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The article presents the discussion on COVID-19 pandemic highlighting the contributions critical care. Topics include intensive care units (ICUs) around the world suddenly inundated with patients who were critically ill from an unknown virus, along with all the other patients needing critical care services; and warrants consideration of energy, clinical supplies, pharmaceuticals, technical equipment and physical facilities.

Objective To disentangle the concepts of primary health care and primary care as well as their conceptual and empirical ramifications for progressive transformation. Methods over 400 international and interdisciplinary abstracts and papers with 96 annotated bibliography abstracts of literature across multiple dimensions relating to the knowledge base around mechanisms in PHC development were reviewed. The text is confronted with the reality, as it exists in the field and makes the case for complexity perspectives to assess this phenomenon in its context. Conclusion PHC complexity is an important analytical tool to interrogate the ways in which this phenomenon is socially constructed as well as in the matrices in which it is embedded. It is also a potent analytical tool to assist in the deconstruction of prevalent linear thinking built around PHC as a whole. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify needs of Jordanian families of hospitalized, critically ill patients. The Critical Care Family Needs Inventory was introduced to 158 family members who were visiting their hospitalized, critically ill relatives. The findings revealed that ≥ 80% of the family members perceived 16 need statements as important or very important. The participants ranked order needs for assurance, information and proximity the highest and needs for support and comfort the lowest. Specifically, the most important needs of the families were to receive information about the patients, to feel that the hospital personnel care about the patients and to have the information given in understandable terms. Results of this study indicated that Jordanian families had specific and identifiable needs. Providing families of critically ill patients clear, simple and updated information about the patients, and assuring them about the quality of care the patients receive, should be essential components of the critical care nursing delivery system. [ABSTRACT FROM AUTHOR]

Postnatal depression is a major health issue for childbearing women world-wide, as it is not always identified early. This study aimed to evaluate the clinical application of three screening instruments for the early recognition of post-partum depression, the Postpartum Depression Prediction Inventory, the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale, and to examine nurse interventions following use of the instruments. Data were collected at two points, at 28 weeks prenatal (107 women) and eight weeks postnatal (84 women). Results showed that 17% of the women scored significant symptoms of post-partum depression and 10–15% had a positive screen for major postnatal depression. There was a statistically significant correlation between the total score on the Postpartum Depression Screening Scale and the Edinburgh Postnatal Depression Scale. Of those eight women identified as being at risk, seven had received anticipatory guidance and five had received counselling by the nurses. The Postpartum Depression Prediction Inventory enabled nurses to identify women at risk of post-partum depression and offer interventions. [ABSTRACT FROM AUTHOR]

Objectives: To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. Design: A scoping review was applied. Papers published in English between 2012 and 2023 were included but non‐human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. Results: The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non‐communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. Conclusion: Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non‐ and communicable‐diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca. [ABSTRACT FROM AUTHOR]

Loneliness is a major public health concern, particularly during pandemics such as Covid. It is extremely common, and it poses a major risk to human health. Technological solutions including social media, robots, and virtual reality have been advocated and implemented to relieve loneliness, and their use will undoubtedly increase in the near future. This paper explores the use of technological solutions from a normative perspective, asking whether and to what extent such measures should indeed be relied upon. The conclusion is that technological solutions are unquestionably part of the solution to loneliness, but that they cannot and should not constitute the whole solution. It is important to note that this is not a straw‐man argument, as several organizations and scholars have strictly focused on such technological solutions for loneliness. [ABSTRACT FROM AUTHOR]

The article describes the American Dental Association's (ADEA) official statement and recommendations on the roles and responsibilities of academic dental institutions in improving the oral health in the U.S. ADEA believes that with the collaboration of communities of dental education and dental practice and other health professions, the oral health care needs of the poor will be met. The association's believes that academic dental institutions are the fundamental of the country's oral health.

