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In 2021, a large urban university-based hospital transitioned to a new two-floor emergency department. Despite the new environment, there were usability and workflow challenges with the space. The authors of this paper created a multidisciplinary, human-centered design collaborative of clinicians, university faculty, and students in an effort to increase emergency department efficiency. After thorough design-research and clinician-focused collaboration, the authors and design team identified the need to improve medical supply retrieval time, which directly impacts patient care and clinician satisfaction. The primary interventions consisted of a redesign that is as follows: (a) created standardized icons related to organ system, (b) increased visibility of supply labels, and (c) reorganized supplies based on usage data. Although a successful project, it was not without several barriers discussed in this article, including design researcher and clinician-level setting and engagement, academic/institutional policies, and conflicting schedules. In addition, the lessons learned from implementing human-centered design concepts into clinical workflow sets forth future research opportunities and inspiration for other institutions to collaborate. [ABSTRACT FROM AUTHOR]

The article offers information on the updated position paper on the policies relating to HIV infection in the U.S. The position paper on HIV policy has been established in collaboration with the HIV Medicine Association of the Infectious Diseases Society of America and the American College of Physicians. The updated HIV policy highlights major advances on the treatment of HIV infection, the expansion of HIV as a pandemic and the prevalence of HIV transmission in health care settings. Details on these updates emphasizing public health and clinical imperatives in identifying HIV infection are discussed.

Background: The role of Artificial intelligence (AI) which is defined as the ability of computers to perform tasks that normally require human intelligence is constantly expanding. Medicine was slow to embrace AI. However, the role of AI in medicine is rapidly expanding and promises to revolutionize patient care in the coming years. In addition, it has the ability to democratize high level medical care and make it accessible to all parts of the world. Main text: Among specialties of medicine, some like radiology were relatively quick to adopt AI whereas others especially pathology (and surgical pathology in particular) are only just beginning to utilize AI. AI promises to play a major role in accurate diagnosis, prognosis and treatment of cancers. In this paper, the general principles of AI are defined first followed by a detailed discussion of its current role in medicine. In the second half of this comprehensive review, the current and future role of AI in surgical pathology is discussed in detail including an account of the practical difficulties involved and the fear of pathologists of being replaced by computer algorithms. A number of recent studies which demonstrate the usefulness of AI in the practice of surgical pathology are highlighted. Conclusion: AI has the potential to transform the practice of surgical pathology by ensuring rapid and accurate results and enabling pathologists to focus on higher level diagnostic and consultative tasks such as integrating molecular, morphologic and clinical information to make accurate diagnosis in difficult cases, determine prognosis objectively and in this way contribute to personalized care. [ABSTRACT FROM AUTHOR]

During the last third of the nineteenth century, Buenos Aires physicians dealt extensively with hysterical pathology, especially among the female population. The purpose of this paper is to analyze the various theoretical fabrications elaborated by those professionals about the disease. After recognizing a first set of writings in which a certain morbid autonomy was not granted to the condition, the theoretical frameworks prevailing in the subsequent works are described in detail. Special attention is paid to clinical devices used by doctors in their practice, since it is assumed that those devices had a clear impact on the ways the pathology was understood. [ABSTRACT FROM AUTHOR]

The paper uses a bibliometric analysis explore citations trend of ethnomedicine and information management, and text mining algorithm of a total number of 8, 333 publications (n = 8,333) were conducted based on the title, abstract and keywords to find co-occurrence of key terms in indigenous medicine and information management. The objectives of this study were to first, analyze the authorship, outputs and citation trend and to find out if researchers have been able to establish a nexus between indigenous herbal use and the role of information management in promoting such use. Second, to establish if there is an already link in the information management research through collaboration as a nexus to promoting indigenous use of herbal medicine to enhance public healthcare delivery systems in the continent. A computation synthesis of the data was performed using R programming statistical analysis and VOS bibliometric software to visualize the analyzed data. Based on the R programming output, the total author sample size were 35,970 (n = 35,970), and their total publications outputs were n= 8,333 and the total outputs parameters was as follows: Min = 5.00 Max = 71.00, µ = 10.59. The average citation per items was 4.74 (ACP = 4.74) h-index=60, sum of times cited (STC = 39,572), citing articles (CA = 32,749) without self-citations (n =36,042) and it's citing articles (CA= 30,777). The findings suggested that researchers were yet to establish the nexus between information management and its impact in promoting indigenous use of natural remedies within the public healthcare delivery to promote its efficacies. [ABSTRACT FROM AUTHOR]

