands on information security. The expanded functionality of e-health and the increased legislative requirements, coupled with new uses of technology, means that enhancement of existing security practice will be necessary. This paper analyses the new operating environment for Australian healthcare and the legislation governing it, and highlights the changes that are required to meet this new context. Individuals are now more responsible for security and organisations should be prompted to review their security measures in light of the new demands of legislative compliance. [ABSTRACT FROM AUTHOR]

India’s current healthcare system under serves the basic healthcare needs of its huge population, as demonstrated by India’s below-benchmark performance in key health indicators, such as infant mortality, malnutrition, maternal mortality and burden of communicable diseases. The fact that public healthcare spending in India is just 1.2% of its gross domestic product, which is low even when compared to countries of similar income levels, shows that healthcare has not previously been a high priority for various presiding governments. In order to address these issues, in 2010 the Planning Commission (a central government body), with permission from the Prime Minister of India, instituted a high level expert group to propose an overall framework for establishing universal health coverage (UHC) in India. A pivotal question is, therefore, if UHC is implemented in India, what would be its impact on the pharmaceutical industry? This paper describes how:the UHC will primarily grow the generics market, with low prices moderating the financial impact of increased volume, thereby eroding the margin for multinational corporation generic players competing with low-cost locals;innovator brands are already under significant threat as next compulsory licensing candidates, as demonstrated by the recent court orders related to the compulsory licensing of Nexavar® and the listing of Sprycel®, Ixempra® and Herceptin® considered to be priced too high for India. Allowing generic versions of these drugs to be sold before patent expiration is to the detriment of both multinational corporation pharma revenues and Indian public health as, under these circumstances, new products are less likely to launch in India andauthor’s contend that, despite these twin pressures, UHC will unlock pockets of value in a growing Indian healthcare market, which agile multinational corporations with smart customer segmentation, supportive pricing strategies and local collaboration partners should be able to access. [ABSTRACT FROM AUTHOR]

Randomized clinical trials are considered the 'gold standard' in primary research for healthcare interventions. However, they can be expensive and time-consuming to set up and require many approvals to be in place before they can begin. This paper outlines how to determine what approvals are required for a trial, the background of each approval and the process for obtaining them. [ABSTRACT FROM AUTHOR]

India is the second most populous country in the world characterized by regional imbalances like a large north–south divide in health and development. The National Population Policy, 2000 focuses on ‘Decentralised Planning and Programme Implementation’. The 73rd Constitutional Amendment Act, 1992, made health, family welfare, and education a responsibility of village panchayats. The panchayati raj institutions are an important means of furthering decentralized planning and programme implementation. The National Rural Health Mission (NRHM) also clearly spells out this by recognizing the importance of decentralization and district management of health programmes. In this direction, the concepts of Village Health Plan and Fund, Village Health and Sanitation Committees and Rogi Kalyan Samities are inbuilt in this programme to decentralize the powers, functions and funds to the local frontline health functionaries and to empower them to take decision and utilize the funds for the welfare of the patients. The present study focuses on the decentralization of healthcare systems in Indian context and its relationship with improvement in healthcare service delivery, utilization and outcomes in rural areas. This study was carried out in two districts of Vadodara and Khurdha in the states of Gujarat and Odisha respectively. The data includes both primary and secondary sources. The primary quantitative survey includes data collected through a questionnaire for 480 women (15–49 years of age) and 480 men (15–54 years of age) from 480 households. The primary qualitative data includes data collected from in-depth interviews, focus group discussions and case studies. The secondary source includes the data from the health facility survey of the DLHS-3. The study was carried out during 2009–2010. In this paper, an attempt has also been made to construct an index of health systems decentralization using secondary data with inputs from the field from the primary study in the two states of Gujarat and Odisha, which revealed that Gujarat fared higher in terms of health system decentralization compared to its counterpart. [ABSTRACT FROM PUBLISHER]