An editorial is presented on presentations offered at the International Association of Bioethics' (IAB) 15th World Congress of Bioethics (WCB) hosted by the University of Pennsylvania in June 2020. Topics include expanding beyond clinical and medical ethics to encompassing public health ethics and matters of social justice; and committed to the defense of women's human rights and the eradication of violence in all interpersonal relationships.

The article presents the author's outlook on failure of the national eHealth strategy to focus on needs of the community. Topics discussed include implementation strategy of national eHealth, funding of various core foundation eHealth technology services by the National Electronic Health Transition Authority (NEHTA) and adoption strategy to address the needs of the community healthcare sector at the provider and practice level.

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights‐based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service‐led to a rights‐based, service‐user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State. [ABSTRACT FROM AUTHOR]

Abstract: Health information technology (HIT) has become a significant tool in medical practice, and public and international health. Much has been written about HIT and its implications on policy development in the management, practice, and delivery of health care. To better understand the implications on policy development of HIT, a limited literature search was conducted using key terms and a simple search engine. Twelve peer‐reviewed published papers were chosen based on keywords and citation frequency from 2000 to 2012. Twelve papers were reviewed. The implications toward policy formulation based on the search terms and the number of citations the paper had from its initial appearance in the literature are presented. The range of citations is 379 to 2. Citation frequency improves over time and in this case, a low citation number reflects relatively recent publication. HIT is a significant tool in healthcare at all levels. Innovation since 2000 has rapidly outpaced technological innovation prior this decadal review. Policy formulation can be impacted by HIT as well as other innovation. However, the current policy framework is not adept to support the accelerated rate of change. The scholarly publications presented here highlight the impact HIT can have on policy and the need to amend the current policy framework. [ABSTRACT FROM AUTHOR]

Trust has been consistently identified as an important enabling factor for joined‐up government activity to generate strong, integrated and effective social policy. Despite this, there has been comparatively little detailed analysis of the complexities and dynamics involved. This paper provides a detailed examination of how trust is built, nurtured and, in some instances, lost during joined‐up policy activity. It draws on interview and survey data that reveal the dynamics of relationships formed under the South Australian Health in All Policies initiative. The research extends the parameters of organisational analyses of trust. Previous typologies are mostly descriptive, with limited explanatory power, typically focusing on individuals and institutions separately rather than integrating these foci to consider how trust operates within whole systems. By integrating Giddens' theoretical perspectives on trust with existing typologies, the paper generates understanding about how trust operates as a resource within non‐traditional joined‐up government working relationships, serving to bridge the gap between the known and unknown, and acting as a productive resource to stimulate action within government systems that are perceived to feature high levels of risk. A model is provided to explain the interrelated dynamics of trust building, maintenance, monitoring and repair. Trust is vital for joined‐up government yet has been rarely studied in detail. The paper provides one of the first empirical studies and draws on sociological theory to determine how trust operates in government systems. A practical model is offered to show how trust is generated, supported and undermined during collaborative policy making. [ABSTRACT FROM AUTHOR]

Background: Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. Aim: In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co‐designed research. Discussion: More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence‐based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. Conclusion: To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co‐joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships. [ABSTRACT FROM AUTHOR]