Research in the field of health with the participation of social anthropology in Chile is scarce. On the other hand, studies in social sciences, whether funded by the state and / or universities, are usually not linked to concrete problems. In this context, this paper presents an experience of forming an interdisciplinary team that has tried to know the medical models of indigenous origin in the Chilean north and the strategies of attention to the diseases deployed by Aymara families. Its purpose is to address the problems faced by health and social sciences professionals, the constraints generated by specialized training to find solutions in specific situations, and the difficulties that arise for transdisciplinary research. [ABSTRACT FROM AUTHOR]

This paper has in part emerged from work recently undertaken by Parker and Pant under a British Academy funded Small Grant examining the phenomenon of aging in Nepal. This has enabled them to work in collaboration with the Nepal School of Social Work in Kathmandu to both generate locally relevant empirical research on aging and to facilitate the creation of spaces for dialogue on the implications of aging in Nepal. As a result of this project a network of key academics, activists, government policy makers and non-government organizations, both national and international, has been formed. The findings of this study reveal a lack of both empirical data and theoretical development on aging in Nepal. Aging in the west is often viewed from a biomedical perspective where the emphasis is on medical treatment and health and social care arrangements. Biomedicine also dominates international health strategies, organizations, and the funding streams for aid, of which Nepal is a recipient. Whilst longevity is clearly a positive outcome of development, it also presents health and social care dilemmas. This paper provides an opportunity to explore some of these key issues and highlights the need for practitioners, policy makers and the research community in Nepal to provide an open dialogue in which local, culturally appropriate decisions can be developed in the best interest of older people in Nepal. [ABSTRACT FROM AUTHOR]

Background: Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings: Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions: One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm. [ABSTRACT FROM AUTHOR]

This purpose of this paper is to review the literature on racial/ethnic disparities in the utilization and quality of care and the proposed explanations for these differences. First, the literature on racial/ethnic disparities in medical treatment is reviewed briefly with the goal of providing a sense of the range of procedures and conditions on which these disparities occur. Then, the possible role of physician/provider, patient, and health care system factors in contributing to these disparities is reviewed. Finally, suggestions for new or expanded directions for research in each of these three areas are given. The goal of the paper is to identify factors that might be particularly amenable to the type of research done by health psychologists. [ABSTRACT FROM AUTHOR]

Despite incredible technological advancements in diagnostics and treatment, medicine remains the last significant paper-based industry in the United States. In fits and starts, the American healthcare system is transitioning from paper charts to electronic records. The ultimate goal is a nationwide health information network that includes a comprehensive, interoperable electronic medical record for each patient. The effective use of health information technology (HIT) in physician offices, hospitals, and even patients' homes promises to hold down rising healthcare costs and improve Americans' health. Unfortunately, no overarching national strategy has emerged for designing and implementing such a system. Though federal officials increasingly promote the use of HIT, state efforts have driven most government progress. This dual-track regulatory strategy carries significant risks of interstate redundancy and incompatibility. This Note argues that a national policy of state experimentation would mitigate these risks and best exploit HIT's considerable potential. Building on the ideas of democratic experimentalism, such a framework would encourage state innovation but require interstate collaboration and adherence to emerging standards in return. This Note's proposal would establish a forum for interstate collaboration, require state participation through a designated HIT coordinator, mandate information sharing among state and federal officials, and create a mechanism to rein in potentially disruptive state policies. In addition to offering a roadmap for the nation's HIT transition, this Note also provides a lens through which to view-and an opportunity to address-several criticisms of democratic experimentalist theory. [ABSTRACT FROM AUTHOR]

A challenge has recently been levelled against the legal and/or moral legitimacy of some advance directives. It has been argued that in certain cases an advance directive carries no weight in a decision on whether to withhold treatment, since the individual in the debilitating state is not the same person as the person who created the advance directive. In the first section of this paper, I examine two formulations of the argument against the moral legitimacy of the advance directives under review. The second section reviews, and criticizes, an objection to such arguments. In the penultimate section, possible models supporting the viability of the advance directives are considered. The final section makes good on an obligation incurred by the title of the paper. [ABSTRACT FROM AUTHOR]

