Search

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]

This paper examines caregiving for sick older family members in the context of socio‐economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members' weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest or make care‐related choices. Underpinning people's weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings. [ABSTRACT FROM AUTHOR]

Aim: To systematically review the literature to investigate the role of the hospital pharmacist and the services provided for Aboriginal and/or Torres Strait Islander people. Methods: A systematic literature review was performed following a search from inception to present of MEDLINE, International Pharmaceutical Abstracts (IPA), EMBASE, Scopus and Pubmed, in accordance with PRISMA guidelines. All forms of published literature were included. Aboriginal and/or Torres Strait Islander people and hospital pharmacists/pharmacy department services in Australia were the populations included. Results: 1592 studies were identified. After removal of duplicates and application of inclusion and exclusion criteria, 16 papers underwent full text review, with 7 papers included in the final review. No high‐level evidence articles were found. Joanna Briggs Institute Levels of Evidence for meaningfulness were low. Settings were varied and included rural, remote and urban sites. Five articles were allocated a Donabedian Model level where the structure was described. Two papers described structure and process. None described outcomes. Hospital pharmacy services included development of models for patient care, partnerships and resource sharing in rural and remote areas and ensuring continuity of care. Conclusion: Systematic review of the literature to determine the role of hospital pharmacy services for Aboriginal and/or Torres Strait Islander people produced limited publications for review. From these, roles identified included: development of models for patient care, partnerships and resource sharing in rural and remote areas and ensuring continuity of care. Future research and publication of work by hospital pharmacists nurturing and developing relationships in partnership with Aboriginal and Torres Strait Islander communities is encouraged. [ABSTRACT FROM AUTHOR]

PAPER: Longitudinal risk of psychosis in adolescent psychiatric inpatients: A Scottish popula... I Liana Romaniuk, Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, UK i I Ian Kelleher, Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, UK i B Background: b Current approaches to identifying individuals at high risk of developing psychosis capture only a small minority of the total population who will ultimately develop psychosis. PAPER: Moving beyond psychosis transition: Stressing functioning as a key outcome in UHR rese... I Louise Birkedal Glenthøj, Mental Health Centre Copenhagen, University of Copenhagen i I Tina Dam Kristensen, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Christina Wenneberg, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Lise Mariegaard, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Merete Nordentoft, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i Expanding research into the UHR state has recognized that the UHR status confers a clinical risk beyond conversion to psychosis; that is the risk of poor functional outcome irrespective of psychosis development. Almost three decades of research on subjects with an "at risk mental state" (ARMS) have revealed few basic facts: (1) about 1 out of 3 young help-seekers with ARMS transition to psychosis at 10-11 years; (2) transition to psychosis prevalence in adolescence are commensurable to those found in adult samples, hence legitimating the rational for transitional age mental health; (3) clinical outcomes other than psychosis (e.g., suicide, self-harms, exit-syndromes other than psychosis, declining functional adaptation) are heterogeneous in both adult and adolescent ARMS, yet they are proportionally more severe than in non-ARMS help-seekers. [Extracted from the article]

Background: Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service‐delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. Aims: The first aim was to explore how school‐based speech–language therapists approached outcomes management as their clinical programmes transitioned to tiered service‐delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. Methods & Procedures: A secondary deductive‐inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. Findings & Results: Participants reported measuring and qualitatively assessing seven key outcomes for school‐based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy‐in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. Conclusions & Implications: School‐based speech–language therapists measure, assess and manage multiple outcomes relevant to school‐based practice in tiered service‐delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service‐delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical–research collaboration and knowledge exchange is recommended. What This Paper Adds: What is already known on the subject: Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech–language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school‐based practice. What are the potential or actual clinical implications of this work?: Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school‐based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools. [ABSTRACT FROM AUTHOR]

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person's own home or in an institutional setting, ought always to be a last resort. In this paper, however, I suggest that this common intuition gets things the wrong way around. Adopting a relational egalitarian framework, I argue that the most serious injustices engendered by present‐day dementia care services are contingent on broader societal structures—they can thus be ameliorated relatively easily (if resource intensively) by changing those structures. Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present‐day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart. Though we may be far from achieving just care arrangements in most of our societies, we must never lose sight of the fact that, when we engage in morally permitted informal dementia care, we are exercising our last resort. [ABSTRACT FROM AUTHOR]

Background: A Learning Health System (LHS) is a model of how routinely collected health data can be used to improve care, creating 'virtuous cycles' between data and improvement. This requires the active involvement of health service stakeholders, including patients themselves. However, to date, research has explored the acceptability of being 'data donors' rather than considering patients as active contributors. The study aimed to understand how patients should be actively involved in an LHS. Design: Ten participatory codesign workshops were conducted with eight experienced public contributors using visual, collective and iterative methods. This led contributors to challenge and revise not only the idea of an LHS but also revise the study aims and outputs. Results: The contributors proposed three exemplar roles for patients in patient‐driven LHS, which aligned with the idea of three forms of transparency: informational, participatory and accountability. 'Epistemic injustice' was considered a useful concept to express the risks of an LHS that did not provide active roles to patients (testimonial injustice) and that neglected their experience through collecting data that did not reflect the complexity of their lives (hermeneutic injustice). Discussion: Patient involvement in an LHS should be 'with and by' patients, not 'about or for'. This requires systems to actively work with and respond to patient feedback, as demonstrated within the study itself by the adaptive approach to responding to contributor questions, to work in partnership with patients to create a 'virtuous alliance' to achieve change. Patient or Public Contribution: Public contributors were active partners throughout, and co‐authored the paper. [ABSTRACT FROM AUTHOR]