Background: Prioritized research agendas are viewed internationally as an important method for ensuring that health research meets actual areas of clinical need. There is growing evidence for speech–language therapy‐prioritized research agendas, particularly in disorder‐specific areas. However, there are few general research priority agendas to guide speech–language therapy research. Aims: To collaboratively develop a prioritized research agenda for an Australian public health context with clinical speech–language therapists (SLTs), academic SLTs and consumers of speech–language therapy services. Methods & Procedures: An initial stimulus list of potential research areas for prioritization was collected from SLTs via an online survey. Two categories (service delivery and expanded scope of practice) were selected from this list for prioritization due to their relevance across multiple health services. The Nominal Group Technique (NGT) was used to develop a prioritized research agenda for each of the two categories. One NGT session was conducted with each of the three participant groups (clinical SLTs, academic SLTs, consumers) for each category (total NGT sessions = six). The prioritization data for each group within each category were summed to give a single, ranked prioritized research agenda for each category. Outcomes & Results: Two prioritized research agendas were developed. Within each agenda, SLTs and consumers prioritized a need for more research in areas related to specific practice areas (e.g., Alternative and Augmentative Communication, Communication Partner Training), as well as broader professional issues (e.g., telehealth, working with culturally and linguistically diverse families). Conclusions & Implications: The current findings support the need for funding proposals and targeted projects that address these identified areas of need. What this paper adds: What is already known on this subject: Evidence‐based practice is a critical component of SLT practice. There is often a disconnect between the research evidence generated and areas of clinical need, and in some areas a lack of evidence. Prioritized research agendas can help drive research in areas of clinical need. What this paper adds to existing knowledge: A collaborative, prioritized SLT research agenda was developed using the NGT according to the views of clinical SLTs, academic SLTs and consumers of speech–language therapy services in a conglomerate of public health services. SLTs and consumers identified a need for further research in specific areas of SLT practice as well as broader emerging professional issues What are the potential or actual clinical implications of this work?: Targeted research projects funded on a large scale are required to address these identified areas of need. Other health services around the world could replicate this prioritization process to drive research in areas of clinical need [ABSTRACT FROM AUTHOR]

Background: Use of the National Healthcare Safety Network (NHSN) has been essential to the success of the Massachusetts Hemovigilance Program and has allowed for the timely identification of signals and trends over a defined population that correlate with national and international hemovigilance (HV) data. Here, we outline how the NHSN system is used for monitoring HV data in Massachusetts and encourage adoption of NHSN for nationwide HV surveillance. Study Design and Methods: A collaboration that grew over time between local HV stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper‐based method of reporting adverse reactions and monthly transfusion activity for compliance with state requirements to replacement with statewide adoption of reporting via NHSN. Results: Over 1.5 million blood products were transfused in Massachusetts between 2017 and 2021, with 3000 adverse reactions among 10 defined types reported. Using NHSN, MDPH has been able to produce numerous reports, publications, and presentations that have made previously non‐obtainable HV and blood utilization data available. Discussion: Although limitations to these self‐reported data exist, such as lack of external validation, successful statewide implementation of NHSN for hospital blood bank reporting is possible and has benefits beyond those for regulatory oversight. It results in standardized, actionable data at both the hospital and state level, enabling inter‐facility comparisons, benchmarking, and opportunities for practice improvement. [ABSTRACT FROM AUTHOR]

The article focuses on the White Paper on community care titled "Caring for People" in relation to the 1990 National Health Service and Community Care Bill pending in the House of Lords. Criticisms levelled against the White Paper, particularly the issue of grant aid, are misplaced. The White Paper's outstanding value is that it outlines a clear structure and a set of general principles which should grant local authorities greater autonomy, authority and responsibility in healthcare administration.

Focuses on key issues in gerontological nursing that have a direct impact on practice. Definition of practice development; Overview of the philosophy of personhood; Discussion of the concept of person-centered practice in the context of gerontological nursing.

The article discusses the use of newspaper as a source material in health education. In evaluating the extent and the nature of material on public health and hygiene, and the methods of using the material in teaching public health and hygiene at college level, the selected article must include material on hygiene, must treat topics included in standard texts on public health and hygiene. Each article clipped from one of the issues of the newspapers should be marked with the name and date of the paper from which it had been taken, and inserted in an envelope. In some articles publicity was given to meetings and conferences, awards of prizes for distinction in health activities, openings of hospitals and health centers. In determining the extent to which the average person is interested in reading news on public health and hygiene, students were asked to check the articles they read in the papers during a period of one week. It was noted that health news was not widely read.