This paper re-examines missionary medicine in Tanganyika, considering its relationship with the colonial state, the impulses that led it to evolve in the way that it did, and the nature of the medical services it offered. The paper suggests that, contrary to traditional depictions, missionary medicine was not entirely curative in focus, small in scale, nor inappropriate to the health needs of the communities in which it was based. Rather, missionary medicine should be considered as a vital aspect of early colonial health services, serving those excluded by the colonial state. Missionary medicine before 1945 was fragmented, small-scale, lacking in resources and overstretched. Its services could not necessarily compete in quality with the best of the state hospitals. But it succeeded, within the local context, in providing a network of health services that stretched into the rural society, and ensured that, where there was a mission hospital, there was an option for the local people to make western biomedicine a choice for healing. [ABSTRACT FROM AUTHOR]

Background: There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006. Methods: The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases. Results: This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system. Conclusion: The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis. [ABSTRACT FROM AUTHOR]

Health-care costs are rising dramatically. Errors in medical delivery are associated with an alarming number of preventable, often fatal adverse events. A promising strategy for reversing these trends is to modernize and transform the health-care information exchange (HIE), that is, the mobilization of health-care information electronically across organizations within a region or community. The current HIE is inefficient and error-prone; it is largely paper-based, fragmented, and therefore overly complex, often relying on antiquated IT (information technology). To address these weaknesses, projects are underway to build regional and national HIEs which provide interoperable access to a variety of data sources, by a variety of stakeholders, for a variety of purposes. In this paper we present a technologist's guide to health-care interoperability. We define the stakeholders, roles, and activities that comprise an HIE solution; we describe a spectrum of interoperability approaches and point out their advantages and disadvantages; and we look in some detail at a set of real-world scenarios, discussing the interoperabitity approaches that best address the needs. These examples are drawn from IBM experience with real-world HIE engagements. [ABSTRACT FROM AUTHOR]

This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them. After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause. This is followed by proposals for interventions aimed at strengthening the overall process. Finally, potential limitations on the application of this framework at the country level are addressed. [ABSTRACT FROM AUTHOR]

This paper briefly outlines health advisor L.W. Harrison's contribution to venereology or genitourinary (GU) medicine, and shows how his principles of good practice fulfil many of the principles of clinical governance. The paper then outlines some general principles of clinical governance and indicate how they relate to GU medicine. Harrison set up the specialty on a firm foundation of clinical excellence that fulfils many of the latest requirements. He would have been thrilled to see how the specialty has broadened and would have applauded the drive for excellence. However, he might have been concerned over the literature on clinical governance, reminding that the pursuit is excellence of clinical care for the patient, and that clinical governance must not become an end in itself.

Background: Involving doctors in management has been intended as one of the strategies to spread organizational principles in healthcare settings. However, professionals often resist taking on relevant managerial responsibility, and the question concerning by which means to engage doctors in management in a manner that best fit the challenges encountered by different health systems remains open to debate.Methods: This paper analyzes the different forms of medical management experienced over time in the Italian NHS, a relevant "lab" to study the evolution of the involvement of doctors in management, and provides a framework for disentangling different dimensions of medical management.Results: We show how new means to engage frontline professionals in management spread, without deliberate planning, as a consequence of the innovations in service provision that are introduced to respond to the changes in the healthcare sector.Conclusions: This trend is promising because such means of performing medical management appear to be more easily compatible with professional logics; therefore, this could facilitate the engagement of a large proportion of professionals rather than the currently limited number of doctors who are "forced" or willing to take formal management roles. [ABSTRACT FROM AUTHOR]

Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context.Main Text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes.Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures. [ABSTRACT FROM AUTHOR]

This paper is devoted to the fault diagnosis of electronic systems by combining logical signals, such as built-in test output, and analog signals, such as voltage, current and temperature. First, the basic inference principles of dependency matrix (D matrix) diagnosis and fuzzy diagnosis are introduced, and the characteristics of their inference operators are summarized. Then, the similarities and differences between the two diagnostic methods are analyzed. Based on the judgement of close degree, a new enhanced inference operator is defined to suit both the D matrix and the fuzzy relation matrix (R matrix). A DR matrix is defined to describe the mixed relationships between faults and the two types of signals. Based on the enhanced inference operator and the DR matrix, a new hybrid diagnostic method is established. Finally, a signal modulating circuit is used to verify the effectiveness of the enhanced inference operator on the D matrix, the R matrix and the DR matrix, which demonstrates the high efficiency of the enhanced inference operator and the feasibility of the new hybrid diagnostic method. [ABSTRACT FROM AUTHOR]