The shift towards recovery‐oriented mental health care has led to the extensive growth of peer support in contemporary service delivery. When enacting peer support, peer workers (PWs) use their lived experiences of mental illness to provide support to individuals experiencing mental health difficulties. While PWs are increasingly an integrated part of mental health services, the way in which peer support unfolds in everyday practices remains understudied. Drawing on ethnographic fieldwork from Danish mental health centres, this paper investigates how peer workers and users enact experiential knowledge and expertise to support one another. Theoretically, this paper draws on a micro‐sociological approach that comprehends expertise as an interactional accomplishment enacted within institutional arrangements. First, the analysis shows how PWs and users develop affective relations based on shared illness experiences that enable the enactment of expertise. Second, it demonstrates how PWs and users engage in these relations by exchanging sympathy and knowledge according to different situational demands. Third, it shows how experiences of relational limitations make service users contest the value of experiential knowledge and PWs' position as valid experts. Centrally, this paper contributes to a general discussion of expertise and the implications of bringing lived experiences into mental health services. [ABSTRACT FROM AUTHOR]

Summary: The healthcare industry is more challenging and the super‐process interoperability should be planned in order to architecture an informational technology structure of the required data for progression of care. Large‐scale enterprises could be provided cross‐organization super‐processes operations. Therefore, each enterprise's business process management system (BPMS) may be executed cross‐organizational BPM as a kind of the process model. This study proposed a Super‐process Interoperable Optimized Architecture based on BPMS as a paradigm to satisfy the consistency of cross‐organization operations in healthcare industry. For developing the healthcare ultra‐large‐scale process management system (H‐ULS‐PMS), the paper provided interoperability optimization with intelligent recommender system in estimation component of BPMS that has been altered to H‐ULS‐PMS. This system could be recommended the appropriate concept of crossed healthcare process according to the hospitals' requirements. A graph‐based multi‐objective optimization method has been applied to control distributed resources across the hospitals. The community cloud is used as proposed architecture infrastructure for largely scaled interoperability. A practical case in hospital as a research project of a hospital in Dusseldorf‐Wersten of Germany has been studied to show the better interoperability and resource management of the proposed super‐process interoperability architecture. [ABSTRACT FROM AUTHOR]

Context: Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians’ activities in practice as they sought follow‐up information about patients. Methods: Using a constructivist grounded theory approach, semi‐structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants’ strategies when deliberately conducting follow‐up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow‐up. Results: The authors identified three themes related to follow‐up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow‐up. Analysis of participants' follow‐up processes as an activity system highlighted key tensions in the system and participants’ work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients’ outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients’ health information (rules) led to rule‐breaking or abandoning activities of locating information. Finding time to conduct desired follow‐up produced tension between this and other activity systems. Conclusion: In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow‐up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians’ skill development in developing and maintaining tracking systems for follow‐up; (iii) dedicate time in physicians’ work schedules for conducting follow‐up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians’ learning and respect patients’ privacy. [ABSTRACT FROM AUTHOR]

Hearing loss is remarkably prevalent in the geriatric population: one-quarter of adults aged 60-69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician-patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician-patient communication with older patients that were published since 2000, using the natural language phrase 'older patient physician communication.' We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician-patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one-quarter of studies of physician-elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication. [ABSTRACT FROM AUTHOR]