Modern health‐care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as 'HIV exceptionalism'. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS‐related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other 'boutique' public health strategies. The recent availability of highly effective, direct‐acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its 'normalisation'. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C‐affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.'s (2017, International Journal of Drug Policy, 44, 192–201) theorisation of stigma, and Rosenbrock et al.'s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99‐202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma‐reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C. [ABSTRACT FROM AUTHOR]

Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [ABSTRACT FROM AUTHOR]

Objective: The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight other developed countries. By disaggregating by age and income, the paper focuses on the poor and elderly populations within each.Data Source: The study uses nationally representative household survey data made available through the Luxembourg Income Study. It includes nations with high, medium, and low levels of OOP spending.Study Design: Households have high medical spending when their OOP expenditures exceed a threshold share of income. I calculate the share of each nation's population, as well as subpopulations within it, with high OOP expenditures.Principal Findings: The United States is not alone in exposing large numbers of citizens to high OOP expenses. In six of the other eight countries, one-quarter or more of low-income citizens devoted at least 5 percent of their income to OOP expenses, and in all but two countries, more than 1 in 10 elderly citizens had high medical expenses.Conclusions: For some populations in the sample nations, health insurance does not provide adequate financial protection and likely contributes to inequities in health care delivery and outcomes. [ABSTRACT FROM AUTHOR]

Discusses the World Health Organization Euro Office "Nursing in Action" six-year program which will be launched in 1992. Description of the first phase of the program which focused on multinational study on people's needs for nursing care; List of titles of the eight working documents in the Health for All Nursing series.

The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on‐site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on‐call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro‐located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles. [ABSTRACT FROM AUTHOR]

The paper analyses the incidence of malaria in rural Nigeria and its implication for the country's efforts to meet the targets of various domestic and global development policy blueprints. In recent years, there has been remarkable increase in human and financial commitments to global malaria control, partly due to the need to meet specific and relevant development targets set in the millennium development goals (MDGs). However, these efforts have not translated into a significant decrease in the incidence of the disease and its impact in Nigeria. Using the cost of illness method to analyse the impact of malaria on various attempts at national development, the paper found that substantial resources and domestic output is lost annually to malaria attack in Oyo State. This has serious implications for the achievement of the principles of the National Economic Empowerment and Development Strategies (NEEDS) and the MDG target. It is implied from the results that effective control of malaria is capable of reducing household poverty, inequality, while improving various determinants of welfare and national development. [ABSTRACT FROM AUTHOR]

The article presents information on the future of public health in Great Britain. This paper reviews the government's early commitment to, and initiatives in, public health which formed the foundations of its present policy, and examines the reasons for public health becoming an issue of almost unprecedented prominence. Finally, it looks ahead to anticipate what public health might look like in the aftermath of the White Paper expected in November 2004. Public health underwent something of a renaissance following the election of the Labor government in 1997.

Health care‐associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment. This does not detract from national guidelines and cannot replace expert advice but will raise awareness and complement safe and effective care delivery. [ABSTRACT FROM AUTHOR]

Zoonotic pathogens cause an estimated 70% of emerging and re‐emerging infectious diseases in humans, affecting various aspects of human development on a global scale. The significance of bats as a source of emerging infectious diseases is being progressively appreciated. This study was undertaken post‐Ebola virus disease in West Africa and assessed the public health implications of human–bat interactions by exploring the reasons for contact between humans and bats, as well as reported actions taken upon experiencing bat bites or scratches. The paper highlights the nuances of human–bat interactions, stressing zoonotic disease risk awareness as well as the sources of information. The study used questionnaires to solicit information from 788 respondents in five communities with significant bat populations. We show that bat consumption was one of the main reasons for human–bat interactions. More men across the various communities ate bat meat. Only a small number of respondents (4.4%) reported being bitten by a bat, and 6.1% had been scratched by a bat. More than 21% had come into direct contact with bat blood. An even lower number went to the hospital after been bitten or scratched by bats. There was little knowledge on post‐exposure management. The most common places human–bat interactions occurred were at home and on farms. Seventy‐three per cent of the respondents believed that bats carried diseases, with Ebola virus disease being the most mentioned. Respondents indicated that the way they interacted with bats had not changed, even though they believed bats carried diseases and 46% stated that they had not changed the way they interacted with bats over the last two years. Apart from providing information on avoiding bites and scratches, a more holistic framework is needed to reduce human–bat interactions. The paper recommends a comprehensive and coordinated approach to optimizing an effective response to a potential bat‐borne zoonotic disease spillover. [ABSTRACT FROM AUTHOR]