This paper examines psychiatric diagnosis-making within biomedicine, as studies in this field, especially empirical ones, have attracted little attention throughout the scientific world. The widely accepted assertion, that diagnosis is the result of clinical judgement, will be discussed. Through analysis of a case study conducted in a Barcelona hospital, it will be suggested that psychiatric diagnosis is not only the result of clinical assessment, but also of psychotropic drugs translation. Drawing on actor-network theory and the notion of boundary objects established by Star and Griesemer (1989), it is therefore proposed that psychotropic drugs are boundary objects which act as central mediators in knowledge management, setting up the semiotic-material assemblage of diagnosis. [ABSTRACT FROM AUTHOR]

A great wealth of information is hidden amid medical research data that in some cases cannot be easily analyzed, if at all, using classical statistical methods. Inspired by nature, metaheuristic algorithms have been developed to offer optimal or near-optimal solutions to complex data analysis and decision-making tasks in a reasonable time. Due to their powerful features, metaheuristic algorithms have frequently been used in other fields of sciences. In medicine, however, the use of these algorithms are not known by physicians who may well benefit by applying them to solve complex medical problems. Therefore, in this paper, we introduce the genetic algorithm and its applications in medicine. The use of the genetic algorithm has promising implications in various medical specialties including radiology, radiotherapy, oncology, pediatrics, cardiology, endocrinology, surgery, obstetrics and gynecology, pulmonology, infectious diseases, orthopedics, rehabilitation medicine, neurology, pharmacotherapy, and health care management. This review introduces the applications of the genetic algorithm in disease screening, diagnosis, treatment planning, pharmacovigilance, prognosis, and health care management, and enables physicians to envision possible applications of this metaheuristic method in their medical career. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

Background: Cloud computing is a recent and fast growing area of development in healthcare. Ubiquitous, on-demand access to virtually endless resources in combination with a pay-per-use model allow for new ways of developing, delivering and using services. Cloud computing is often used in an "OMICS-context", e.g. for computing in genomics, proteomics and molecular medicine, while other field of application still seem to be underrepresented. Thus, the objective of this scoping review was to identify the current state and hot topics in research on cloud computing in healthcare beyond this traditional domain. Methods: MEDLINE was searched in July 2013 and in December 2014 for publications containing the terms "cloud computing" and "cloud-based". Each journal and conference article was categorized and summarized independently by two researchers who consolidated their findings. Results: 102 publications have been analyzed and 6 main topics have been found: telemedicine/teleconsultation, medical imaging, public health and patient self-management, hospital management and information systems, therapy, and secondary use of data. Commonly used features are broad network access for sharing and accessing data and rapid elasticity to dynamically adapt to computing demands. Eight articles favor the pay-for-use characteristics of cloud-based services avoiding upfront investments. Nevertheless, while 22 articles present very general potentials of cloud computing in the medical domain and 66 articles describe conceptual or prototypic projects, only 14 articles report from successful implementations. Further, in many articles cloud computing is seen as an analogy to internet-/web-based data sharing and the characteristics of the particular cloud computing approach are unfortunately not really illustrated. Conclusions: Even though cloud computing in healthcare is of growing interest only few successful implementations yet exist and many papers just use the term "cloud" synonymously for "using virtual machines" or "web-based" with no described benefit of the cloud paradigm. The biggest threat to the adoption in the healthcare domain is caused by involving external cloud partners: many issues of data safety and security are still to be solved. Until then, cloud computing is favored more for singular, individual features such as elasticity, pay-per-use and broad network access, rather than as cloud paradigm on its own. [ABSTRACT FROM AUTHOR]

The paper analyses the traditional speeches and imaginaries on the Revolution of the Communards in Colombia and contrasts it with sociocultural analysis and etiopathological descriptions of two illustrated parish priests and medical physicist of the eighteenth century in New Granada with the purpose of demonstrate how determinant factors of popular revolt of 1781 the tax difficulties to access the herbs, fruits and popular beverages considered medicinal and healthy, and sources of environmental welfare and socio-economic prosperity of the poorest. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the social determinants of child health is a prominent area of research. This paper examines the measurement of socioeconomic position in a sample of families of children with cancer. Socioeconomic position is difficult to measure in pediatric health research due to sensitivity of asking about finances when research is conducted in health care delivery settings, financial volatility associated with periods of pediatric illness, and difficulty recruiting fathers to research. Methods: Caregivers of children with cancer (n = 76) completed a questionnaire that included the MacArthur Scale of Subjective Social Status (SSS). SSS was measured using two 10-rung ladders with differing referent groups: the US and respondents’ communities. Respondents placed themselves on each ladder by placing an X on the rung that represented their social position in relation to the two referent groups. Individuals’ SSS ratings and discrepancies in SSS ratings within couples were examined, and associations with objective social status measures were evaluated using Pearson correlations or t-tests. Results: Parents’ placement on the US and community ladders was positively associated with their income, education, wealth, household savings, and household savings minus debt. On average, respondents placed themselves higher on the US ladder compared to the community ladder. There was an average intra-couple discrepancy of 1.25 rungs in partner’s placements on the US ladder and a 1.56 rung difference for the community ladder. This intra-couple discrepancy was not associated with gender. Discussion: Results offer insight into the use of subjective social status measures to capture a more holistic assessment of socioeconomic position and the measurement of socioeconomic position in two-parent families. [ABSTRACT FROM AUTHOR]