In response to headlines about the oral health of persons experiencing social exclusion resonating in high‐income countries, and research demonstrating the need for urgent action, a symposium entitled 'International Perspectives on Socially Inclusive Dentistry: A Call to Action' was organized for the IADR International Meeting of 2018. The aim of the symposium was to initiate an international dialogue on barriers to care, multidisciplinary action and examples of best practice for service delivery for people experiencing social exclusion; in other words, to develop the idea of inclusion oral health. Through our international exchange, what emerged was an awareness of a lack of professional consensus: What exactly is inclusion oral health? A theoretical framework to push forward the policy, research and practice agenda was clearly needed. This paper advances such a framework. Over the decades, dentistry has forged an approach to service delivery mainly through a business, demand‐led model. While oral health continues to improve globally, an important consequence of this approach is that it compounds the social exclusion that many people are already experiencing because of a constellation of economic, political, cultural and individual factors. Thus, many people are simply not getting the dental care they need. In contrast, drawing on the theoretical literature on social exclusion, intersectionality and othering, we suggest that dentistry could act as an agent for social inclusion as a more responsive, all‐encompassing form of oral health care and delivery. This paper advances a theoretical framework for inclusion oral health, and an action plan to show how inclusion oral health may become one solution in an armamentarium to tackle the global phenomena of oral health inequities. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper are to (a) Review published references to systematic reviews; (b) offer a typology of systematic reviews for synthesising evidence on health care; and (c) summarise the guides for designing, reporting and appraising the reviews.Background: Systematic reviews play a role in finding, synthesising, transferring and implementing evidence for healthcare policy, practice guidelines and allocation of health resources. They have been particularly successful in confirming or synthesising evidence for health care by meta-analysing aggregated data from multiple randomised controlled trials. However, concerns about the limitations of evidence from controlled trials have prompted interest in other review methods capable of locating and appraising evidence from more diverse, and possibly more realistic, healthcare situations.Methods: An iterative citation-tracking process with Google Search and grey literature identified 204 papers on previous typologies and methods of systematic reviews.Results and Conclusions: There are six types of systematic reviews: narrative; meta-analysis; scoping; qualitative; umbrella; and realist. Each type has distinct objectives, characteristics and attributes, but with much overlapping of methods and guides. Sensitivity to the need for qualitative evidence on complex human responses to ill-health and health care has broadened the objectives and methods of health-related systematic reviews to find, appraise and synthesis useful evidence for practice guidelines, healthcare policy and allocation of health resources. [ABSTRACT FROM AUTHOR]

Building on geography's ongoing interest in therapeutic landscapes (and assemblages), this article contributes a further dimension to thinking about the spaces and places of health and care. Whilst recognising the value of focusing on the variegated ways in which "improvements" in health, wellness, and well‐being take shape, it suggests there is also something to be gained by addressing these spaces through de‐centring "the therapeutic," and instead adopting a more‐than‐therapeutic approach in which the question of "what‐else happens?" is brought to the fore. Drawing on eight months of ethnographic research within care homes in the UK, it notes that within these spaces many activities and forms of relation can emerge that are not necessarily focused on the maintenance or improvement of health or well‐being. In particular the paper highlights: everyday homemaking by residents, friendships and rivalries between staff members, and major political events as exemplars of ordinary life within care homes that occur beyond "therapy" in its conventional sense. That said, it also notes that the therapeutic and more‐than‐therapeutic are relational, and as such, the paper's conclusion is that a more‐than‐therapeutic approach to landscapes of care can augment existing approaches through encouraging a more holistic attunement to their workings. This article proposes the idea of more‐than‐therapeutic landscapes. This idea looks to advance the therapeutic landscapes concept further by suggesting the value of an approach which de‐centres "the therapeutic" and therefore pays attention to "what else" happens in spaces of health and care and how these matter. It elaborates on this idea through reference to care homes in the UK, noting practices of homemaking, friendships, and rivalries between staff members, and the responses to major political events (in this case Brexit) as exemplary of these more‐than‐therapeutic characteristics. [ABSTRACT FROM AUTHOR]

The concept of networks has gained interest in public administration and management. They address concerns such as the coordination of multiple actors within the policy process. Networks take both formal and informal forms. As the integration of formal and informal networks in public service delivery is gaining traction, this paper uses the example of diabetes care in Australia and India to provide an analytical framework to examine one of the ways such integration of networks take place. Diabetes, a chronic long‐term disease, poses to be a global problem with a high rate of diagnosis with implications for public health expenditure. A multi‐disciplinary team, which comprises both formal and informal categories, is required to manage diabetes. This paper highlights the integration of networks in diabetes care in different institutional and cultural settings. For such form of integration of networks to work, collaboration among the various actors is important. Lessons learnt from diabetes care will be relevant for other long‐term chronic conditions to help reduce the human resource and financial burden. The analytical framework developed based on the example of diabetes care will provide useful lessons for examining the mechanics and dynamics of the integration between formal and informal networks in the field of public administration and management. The concept of networks is gaining prominence as a useful model. This paper supports the existing literature on the need for both formal and informal networks using the example of diabetes care. It develops an analytical framework to examine the interactions of formal and informal networks, which will be relevant for similar studies related to other long‐term chronic conditions and for public administration and management. [ABSTRACT FROM AUTHOR]

Summary: Background: Well‐being and uncertainty are intimately related, although less easily defined from a health care perspective. Uncertainty is intrinsic to both the science and practice of health care, and dealing with uncertainty can bring feelings of stress, avoidance and resistance, all of which are detrimental to an individual's well‐being. Context: Contrary to the majority of the literature, which suggests promoting resilience as a way to improve health care professionals' well‐being, our paper argues that a better understanding of the relationship between well‐being and uncertainty can support health care professionals in managing the complexity of everyday clinical interactions. Innovation: Various strategies and educational exercises around being comfortable in not knowing, preserving uncertainty through effective communication and the use of reflective silence are discussed to support clinical educators in recognising the impact of uncertainty on individual well‐being. The relationship between uncertainty and well‐being is poorly understood and vaguely defined ... Implications: Our paper calls for a broader understanding of the term well‐being, recognising the interplay between individual and environmental factors that contribute to maintaining our well‐being. The recommended strategies and exercises can be considered in faculty member development sessions and used to promote the incorporation of curriculum initiatives in this area. [ABSTRACT FROM AUTHOR]