Bangladesh is the signatory of both, International Conference on Population and Development (ICPD) programme of action and Millennium Development goals (MDGs). The Government of Bangladesh has set ambitious agendas for improving Reproductive Health (RH) services, to achieve the targets till 2015. In Bangladesh, poor access to services, both primary and tertiary care, low quality services, high rate of maternal mortality and child malnutrition are the key challenges in achieving MGDs. An equitable and efficient use of financial resources is essential for the adequate implementation of these agendas to achieve MGDs for reproductive health. This paper discusses the financing for reproductive health in Bangladesh based on various secondary sources including National Health Accounts.The budget allocation for Reproductive Health (RH) and Family Planning (FP) is around 11 per cent of the total health budget. Among RH providers, nearly 48 per cent of the expenditure is incurred through Family Planning Centres, which are key providers for reproductive health services in Bangladesh. General hospitals and outpatient care centres are providers for 23 per cent and 21 per cent expenditure respectively. A large proportion the total expenditure on service provision for RH is spent through the government system, which includes donor support channelled through the government system under pooled funding. The donor expenditure on population assistance in Bangladesh showed fluctuations in the past, but is showing increasing trend for last three to four years. Of the total donor expenditure, almost half is distributed through multilateral channels, one-third through NGOs in 2008, and remaining through bilateral channels. The role of multilateral channels has increased since 2006. Out of pocket spending constitutes a significant proportion (around 65 per cent) of the total spending on reproductive health. The study suggests that Bangladesh needs to increase spending on RH in order to achieve MDG 5. Due to resource constraints, the GOB is currently in a position to contribute only one-fourth of the total estimated budget needed for implementing the RH related operational plans, while the rest is considered to be the funding gap, and needs to be ensured from external sources. [ABSTRACT FROM PUBLISHER]

There is a lack of scientific evidence on the impact of a biomedical industry on the surrounding economy. The assessment of this issue would allow policy makers to identify the impact on production, local employment and wages in addition to public sector costs. With this aim, the paper evaluates the socio-economic impact of a medical devices firm’s decision to set up its manufacturing plants in Italy, i.e. the effect of industrial activity on employment, earnings and output, using information on production processes to derive the associated interactions with suppliers for the primary industry and secondary industries. Besides being amongst the major contributors of health outcomes, medical technology manufacturers provide additional benefits to public sector and to the economy as a whole. This suggests that a broad perspective needs to be endorsed by policy makers when deciding about the introduction of new technologies in the healthcare sector in order to achieve optimal outcomes for society as a whole. [ABSTRACT FROM PUBLISHER]

This paper analyzes the development of retail chain drugstores in China from 2003 to 2010 based on statistical data of ‘Chinese drugstores’ magazine. There are two developing trends in retail chain drugstores based on the total sales, the sales growth rate, the total number of branches, the growth rate of the total number of branches and the daily sales of branches of the top 100 retail chain drugstores in China. In the first trend, the business scale expands gradually, while, in the second trend, the speed of expansion becomes more and more slow. Further, we made a correlation and regression analysis. Results showed that the total sales and the number of branches of retail chain drugstores in China have a positive linear correlation and so does the sales and the business area. In contrast, the total number and the average sales have a negative linear correlation. According to this, we made a conclusion that blind expansion of branches is not always helpful for enlarging sale scale in increasingly competitive market. At last, we brought out two proposals to enhance the competitiveness and viability of retail chain drugstores in China. One is to improve the quality and intensity of patient medication instruction. The other is to set up an online pharmacy. [ABSTRACT FROM PUBLISHER]

Systematic reviews are increasingly being viewed as important sources of information for policymakers who need to make decisions on different aspects of the health system, often under tight time constraints and with many factors competing for their attention. Unfortunately, a number of misconceptions, or 'myths', stand in the way of promoting their use. The belief that systematic review topics are not relevant to health systems policymaking, that they cannot be found quickly, and that they are not available in formats that are useful for policymakers are but three examples of such myths. This paper uses evidence drawn mainly from Health Systems Evidence, a continuously updated repository of syntheses of health systems research, to counter these and nine other common myths, with the aim of changing the constraining beliefs associated with them, while improving the prospects for the use of systematic reviews in health system policymaking. [ABSTRACT FROM AUTHOR]