Background: It is known that experience of a previous crash is related to incidence of future crashes in a cohort of New Zealand cyclists. This paper investigated if the strength of such association differed by crash involvement propensity and by the need for medical care in the previous crash. Methods: The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The crash involvement propensity was estimated using propensity scores based on the participants' demographic, cycling and residential characteristics. Cox regression modelling for repeated events was performed with multivariate and propensity score adjustments. Analyses were then stratified by quintiles of the propensity score. Results: A total of 801 (31.0%) participants reported having experienced at least one bicycle crash in the twelve months prior to the baseline survey. They had a higher risk of experiencing crash events during follow-up (hazard ratio (HR): 1.43; 95% CI: 1.28, 1.60) but in the stratified analysis, this association was significant only in the highest two quintiles of the propensity score where the likelihood of having experienced a crash was more than 33%. The association was stronger for previous crashes that had received medical care (HR 1.63; 95% CI: 1.41, 1.88) compared to those that had not (HR 1.30; 95% CI: 1.14, 1.49). Conclusions: Previous crash experience increased the risk of future crash involvement in high-risk cyclists and the association was stronger for previous crashes attended medically. What distinguishes the high risk group warrants closer investigation, and the findings indicate also that health service providers could play an important role in prevention of bicycle crash injuries. [ABSTRACT FROM AUTHOR]

Background: Nearly half of births in low-income countries occur without a skilled attendant, and even fewer mothers and babies have postnatal contact with providers who can deliver preventive or curative services that save lives. Community-based maternal and newborn care programs with postnatal home visits have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits. Methods: Using data from cross-sectional surveys of women with live births (Bangladesh 398, Malawi: 900, Nepal: 615), generalized linear models were used to assess the strength of association between three factors - receipt of home visits during pregnancy, birth place, birth notification - and receipt of home visits within three days after birth. Meta-analytic techniques were used to generate pooled relative risks for each factor adjusting for other independent variables, maternal age, and education. Findings: The proportion of mothers and newborns receiving home visits within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. Mothers and newborns were more likely to receive a postnatal home visit within three days if the mother received at least one home visit during pregnancy (OR2.18, CI1.46–3.25), the birth occurred outside a facility (OR1.48, CI1.28–1.73), and the mother reported a CHW was notified of the birth (OR2.66, CI1.40–5.08). Checking the cord was the most frequently reported action; most mothers reported at least one action for newborns. Conclusions: Reaching mothers and babies with home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision. In all settings, programs must evaluate what community delivery systems can handle and how to best utilize them to improve postnatal care access. [ABSTRACT FROM AUTHOR]

Background: The vulnerability of clinical trials to volunteer bias is under-reported. Volunteer bias is systematic error due to differences between those who choose to participate in studies and those who do not. Methods and Results: This paper extends the applications of the concept of volunteer bias by using data from a trial of probiotic supplementation for childhood atopy in healthy dyads to explore 1) differences between a) trial participants and aggregated data from publicly available databases b) participants and non-participants as the trial progressed 2) impact on trial findings of weighting data according to deprivation (Townsend) fifths in the sample and target populations. 1) a) Recruits (n = 454) were less deprived than the target population, matched for area of residence and delivery dates (n = 6,893) (mean [SD] deprivation scores 0.09[4.21] and 0.79[4.08], t = 3.44, df = 511, p<0.001). b) i)As the trial progressed, representation of the most deprived decreased. These participants and smokers were less likely to be retained at 6 months (n = 430[95%]) (OR 0.29,0.13–0.67 and 0.20,0.09–0.46), and 2 years (n = 380[84%]) (aOR 0.68,0.50–0.93 and 0.55,0.28–1.09), and consent to infant blood sample donation (n = 220[48%]) (aOR 0.72,0.57–0.92 and 0.43,0.22–0.83). ii)Mothers interested in probiotics or research or reporting infants’ adverse events or rashes were more likely to attend research clinics and consent to skin-prick testing. Mothers participating to help children were more likely to consent to infant blood sample donation. 2) In one trial outcome, atopic eczema, the intervention had a positive effect only in the over-represented, least deprived group. Here, data weighting attenuated risk reduction from 6.9%(0.9–13.1%) to 4.6%(−1.4–+10.5%), and OR from 0.40(0.18–0.91) to 0.56(0.26–1.21). Other findings were unchanged. Conclusions: Potential for volunteer bias intensified during the trial, due to non-participation of the most deprived and smokers. However, these were not the only predictors of non-participation. Data weighting quantified volunteer bias and modified one important trial outcome. Trial Registration: This randomised, double blind, parallel group, placebo controlled trial is registered with the International Standard Randomised Controlled Trials Register, Number (ISRCTN) 26287422. Registered title: Probiotics in the prevention of atopy in infants and children. [ABSTRACT FROM AUTHOR]