Objective: Stepped care models are a possible solution to address service gaps in the provision of psychological therapies for anxiety and/or depression. The benefits may be particularly relevant for people in rural and remote areas and other under‐serviced and/or hard to reach populations, such as older adults. Design: Narrative literature review. Participants: Narrative literature review of the PubMed, Medline, and Psycinfo databases for studies reporting on the results of stepped care psychological interventions for older adults with anxiety and/or depressive symptoms. Main outcomes: Seventy‐seven papers were identified for evaluation of which nine papers met the study criteria (reporting on four individual trials). Results: We identified four controlled studies. Three of the four studies found stepped care intervention to be associated with significantly better clinical outcomes and cost‐effectiveness compared to treatment as usual. Studies primarily targeted subthreshold symptoms, mostly in primary care. Various interventions and stepping models were used. Conclusion: Stepped care has been associated with improved clinical outcomes and costs in older adults, particularly in primary care. There have been no rigorous studies of stepped delivery of psychological interventions to older depressed and anxious adults in alternative settings such as in specialist older adult mental health services or in private clinics. Although the evidence‐base for stepped care interventions is growing, it is not clear what evidence‐based treatment model should be adopted and in what services it could apply. More research is needed. However, the evidence to date is promising and suggests that stepped care approaches are feasible in older adults, and are likely to increase access to high quality interventions for older adults living in rural communities. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of the relationship between spatial control and care in nursing homes governed by Finnish municipalities. Although the attitude towards elderly care is gradually changing, most nursing homes governed by Finnish municipalities are still traditional, large institutions. In the study, I examine how care and control emerge spatially in nursing homes and how living in a limited environment shapes the everyday life of the residents. I argue that spatial practices affect the well‐being of the residents, since a great deal of the control in Finnish nursing homes is spatiotemporal. The institutions use multiple methods to control residents, such as limiting mobility and daily routines, which can also result in unintended mistreatment. As the analysis demonstrates, staff and their attitudes have a significant effect on the residents' well‐being. It also underlines how feelings of self‐determination or "imagined" liberty can relieve anxiety and feelings of being confined. Control may be needed to keep residents safe; however, there is a risk that control can merge into care which affects staff culture and the well‐being of residents. This paper responds to the call for greater diversity within carceral geography, and conceptualises the nursing home as a complex (quasi‐)carceral environment that sits uneasily on the continuum between care and control. [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]

Objective. To determine whether e/Tablets (wireless tablet computers used in community oncology clinics to collect review of systems information at point of care) are feasible, acceptable, and valid for collecting research-quality data in academic oncology. Data/Setting. Primary/Duke Breast Cancer Clinic. Design. Pilot study enrolling sample of 66 breast cancer patients. Methods. Data were collected using paper- and e/Tablet-based surveys: Functional Assessment of Cancer Therapy General, Functional Assessment of Cancer Therapy-Breast, MD Anderson Symptom Inventory, Functional Assessment of Chronic Illness Therapy (FACIT), Self-Efficacy; and two questionnaires: feasibility, satisfaction. Principal Findings. Patients supported e/Tablets as: easy to read (94 percent), easy to respond to (98 percent), comfortable weight (87 percent). Generally, electronic responses validly reflected responses provided by standard paper data collection on nearly all subscales tested. Conclusions. e/Tablets offer a valid, feasible, acceptable method for collecting research-quality, patient-reported outcomes data in outpatient academic oncology. [ABSTRACT FROM AUTHOR]

The article features the 'Milbank Quarterly" for scholarly analysis of important issues in health and health care policy. The contributions of the issue is published from many disciplines which includes history, law, medicine, epidemiology, bioethics, and full array of social science and health services research disciplines. The manuscript submissions are sent electronically to quarterly@milbank.org and editor Bradford H. Gray will make an initial determination about the suitability of the manuscript.

Background No attempt has been made to give a systematic overview of the innovative use of unannounced or incognito standardised patients. Objective To provide a systematic overview of all published studies with incognito standardised patients assessing doctors in actual practice situations using sound reliable and valid standardised patient methodology. Methods Systematic literature search in Medline, Eric and Psyclit with piloted search terms, followed by retrieving additional papers from reference lists. All papers were scored with a predefined protocol-sheet using predefined inclusion and exclusion criteria. Results Forty papers referring to 21 projects with incognito standardised patients were found and described in detail. The majority of studies were conducted in primary care and were descriptive. Discussion There is a need for research on the additional value of the incognito standardised patient methodology and for a consensus on how to report on accuracy and consistency of standardised patients. [ABSTRACT FROM AUTHOR]

The article presents instructions and publication policies which should be followed by contributors of the periodical "The Milbank Quarterly." All text in manuscript must be typed double space. Its title page should include the names, academic degrees and affiliation of all authors. Contributors should also include an abstract of not more than 125 words and four key words which introduces the topics discussed in their article.