Provides information on "Oral Healthcare for Older People: 2020 Vision," a policy paper from the British Dental Association. Members of an Expert Reference Group that helped in the production of the paper; Information on demographic changes in Great Britain; Expectations on oral healthcare services for older people in Great Britain in 2020.

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools. [ABSTRACT FROM AUTHOR]

It has been nearly 50 years since Robert Kennedy's iconic trips to the Mississippi Delta (1967) and Appalachian Kentucky (1968). What he found shocked him. 'It's unacceptable in this country that we should have this kind of poverty. And I think we need to do something about it.' This paper explores whether the conditions that produce health have improved in these two areas 50 years later. Are people healthier? A comparative case study examining health in these two regions is a unique way to understand the progress and shortcomings of the Affordable Care Act (ACA). I use the social ecological framework as a guide to focus on the social determinants of health in two of the least healthy places in the United States. Access to insurance and medical care is important, but will not produce health if housing is unsafe, food systems are inadequate, and poverty remains pervasive. [ABSTRACT FROM AUTHOR]

It is nearly two decades now since the publication of Godfrey Tangwa's article, 'Bioethics: African Perspective', without a critical review. His article is important because sequel to its publication in Bioethics, the idea of 'African bioethics' started gaining some attention in the international bioethics literature. This paper breaks this relative silence by critically examining Tangwa's claim on the existence of African bioethics. Employing conceptual and critical methods, this paper argues that Tangwa's account of African bioethics has some conceptual, methodic and substantive difficulties, which altogether do not justify the idea of African bioethics, at least for now. Contra Tangwa, this article establishes that while African bioethics remains a future possibility, it is more cogent that current efforts in the name of 'African bioethics' be primarily re-intensified towards 'Healthcare ethics in Africa'. [ABSTRACT FROM AUTHOR]

Introduction: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline‐specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. Methods: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi‐structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. Results: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline‐specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. Conclusion: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery. [ABSTRACT FROM AUTHOR]

Radical market‐oriented health reforms in New Zealand in the early 1990s failed to deliver key financial targets, resulted in unnecessary patient deaths, adversely affected public healthcare services, induced serious tensions between clinicians and managers and encouraged a predisposition to private healthcare. A more co‐operative health system was implemented in the late 1990s but remaining problems of inadequate patient access led to establishment of a charity hospital in Christchurch which, by November 2018, had registered over 18 000 patient visits. This is one indication of the need to resurrect our public healthcare system. In this paper, we discuss briefly the health reforms of the 1990s then, for discussion and debate, provide seven suggestions for how this resurrection might be achieved thereby avoiding the need for charity hospitals throughout the country. [ABSTRACT FROM AUTHOR]

A wide ranging set of reforms is being introduced into the English National Health Service (NHS). They are designed to increase the market-like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services. This paper is concerned with one aspect of those reforms: namely the policy to increase the diversity of types of providers of care to NHS patients. In this context, increasing diversity means that providers will not all be standard publicly owned NHS organizations. They can be publicly owned but autonomous, or independent (both in for-profit and not for profit). The paper discusses the wide range of organizational forms available, analyzing their governance structures It then discusses the small amount of evidence currently available about the performance of diverse providers of health care. [ABSTRACT FROM AUTHOR]