Objective: Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method. Results: The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Conclusion: Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years. [ABSTRACT FROM AUTHOR]

Background: Starting in the 1960s, a broad-based patients’ rights movement began to question doctors’ paternalism and to demand disclosure of medical information, informed consent, and active participation by the individual in personal health care. According to scholars, these changes contributed to downplay the biomedical approach in favor of a more patient-oriented perspective. The Swedish non-profit organization Consumer Association for Medicines and Health (KILEN) has offered the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. Methodology: In this paper, qualitative content analysis was used to analyze 181 KILEN consumer reports of adverse events from antidepressant medications in order to explore patients’ views of mental ill health symptoms and the doctor-patient interaction. Principal Findings: Overall, the KILEN stories contained negative experiences of the patients’ medical encounters. Some reports indicated intense emotional outrage and strong feelings of abuse by the health care system. Many reports suggested that doctors and patients had very different accounts of the nature of the problems for which the patient was seeking help. Although patients sought help for problems like tiredness and sleeplessness (often with a personal crisis of some sort as a described cause), the treating doctor in most cases was exceptionally quick in both diagnosing depression and prescribing antidepressant treatment. When patients felt they were not being listened to, trust in the doctor was compromised. This was evident in the cases when the doctor tried to convince them to take part in medical treatment, sometimes by threatening to withdraw their sick-listing. Conclusions: Overall, this study suggests that the dynamics happening in the medical encounter may still be highly affected by a medical dominance, instead of a patient-oriented perspective. This may contribute to a questionable medicalization and/or pharmaceuticalization of depression. [ABSTRACT FROM AUTHOR]

Objective: Despite substantial investment in Electronic Medical Record (EMR) systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it. Methods: We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients. Results: There were 9,752 doctor consultations (in 5,512 consulting hours) in the Paper Medical Record (PMR) period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08) after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17). A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P<0.01) and a patient survey in each period showed no difference in satisfaction of their care (97% for PMR, 95% for EMR, P = 0.61). Conclusion: The introduction of an integrated EMR improved efficiency while maintaining the quality of the patient record. The EMR was popular with staff and was not associated with a decline in patient satisfaction in the clinical care provided. [ABSTRACT FROM AUTHOR]

Background: Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the first paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on describing the characteristics of the patients at admission. Methods: The study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009. Results: Although diverse in their characteristics, the patients were over represented by females, young to middle aged, and people on public support. The patients were mostly referred to the team by self/family members and primary care physicians. At admission, depression was the most prevalent symptom, the overall intensity level of mental health problems was low, and most of the patients had long-standing mental health problems. Conclusions: Self/family referral seems to be a critical route to receive services by CRTH teams as shown in our study, suggesting a need to examine policies that disallow this form of referral in some communities. The findings from our study show that the patients of the CRHT team, while mostly having long-standing mental health problems and had been receiving healthcare for them, did not have severe mental health problems at admission, although could have been in crises. There is a need for further studies to examine how people with severe mental health problems obtain services in time of crises, and to address the need to gain a greater understanding of the role of CRHT. [ABSTRACT FROM AUTHOR]