The article offers instructions and specifications required in the passing of manuscripts to "The Milbank Quarterly." It includes writing specifications such as the contents of the title pages, references, abstracts and key words. A policy on authorship , prior dissemination, assignment of copyright and conflict of interest are also presented.

Presents instructions to authors and publication policies of the periodical "Milbank Quarterly," which deals with issues in health and health care policy. Submission of manuscripts; Specifications for manuscripts; Policies on authorship, conflict of interest, prior dissemination and assignment of copyright.

In this article the author has presented a case study on back injury prevention training and back belts. The workplace is increasingly replacing clinic and hospital settings as the preferred site for injury prevention. In this study data were systematically extracted from studies of workplace interventions aimed at the prevention of lower back pain. The focus was on job-specific interventions and compliance with these interventions, factors not often considered in studies and systematic reviews.

Pharmacogenomics (PGx)‐based personalized medicine (PM) is increasingly utilized to guide treatment decisions for many drug‐disease combinations. Notably, London Health Sciences Centre (LHSC) has pioneered a PGx program that has become a staple for London‐based specialists. Although implementational studies have been conducted in other jurisdictions, the Canadian healthcare system is understudied. Herein, the multistakeholder perspectives on implementational drivers and barriers are elucidated. Using a mixed‐method qualitative model, key stakeholders, and patients from LHSC's PGx‐based PM clinic were interviewed and surveyed, respectively. Interview transcripts were thematically analyzed in a stepwise process of customer profiling, value mapping, and business model canvasing. Value for LHSC located specialist users of PGx was driven by the quick turnaround time, independence of the PGx clinic, and the quality of information. Engagement of external specialists was only limited by access and awareness, whereas other healthcare nonusers were limited by education and applicability. The major determinant of successful adoption at novel sites were institutional champions. Patients valued and approved of the service, expressed a general willingness to pay, but often traveled far to receive genotyping. This paper discusses the critical pillars of education, awareness, advocacy, and efficiency required to address implementation barriers to healthcare service innovation in Canada. Further adoption of PGx practices into Canadian hospitals is an important factor for advancing system‐level changes in care delivery, patient experiences, and outcomes. The findings in this paper can help inform efforts to advance clinical PGx practices, but also the potential adoption and implementation of other innovative healthcare service solutions. [ABSTRACT FROM AUTHOR]

Objective: To explore how four small towns in rural New South Wales known as the 4Ts are addressing challenges accessing quality care and sustainable health services through a collaborative approach to workforce planning using the collaborative care framework. Design: Descriptive case study approach. Setting: The collaborative care project was developed as a result of ongoing partnerships between 2 rural Local Health Districts, 2 Primary Health Networks and a non‐governmental health workforce organisation. The collaboration works with 5 subregions each comprising 2 or more rural communities. This paper focuses on the 4Ts subregion. Participants: Stakeholders of the collaborative design including organisations and the community. Intervention: A place‐based approach to co‐designing health services with community in one sub‐region of Western New South Wales. Main outcome measures: A synthesis of field observations and experiences of community and jurisdictional partners in implementation of the 4Ts subregional model. Mapping of implementation processes against the collaborative care framework. Results: The collaborative care framework is a useful planning and community engagement tool to build health workforce literacy and to impact on system change at the local level. We identify key elements of effectiveness in establishing the 4Ts model, including the need for coordinated health system planning, better integrating existing resources to deliver services, community engagement, building health workforce literacy and town‐based planning. Conclusion: This study adds to the body of knowledge about how to successfully develop a collaborative primary health care workforce model in practice. The findings demonstrate that the implementation of a collaborative primary health care workforce model using the collaborative care framework can improve service access and quality, which in turn might facilitate workforce sustainability. [ABSTRACT FROM AUTHOR]

This paper uses the decomposition framework from the economics literature to examine the statistical structure of treatment effects estimated with observational data compared to those estimated from randomized studies. It begins with the estimation of treatment effects using a dummy variable in regression models and then presents the decomposition method from economics which estimates separate regression models for the comparison groups and recovers the treatment effect using bootstrapping methods. This method shows that the overall treatment effect is a weighted average of structural relationships of patient features with outcomes within each treatment arm and differences in the distributions of these features across the arms. In large randomized trials, it is assumed that the distribution of features across arms is very similar. Importantly, randomization not only balances observed features but also unobserved. Applying high dimensional balancing methods such as propensity score matching to the observational data causes the distributional terms of the decomposition model to be eliminated but unobserved features may still not be balanced in the observational data. Finally, a correction for non‐random selection into the treatment groups is introduced via a switching regime model. Theoretically, the treatment effect estimates obtained from this model should be the same as those from a randomized trial. However, there are significant challenges in identifying instrumental variables that are necessary for estimating such models. At a minimum, decomposition models are useful tools for understanding the relationship between treatment effects estimated from observational versus randomized data. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Rationale, aims and objectives Clinical governance has been advanced as a mechanism for continuous quality improvement within the UK National Health Service (NHS). This study aimed to assess whether evidence exists to support this claim. Methods A Medline search for evidence to link the introduction of clinical governance to improvements in the quality of health care was conducted. Results Of the 335 papers retrieved initially, 114 were potentially relevant to the question, but only 10 attributed changes in quality to clinical governance directly. Of these, only three attempted to provide data to support the assertion. Conclusion No sound evidence currently exists to support the claim that clinical governance will increase service quality and moves towards its implementation must therefore be questioned. [ABSTRACT FROM AUTHOR]