This paper explores nurses' experiences as members of primary care organisations set up to develop and commission health services for local communities. Nurses, alongside GPs and other health professionals, were given a place on the governing bodies (boards) of Local Health Groups - a move widely welcomed by the nursing profession as long overdue recognition of the important contribution nurses and nursing could bring to the policy arena. Nurse board members faced a number of challenges in their attempts to contribute to and influence local health policy. This ethnographic study (which involved non-participant observation of 33 board meetings and interviews with 29 board members including nurses) suggests that medical authority and control, and hierarchical power relations between doctors and nurses on the board, were seen by nurses as significant obstacles to their participation in this new policy arena. In response to their perceived lack of power and subordinate status, nurses employed a number of strategies to negotiate their participation as board members - these included 'getting it right', 'achieving the right balance', 'self-presentation' and 'unassertiveness'. These strategies reflected and reproduced gendered identities and relations of power and raise important questions regarding the influence of nurses and nursing within policy making. [ABSTRACT FROM AUTHOR]

Although the National Health Service was created to achieve equity of access to health care in 1948, over twenty years later an ‘inverse care law’ was seen to operate. The 1976 Report of the Resource Allocation Working Party laid the principles of formula funding to achieve an equitable distribution of resources, to move, over time, towards the operation of a proportionate care law. These principles have been applied ever since in England. This paper describes the context, governance and subsequent development of formulas and three persistent problems: accounting for populations, their needs and variations in the unavoidable costs of providers. The paper concludes by outlining continuing problems from the past and new challenges of formula funding in England to reduce ‘avoidable’ inequalities in health. [ABSTRACT FROM AUTHOR]

This paper reports on a particular aspect of a larger ethnographic study of nursing culture in an intensive therapy unit (ITU), accomplished through participant observation over a 12-month period, followed by interviews with 15 nurses. The paper suggests that the ITU environment is perceived as 'dangerous', its dangerousness stemming from the ambiguity of its patients' conditions. Drawing on anthropological concepts of liminality, pollution, anomaly and breaching of boundaries, the paper identifies various ambiguities inherent in ITU patients' conditions. It then explores the ways in which these anomalies are managed through sequestration and other ritual and symbolic practices. Notwithstanding the undoubted scientific reasons for particular nursing practices, the paper argues that there are also ritual and symbolic elements serving other more complex purposes, both protecting patients and staff and symbolising the highly valued phenomenon of keeping patients safe. The paper identifies a contradiction inherent in nursing work in this locale inasmuch as rituals and symbolism coexist with technical and research-based elements of nursing care. [ABSTRACT FROM AUTHOR]

Rationale In the evolution of the team concept, clear distinctions between ‘groups’ and ‘teams’ were made. In this paper we argue that these distinctions were not made explicit in the translation of team structures to health care. Even though teams are appropriate for many health care settings, this paper explores the notion that when teams may not be working, it is the concept of team that may not be appropriate, not the functioning of the team itself. Methods This paper reviews the differences between teams and groups, and identifies how these differences are expressed in health care settings using urban and rural examples from the UK and Australia. Results Some suggestions about matching structures to suit the unique nature of health care provision, particularly in community health settings, are made. Discussion Instead of concentrating on improving the process of teams, the focus could be better directed to ensure that whatever structure is utilized best facilitates the necessary outcomes in the most effective way. The team approach may not always be the best approach, and sometimes referring to a number of people working together as a group is sufficient. [ABSTRACT FROM AUTHOR]

There is an interesting and continuing debate on the nature and role of social protection in poverty reduction. Within the health sector, discussion has focussed on the drawbacks associated with fee exemption schemes and community-based health insurance, with much less attention paid to the policy option of abolishing user fees. This paper reviews empirical evidence on the impact of the Government of Uganda's decision in 2001 to abolish user fees for health services. The paper finds that this policy intervention has had a significant positive impact on health-seeking behaviour in Uganda and concludes that this policy measure can make an important contribution towards a more ‘promotional’ policy approach to social protection. [ABSTRACT FROM AUTHOR]