Objectives: Myocardial infarction (MI) is a leading cause of death in both the industrialized and developing countries globally. The economic evaluation of MI is undertaken to rationale the allocation of scarce healthcare resource. The objective is to review costeffectiveness analysis of MI with medications. Methods: We searched PubMed using the key words: "cost effectiveness analysis" and "myocardial infarction". After applying the selection criteria, eight articles were selected for the present study. Results: Out of eight articles, five had studied thrombolytic agents. All of these papers clearly explain the costs and benefits of different drugs for MI. ICER was assessed in six out of the eight articles to compare the costs and health effects between alternative medications. ICER was expressed in different effect units. Conclusions: This study found that various medications including thrombolytic agents, ACEI and heparin are administered to treat MI in many countries. It is also found that five of eight studies focus on thrombolytic therapies. It implies that thrombolytic is generally very cost effective for MI to the whole society. [ABSTRACT FROM AUTHOR]

Abstract: Held on 21st to 23rd November 2009 in Hiroshima, the SiHIS working conference aimed at finding solutions to approach to an idealistic society where (1) the individual can trust information with full understanding and responsibility, (2) the individual can allow the use of information backed by sound legitimated environment, (3) information can play its role for better healthcare and the improvement of medicine. The purpose of this paper is to propose recommendations from this working conference. [ABSTRACT FROM AUTHOR]

Background: Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policymakers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. Methods: This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies. Results: Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice. Conclusions: Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice. [ABSTRACT FROM AUTHOR]

Background: Increasing attention is being paid to variations in the use of prescription drugs because their role in health care has grown to the point where their use can be considered a proxy for health system performance. Studies have shown that prescription drug use varies across regions in the US, UK, and Canada by more than would be predicted based on age and health status alone. In this paper, we explore the determinants of variations in the use of prescription drugs, drawing on health services theories of access to care. Methods: We conducted a cross-sectional analysis using population-based administrative health care data for British Columbia (BC), Canada. We used logistic and hierarchical regressions to analyze the effects of individual- and area-level determinants of use of prescriptions overall and rates of purchase of prescriptions from five therapeutic categories representing a range of indications: antihypertensives, statins, acid reducing drugs, opioid drugs, and antidepressants. To indicate the relative scale of regional variations and the importance of individual- and area-level variables in explaining them, we computed standardized rates of utilization for 49 local health areas in BC. Results: We found that characteristics of individuals and the areas in which they live affect likelihood of prescription drug purchase. Individual-level factors influenced prescription drug purchases in ways generally consistent with behavioral models of health services use. Contextual variables exerted influences that differed by type of drug studied. Population health, education levels, and ethnic composition of local areas were associated with significant differences in the likelihood of purchasing medications. Relatively modest regional variations remained after both individual-level and area-level determinants were taken into account. Conclusions: The results of this study suggest that individual- and area-level factors should be considered when studying variations in the use of prescription drugs. Some sources of such variations, including individual- and area-level socioeconomic status, warrant further investigation and possible intervention to address inequities. [ABSTRACT FROM AUTHOR]

Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach 1 and b) User-centered design 23. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system. [ABSTRACT FROM AUTHOR]

Medicine has historically been a field where the provider of the service (physician, nurse) has a significant amount of power as compared with the recipient of the service (the patient). For the most part, this power is relatively consistent, and the power dynamic is rarely disrupted. In this essay, I share a personal experience in which a racist rant by a patient seemingly reverses the power dynamic. As the physician, I faced the realization that I may not have as much power as I believed, but fortunately I had some tools that allowed for my resilience. It is my hope that this paper will strengthen other family physicians and professional minorities that are victims of racism, discrimination, and prejudice for their race, sex, ability, sexual orientation, religion, and other axes of discrimination. [ABSTRACT FROM AUTHOR]

Abstract: Providing medical care capability in a multinational setting in space is a daunting challenge. As the International Space Station (ISS) has taken shape over the last decade the space medicine community of the ISS partners has established a foundation with which to govern medical policy, medial processes, and medical care during the ISS Program. This foundation was predicated on a rich history of bilateral and multilateral cooperation among space faring nations. Three key organizations were established, they include the agency or senior level Multilateral Medical Policy Board (MMPB), the Multilateral Space Medicine Board (MSMB), and the Multilateral Medical Operations Panel (MMOP). All three are staffed by senior medical personnel within each of the partner organizations of the ISS and each has specific roles and responsibilities. These three entities strive to protect the human element of spaceflight through highly effective interaction in a multilingual, multicultural program. This paper reviews the creation of this tripartite approach to the development of medical policy for ISS. [Copyright &y& Elsevier]

Background: Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.Objective: We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.Design: Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.Participants: Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.Interventions: Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.Measurements: We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main Results: Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.Conclusions: With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services. [ABSTRACT FROM AUTHOR]

The article discusses issues concerning the integration of evidence based medicine and introduces the concept of the Minimum Clinically Important Difference (MCID). It analyses The paper by Walenkamp and colleagues which determined the MCID for the Patient Rated Wrist Evaluation (PRWE) score in patients with distal radius fractures and concludes stressing it as beneficial for patients with diseases and treatments with weak correlation of objective findings.