Many of the failures to replicate clinical findings of treatment efficacy in more realistic field and community settings can be attributed to inappropriate research designs and other methodological shortcomings. In order to increase research designers' awareness of existing methodologies that may be better suited to answer the critical questions inherent in health services research on alcohol-related issues, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) convened an expert conference with three specific goals: (1) to identify the critical issues involved in alcohol services research; (2) to develop a primer that explicated each key area; and (3) to compile the resulting primers into an accessible resource for researchers, policy makers and consumers. The 9 papers in this special supplement are the product of that conference and are organized broadly around three phases of the research process: study design and implementation, data collection and use, and the analysis and interpretation of data. A final summary paper discusses the issues and offers a synthesis of key themes as well as some direction for the future. [ABSTRACT FROM AUTHOR]

Abstract. Over the last decade, British health policy has increasingly considered the role of information and information technologies in the provision of health care. Recently, there is a growing interest in new health applications, often referred to as telemedicine and telehealth, and incorporating a diverse range of services that can be provided in electronic form over various telecommunications networks. This paper discusses how such use of information and communication technologies (ICTs) in health acquires meanings through a policy process, and what implications it has for telehealth in particular. This is done through a hermeneutic exploration of four principal UK health policy papers published between 1989 and 1998. [ABSTRACT FROM AUTHOR]

Purpose The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. Method We systematically searched the Psyc INFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. Results Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. Conclusions Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. Practitioner points Attachment theory should be used to inform the design and delivery of general mental health services., Mental health services should evaluate the extent to which they meet service users' attachment needs., Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time., Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes. [ABSTRACT FROM AUTHOR]

The Internet of Things‐based smart healthcare provides numerous facilities to patients and medical professionals. Medical professionals can monitor the patient's real‐time medical data and diagnose diseases through the medical health history stored in the cloud database. Any kind of attack on the cloud database will result in misdiagnosis of the patients by medical professionals. Therefore, it becomes a primary concern to secure private data. On the other hand, the conventional data aggregation method for smart healthcare acquires immense communication and computational cost. Edge‐enabled smart healthcare can overcome these limitations. The paper proposes an edge‐enabled efficient privacy‐preserving data aggregation (EEPPDA) scheme to secure health data. In the EEPPDA scheme, captured medical data have been encrypted by the Paillier homomorphic cryptosystem. Homomorphic encryption is engaged in the assurance of secure communication. For data transmission from patients to the cloud server (CS), data aggregation is performed on the edge server (ES). Then aggregated ciphertext data are transmitted to the CS. The CS validates the data integrity and analyzes and processes the authenticated aggregated data. The authorized medical professional executes the decryption, then the aggregated ciphertext data are decrypted in plaintext. EEPPDA utilizes the batch verification process to reduce communication costs. Our proposed scheme maintains the privacy of the patient's identity and medical data, resists any internal and external attacks, and verifies the health data integrity in the CS. The proposed scheme has significantly minimized computational complexity and communication overhead concerning the existing approach through extensive simulation. [ABSTRACT FROM AUTHOR]

Background: Speech–language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying. Aims: To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury. Methods & Procedures: This article forms part of a larger qualitative study that explored SLT&As' experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying. Outcomes & Results: Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self‐reflection and religious practices, they reported alleviation of moral injury. Conclusions & Implications: In order to mitigate moral injury in South African SLT&As, they require professional education, self‐care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As' biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury. What this paper adds?: What is already known on this subject?: Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs. What this article adds?: This article highlights the complexity of speech–language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury. Clinical implications of this article: This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self‐care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying. [ABSTRACT FROM AUTHOR]