The rural and remote primary medical workforce continues to struggle to meet community needs. This paper looks at the strengths and weaknesses of the various datasets used to measure workforce. The analysis concludes that no current data set adequately describes workforce from a community need perspective. In particular, activity based data sets based on claims data do not capture issues such as service mix or the importance of issues outside activity collections, such as time on call. The paper calls for a new approach to workforce measurement based on a community needs model. [ABSTRACT FROM AUTHOR]

Current UK policy has resulted in greater requirements for public and patient participation in health service planning and decision making. Organizations and services need to be able to monitor and evaluate the effectiveness and quality of their community involvement processes, but there are few appropriate evaluation tools or sets of indicators available. This paper reports on work within Bradford Health Action Zone to develop a self-assessment tool for organizations on community involvement.A multi-agency working group developed the tool. A literature search was undertaken and evaluation resources were reviewed. A set of benchmarks for community involvement in regeneration was utilized in developing the assessment areas. A range of individuals with expertise on community involvement practice and performance management was consulted. The tool was then piloted in two primary care trusts prior to final modifications.The process resulted in the production of Well Connected– a self-assessment tool on community involvement designed for organizations to assess their progress and identify areas for improvement. A scoring system assesses evidence of a strategic approach to community involvement, good practice throughout the organization, and a range of opportunities and support. Feedback from the pilots revealed that the tool had facilitated assessment of the strengths and weaknesses of organizational practices.The paper discusses some of the methodological challenges pertaining to the measurement of community involvement. Notwithstanding those challenges, it is argued that Well Connected provides a robust and practical framework that health organizations and their partners can use to assess practice. [ABSTRACT FROM AUTHOR]

Due to their propensity for acting out with antisocial behaviours, angry men are often regarded as having antisocial personality disorder with little hope for treatment success. Whilst not denying the difficulties in working with angry men, this paper looks to challenge some of the received wisdom in this area. Antisocial personality disorder is compared with borderline personality disorder and the many similarities, including the association with childhood trauma, course of illness, symptoms and rates of occurrence, are discussed. Differences between the two groups may be associated with the internalization or externalization of anger. Some issues related to bias in diagnosis are raised, as is the universal hopelessness implied in the literature related to treatment of antisocial personality disorder. Some issues related to engaging traditional men are discussed. In this paper the term 'traditional men' is used to describe men who value stoicism, self-reliance, strength, work, status and aggression highly whilst denying any vulnerability and exhibiting restricted emotionality. There is a need to reframe the diagnosis in order to recognize the associated behaviours as being an adult manifestation of complex childhood trauma. Further, there is a need for treatment directed towards altering ongoing patterns of retraumatization which characterize the lives of these men. A case study is included to demonstrate a number of the issues involved in working with angry men. These include issues of connection, boundaries, safety and utilization of the general practitioner in setting up a containing structure. The case study is used to illustrate that when issues of connection and anger containment are positively addressed, good therapeutic outcomes are possible. [ABSTRACT FROM AUTHOR]

Background. A systematic review of the research literature published between 19992003 was carried out to review how primary care trust groups and primary care organisations were monitoring the implementation of clinical governance and the effects this may have on nursing.Method. Studies were limited to research papers with explicit methodology applicable to primary care trusts. The selection criteria, search procedures and methods of data extraction and analysis were formed at the outset.Data collection. A data extraction tool developed by Cormack was adapted as a guide to include nine areas of methodological appraisal in summary forms.Results. Initially 87 articles were identified from the search. When papers were omitted on the exclusion criteria seven studies remained.Conclusion. Clinical governance is a notable example of co-ordinated policy development and the entire concept can be difficult to translate into the integrated and systematic approach to improving quality of care. Clinical governance requires changes at three levels: the individual health care professional, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams.Relevance to clinical practice. Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness. Whilst the sharing of information between practices is seen to be increasing with multi-professional study days occurring in some areas this in turn needs commitment for time and funding. The organisational and cultural environment within the trust as well as resource issues needs continuous attention if high quality governance is to become the norm. [ABSTRACT FROM AUTHOR]