Historical skills—especially the methodologies involved in interpreting a wide range of sources—can provide a useful analysis of the structure and function of health services, and be used as a means of improving public understanding of the expectations and experiences of health and health care. This paper discusses some key examples of different strategies used by historians to show how they can collaborate effectively with health professionals. [ABSTRACT FROM AUTHOR]

The ethics review system of research is now well-established, at least in the developed world, although there are many differences in how countries view it and go about managing it. The UK specifically is now seeking to revise its system by speeding up the process of ethics approval but only for some studies. It is proposed that only those studies which pose "no material ethical issues" should be "fast-tracked". However, it is unclear what this means, who should decide and what should be included in this category. In this paper, we go some way towards answering these questions. While we are certain that the debate is only just beginning, we are equally certain that it will continue to run long after the system has been reformed. To stimulate this conversation and to inform a pilot project of the new system directly, we review two candidates to help give some substance to the notion of "material" ethical issues. Firstly, material could mean a certain type or degree of risk. Second, material could mean how physically invasive the research is. We conclude that there is still much work to be done on making the system of governing health and social care consistent and practicable. [ABSTRACT FROM AUTHOR]

This paper discusses the notion of using international shipping legislation to provide healthcare technologies to inhabitants of a country on a ship in international waters based just outside the country's border. This allows technologies that would otherwise be unavailable, regulated or banned to the citizens of a particular nation to be available, just offshore. This is because in international waters ships are governed by the laws of their home nation not those they are nearby. We focus on the example suggested recently in the UK of "sperm ships", flying Danish flags to circumvent IVF regulation in the UK. While we acknowledge that this general strategy could be used to do good by providing healthcare where it would not be otherwise available, it also provides a significant challenge to the effective sovereignty of the state and its ability to regulate healthcare technologies for the benefit of its citizens. We discuss this challenge to the regulation of healthcare and suggest a few tentative solutions. [ABSTRACT FROM AUTHOR]

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the "Rule of Rescue"). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. [ABSTRACT FROM AUTHOR]

The introduction of conscience clauses after the 1973 US Supreme Court decision in Roe v. Wade allowed physicians and nurses to opt out of medical procedures, particularly abortions, to which they were morally opposed. In recent years pharmacists have requested the same consideration with regard to dispensing some medicines. This paper examines the pharmacists' role and their professional and moral obligations to patients in the light of recent refusals by pharmacists to dispense oral contraceptives. A review of John Rawls's concepts of the "original position" and the "veil of ignorance", along with consideration of the concept of compartmentalisation, are used to assess pharmacists' requests and the moral and legal rights of patients to have their prescriptive needs met. [ABSTRACT FROM AUTHOR]

Objectives: this paper focus on perceptions and experiences of women who practiced exclusive breast- feeding for a minimum period of six months. We tried to understand their attitudes and what breastfeeding meant to them in an attempt to understand how this option took place and was maintained in the group making the decision of exclusive breastfeeding. Methods: the study was oriented by social survey qualitative methodology, with an assessment and interpretative focus. The sample was comprised of 13 lactating mothers, users of the health services network of Fortaleza, State Ceará, Brazil. The technique of choice was in-depth individual interviews. Results: the complexity of breastfeeding became evident, although many times considered natural and easy to be experienced independently from the social environment where it takes place. The role played by parents and grandparents was determined as being an important element in the breastfeeding process. This study concluded that successful breastfeeding was rooted in the concepts construed by the respondents throughout their lives and in their own experiences resulting in new interpretations of concepts prior to their breastfeeding experience, as well as in the events taking place during the experience. Conclusions: such experiences are not only linked to the subjective level for they report to the dimension of real life where relationships with the healthcare professionals and services are established. [ABSTRACT FROM AUTHOR]

A number of philosophers have argued that alcoholics should receive lower priority for liver transplantations because they are morally responsible for their medical conditions. In this paper, I argue that this conclusion is false. Moral responsibility should not be used as a criterion for the allocation of medical resources. The reason I advance goes further than the technical problem of assessing moral responsibility. The deeper problem is that using moral responsibility as an allocation criterion undermines the functioning of medicine. [ABSTRACT FROM AUTHOR]