Background: Speech–language pathologists are often involved in the assessment and management of communication, cognition and swallowing deficits in people with Parkinson's. However, speech–language pathologists' self‐perceived competency levels in serving people with Parkinson's remain elusive, especially in the Indian context where there is an increasing disability burden due to Parkinson's disease. Additionally, the challenges faced by speech–language pathologists in India to provide efficient services to this population are unidentified. Aims: To determine speech–language pathologists' self‐perceived competence and challenges faced when providing services to people with Parkinson's in India. Methods & Procedures: A survey questionnaire was sent to speech–language pathologists through emails and social media asking them questions to evaluate self‐perceived competency in serving people with Parkinson's and to identify the challenges to their service delivery. A total of 69 speech–language pathologists responded to the survey. Outcomes & Results: The majority of respondents reported to be competent in dealing with various domains of assessment and management of people with Parkinson's. Although competent, they reportedly faced a few challenges during their service delivery. Conclusions & Implications: This study provides an insight into the speech–language pathologists' self‐perceived competency in serving people with Parkinson's in India, and also identifies the challenges related to interprofessional service delivery. The findings of the study have educational and clinical implications. What this paper adds: The study delineates speech–language pathologists' self‐perceived competency in working with people with Parkinson's in India, a nation that is seeing a constant rise in the incidence of Parkinson's disease.The study the unique challenges within India to speech–language pathologists' service delivery for people with Parkinson's, thus having educational and clinical implications in Parkinson's disease care. [ABSTRACT FROM AUTHOR]

Aim: Sweden initially chose a different disease prevention and control path during the pandemic than many other European countries. In June 2020, the Swedish Government established a National Commission to examine the management of COVID‐19 in Sweden. This paper summarises, and discusses, its findings. Methods: Three reports published by the Commission were analysed. The first focused on the care of older people during the pandemic. The second examined disease and infection transmission and control and health care and public health. The third updated the first two reports and also covered economic aspects, crisis management and public communication. Results: By 25 February 2022, when the final report was published, 15 800 individuals, 1.5 per 1000 Swedish inhabitants, had died after COVID‐19. The death rates were high in spring 2020, but overall excess mortality in 2020–2021 was +0.79%, which was lower than in many other European countries. The Commission suggested that the voluntary measures that were adopted were appropriate and maintained Swedes' personal freedom during the pandemic. However, more extensive and earlier measures should have been taken, especially during the first wave. Conclusion: The Swedish COVID‐19 Commission felt that earlier and more extensive pandemic action should have been taken, particularly during the first wave. [ABSTRACT FROM AUTHOR]

Although accumulated research has demonstrated the negative impacts of workplace violence and called for effective solutions from a human resource management (HRM) perspective, a valid measure of anti‐violence HRM practices is missing. In this paper, we develop a scale of anti‐violence HRM practices that is critical for both theoretical advancement and managerial practices in health care and aged care contexts. Through an inductive approach in Study 1, we generated items for the scale to be used in health care and aged care contexts, which we then subjected to a content validity test in Study 2. Using the newly developed scale, we further demonstrated in Study 3 that anti‐violence HRM practices that are implemented in aged care facilities reduce workers' experienced violence, improve workers' emotional wellbeing, and enhance workers' organisational and career commitment. [ABSTRACT FROM AUTHOR]

Summary: In today's world, data management plays a key role in smart healthcare applications. However, data availability, trustworthiness, confidentiality, and security are the major issues faced by current healthcare data management systems. The modern healthcare systems manage Electronic Medical Records (EMR) using a centralized manner, which increases the single point of failure in the event of a natural catastrophe. In this paper, a new robust Blockchain‐based Medical Cloud (BC‐MedCl) framework has been proposed to provide secure EMR sharing between patient and doctor. Primarily, Internet of Things (IoT) devices will gather the health‐related data of the patient periodically. The proposed framework then stores the encrypted EMRs in cloud storage while their correlating hash values are placed into the blockchain. Finally, a decentralized selective smart contract‐based access control mechanism is developed to enhance the security of the proposed system. The prototype file‐sharing performance of the proposed architecture has been evaluated using the Ethereum platform. The performance results manifest that the proposed blockchain framework is more effective to handle EMR in the real‐time healthcare system with a superior accuracy ratio of 98.7% and a lesser latency ratio of 25% as compared with the existing systems. [ABSTRACT FROM AUTHOR]

Objective: To investigate the experience of nurses involved in decision‐making to transfer residents from a residential aged care facility (RACF) to their local hospital emergency department. This paper reports on the findings of the second phase of a two‐phase study. Methods: Qualitative semi‐structured interviews with 19 aged care nurses were conducted. Interviews were audio‐taped and transcribed verbatim, and a thematic analysis was carried out. Results: The analysis revealed five major themes that influenced decision‐making in relation to the transfer of a resident from the residential aged care facility to the emergency department: conflict with key stakeholders; knowledge and experience; policy and process; stakeholder perception; and recognition and support. Conclusions: Robust outreach programs, support from other health‐care professionals, and improving interdisciplinary understanding and communication between aged care nurses, paramedics and the emergency department would be advantageous to ensure effective care delivery and decision‐making. [ABSTRACT FROM AUTHOR]

Background: LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person‐centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic. Aim: This study aimed to explore tweets mentioning LGBTQ+ (centred) health care. Methods: The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis. Results: The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments. Conclusion: Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person‐centred care is hardly noticeable. Public Contribution: This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media. [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]