BACKGROUND: The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non-medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS. AIM: The aim of this paper is to discuss a case study of the effects of changing nurses' pay progression. METHODS: Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents. FINDINGS: Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme. CONCLUSIONS: The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging. [ABSTRACT FROM AUTHOR]

This paper is the second of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Based on a theoretical and empirical review of available evidence, here we introduce the process by which a Practice can start to become a Learning Practice (LP). Steps taken to enhance both individual and organizational learning begin the process of moving towards a learning culture. Attention is given to the routines that can be established within the practice to make learning systematically an integral part of what the practice does. This involves focusing on all three of single-, double- and triple-loop learning. Within the paper, a distinction is made between individual, collective and organizational learning. We argue that individual and collective learning may be easier to achieve than organizational learning as processes and systems already exist within the Health Service to facilitate personal learning and development with some opportunities for collective and integrated learning and working. However, although organizational learning needs to spread beyond the LP to the wider Health Service to inform future training courses, policy and decision-making, there currently seem to be few processes by which this might be achieved. This paper contributes to the wider quality improvement debate in three main ways. First, by reviewing existing theoretical and empirical material on LOs in health care settings it provides both an informed vision and a set of practical guidelines on the ways in which a Practice could start to effect its own regime of learning, innovation and change. Second, it highlights the paucity of opportunities individual general practitioner practices have to share their learning more widely. Thirdly, it adds to the evidence base on how to apply LO theory and activate learning cultures in health care settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. AIM: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. DISCUSSION: Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. CONCLUSION: Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced. [ABSTRACT FROM AUTHOR]

Abstract In this paper we describe and analyse results from an empirical study designed to provide insight into factors facilitating and/or inhibiting the emergence of the much-heralded ‘informed patient’ and its sociological equivalent, the ‘reflexive patient’ or ‘reflexive consumer’. In particular, we seek to examine the relationship between information and empowerment in a healthcare context and assess the significance of the Internet in mediating this relationship. The paper draws on data from interviews with 32 mid-life women concerned to know about HRT for the relief of menopausal symptoms. Having analysed these women's ‘information practices’, we conclude that constraints on the emergence of the informed patient identity exist within both patient and practitioner communities and within the space occupied by both in the medical encounter. In particular, in this paper we identify a tension caused by the emphasis on ‘information for choice’ in the informed patient discourse which itself obscures the potential conflict between lay and expert/medical knowledges in the clinical encounter. [ABSTRACT FROM AUTHOR]

A central theme underpinning the reform of public-sector services in western economies since the 1980s has been the emphasis on reorienting service provision around the user. Public-sector organizations have been forced to reappraise the design of the service delivery process, in particular the service encounter, to take account of the resultant changes in service users' expectations. Such focus on the service user has fundamental implications for public-sector professionals, specifically challenging the dominance of service professionals in the design and delivery of services. Based on a survey of patient attitudes towards service provision in the National Health Service in Scotland (NHSiS) and in-depth interviews with senior hospital clinicians and managers, the paper critically examines the reaction of both patients and professionals to politically driven initiatives to reorientate the delivery of health-care services. Specifically the paper explores the emerging perspectives of both patients and professionals towards the consumerization of health care and the changing nature of the relationship between patients and professionals within a publicly funded health-care system. [ABSTRACT FROM AUTHOR]

The paper examines the conception, implementation and abolition of the GP fundholding scheme, all within 10 years, for evidence of a changed style of health care policy-making. A health care policy community, in which the interests of the medical profession were prominent, existed between 1948 and the mid-1980s. The paper highlights the important factors in the breakdown of the policy community and traces the effect through to the negotiation, implementation and abolition of the GP fundholding scheme. In particular, the role of evidence in health care policy-making has changed significantly. A consequence of the collapse of the policy community has been that a ‘folk psychology’ rather than evaluative evidence has guided some aspects of health care policy since the 1990s. [ABSTRACT FROM AUTHOR]