Recently, the spread of COVID‐19 virus infection and the increase of people number with chronic diseases have attracted great attention all over the world. The detection and control of such diseases based on patient demographic data are considered to be a major problem. The key issue in the solution to these problems is the development of methods and algorithms to forecast wellness and categorise patients according to their healthy and unhealthy states. In this paper, a comprehensive analysis of machine learning approaches in the field of diagnosing COVID‐19 has been conducted, and for the detection of chronic diseases in patients, to identify symptoms of COVID‐19 virus infection in advance, and control the situation a healthcare system has been proposed. The constructed system provides real‐time monitoring of chronic diseases and COVID‐19 virus infection in patients. The proposed system consists of five layers: IoT sensor layer, Data transmission layer, Fog layer, Cloud layer, the Application layer. The system architecture in the Fog layer uses machine learning and deep learning algorithms to diagnose patients' diseases, to generate and send diagnostic and emergency alerts to users. The classification module of the system's Fog layer categorises the patient's health status into healthy and unhealthy classes. In this module, to classify medical data the Decision Tree, Random Forest, SVM, Gradient Boosting, Logistic Regression algorithms are used. The COVID‐19 dataset is used to test the effectiveness of the methods. The best results from the comparative analysis of the methods are obtained from the Decision Tree, Random Forest, and Gradient Boosting algorithms, which are recognised data points with high accuracy and on the accuracy metric reached 1.0, 0.99, 1.0 values, respectively. The classification of the other two SVM and Logistic Regression algorithms provided the worst results, and the accuracy score of both classifiers obtained a 0.89 value. [ABSTRACT FROM AUTHOR]

Background: The need for dignity and compassion in healthcare is enshrined in policy, but is often difficult to enact in practice and what is precisely meant by these concepts is unclear. In this paper, we have explored theoretical underpinnings which form the basis of a lifeworld‐led approach which was used in a research study to support the humanity of service providers and users alike. Aim: In this article, we share our analysis of what we have learnt after undertaking an innovative appreciative action research project with patients and staff in a stroke ward with the aim of exploring if a novel phenomenologically driven and philosophically derived humanising framework could be applied in health care. Following the research, we wanted to develop a theoretical understanding of the processes occurring during the research in order to provide a framework and language which could be used to support practical lifeworld developments in the future. We analysed the approach through Participatory and Appreciative Action Reflection. Findings: As researchers, we found that the approach was underpinned by four key existential principles. The first principle was recognising a mutually arising reality rather than a reality 'out there'. The second was recognising a reality which was constantly changing rather than 'fixed'. The third was recognising that we needed to work from within, as part of a human living system rather than trying to control reality from the 'outside'. Finally, we recognised that this reality could only be accessed through human knowing, including embodied knowing rather than intellectual knowing alone. These principles challenged many of the usual ways of thinking and working within research and healthcare contexts. Conclusion: Understanding the processes and reality in this way gave new perspectives; enhancing our understandings and views of ourselves, what is important and most importantly what is possible in caring systems. [ABSTRACT FROM AUTHOR]

Terms like 'levels' and 'nested' are used to describe relationships between components of conceptual systems (theories, models etc.). However, they have not been fully explored. This paper investigates levels to better understand how theories are structured and so how we may develop more useful theories and models to better support more effective practice. We find a horizontal dimension (represented by causal connections between concepts at one ontological level) and a vertical dimension (represented by connections of emergence between concepts of differing ontological levels). This view of emergence offers a new way to structurally distinguish between conceptual components of a theory, thus supporting a new approach to building theories that better reflects our systemic world. A third, perspectival, approach may be applied to aid in the understanding of both dimensions. A typology is proposed as are conventions for diagramming theories and new criteria for improving the structure of theories. [ABSTRACT FROM AUTHOR]

China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China. [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: Worldwide, coronavirus disease 2019 (COVID‐19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID‐19 pandemic, hospitals in NZ were tasked with formulating their own COVID‐19 responses based on the Ministry of Health's (MoH) recommendations. Methods: This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID‐19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician. Results: All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non‐urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID‐19 operating theatres. Potential COVID‐19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency. Conclusion: General surgical departments in NZ had implemented a comprehensive COVID‐19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices. [ABSTRACT FROM AUTHOR]

This paper explores how a new French law incorporating a new conceptualization of disability formulated at the international level by the WHO is appropriated at the local level by multidisciplinary teams of professionals in charge of the assessment of disability. Drawing on social representations theory, its concept of cognitive polyphasia and its conceptualization of legal innovation, the paper specifically examines how the teams deal with the tensions between the old and the new models of disability and how the group dynamic is associated with how they do this: by hybridization of old and new models, by selective prevalence according to context, or by displacement of one model. Focus groups with the teams (n = 65 from 10 groups), analysed with indicators of interaction, bring evidence of the three forms. They show how different groups, by drawing differently, depending on their relational dynamics, from a variety of meaning systems circulating at the cultural level, reach different decisions that may lead to different practices in the local implementation of the same laws. We finish by discussing how social representations theory, linking the cultural/global and the interactional/local levels, can enhance our understanding of how socio‐psychological processes intervening in the appropriation of legal innovations may produce different practical implementations of the same new laws. [ABSTRACT FROM AUTHOR]