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In recent high-quality surveys of health issues, ranging from adult primary care (1) to hospital executive views (2) of quality of care, in 5 English-speaking countries, Canada was found to [...]

Five years ago former RCN general secretary Christine Hancock watched uneasily as the NHS got into bed with the independent sector. The historic 'concordat' between the Department of Health and [...]

Byline: Sharath. Nagaraja, Seema. Prakash, Suresh. Kumbhar, Deepthi. Kiran, Purabi. Phukan, Puneeth. Kumar, Ritesh. Menezes Employees State Insurance Corporation (ESIC) hospital at Rajajinagar, Bengaluru conducts regular health camps at industries. [...]

Byline: Chung-Chu Liu The purpose of this study is to create digital capital measures for hospital service websites. Three methods were employed to collect and analyse data: literature review, content analysis and the analytic hierarchy process. According to the results, the digital capital has been categorised into three dimensions: internet relation capital, internet patient capital and internet service capital. The research has also developed ten indicators for digital capital assessment. Measuring digital capital can be used to improve the service quality of hospital websites and provide evaluation feedback for website managers.

Byline: Mamta. Singh [SUPPORTING:1] A 2-3 day camp for epilepsy awareness, screening and treatment is now a regular service provided on the Lifeline Express. The hospital-train covers 10 rural destinations [...]

Background: Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries. Methods and Findings: In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population. Conclusion: The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality. Please see later in the article for the Editors' Summary., Introduction The current drive towards a health systems approach for delivering health care interventions in Africa opens an opportunity to redress long-standing neglect in the provision of surgical services [1,2]. [...]

Background: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. Methods and Findings: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. Conclusion: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary., Introduction There is a growing realization of the importance of surgical conditions in the overall burden of disease in low- and middle-income countries [1-5]. The Bellagio Essential Surgery Group (BESG), [...]

This two-phase research project was conducted to examine the content of corporate-and hospital-sponsored wellness programs and to determine the characteristics of the nutrition provider. In the first phase of the study, a questionnaire was sent to 150 wellness program directors located throughout the United States to determine the nature of their total wellness program. In the second phase, questionnaires were sent to the nutrition provider to elicit specific information on the characteristics and requirements for that position. Results indicated that corporate- and hospital-sponsored wellness programs offered a variety of activities. Those incorporating a nutrition component offered a range of events from nutrition assessment to individual counseling and disease awareness programs. The position of nutrition provider was most often held by a 26- to 46-year old woman with a master's degree and experience and educational background in an allied health field other than dietetics or nutrition. Registered dietitians were more likely to be responsible for the nutrition component of a hospital program than of a corporate program. Our results suggest that opportunities exist for registered dietitians in the field of health promotion and wellness., Title XVII of the Public Health Service Act of 1976 advocated the establishment of national goals for health promotion and the design of strategies for achieving wellness (1). Large corporations [...]

The temporal and spatial diversity of the microbiota is analyzed in a low-usage and a high-usage Norwegian hospital tap. The studies have shown that founder effects and local adaptation caused the tap-specific colonization patterns and the tap-specific colonization has represented a potential challenge for water safety.

Context.--On-call responsibility is an important part of residency training in clinical pathology. This task provides important consultative services for the hospital and serves as a valuable learning experience for the resident. Objective.--To identify the types of calls received by residents at a large teaching hospital, to assess how and why these calls have changed over time, and to determine the educational value in tracking such changes. Design.--A retrospective review of resident on-call records from 2 periods (2005-2006 and 1997-1998) was performed. Calls were classified based on the call subject and the caller. Results.--Although some general patterns remained similar, several differences were identified between the time periods. Calls regarding mislabeled specimens fell, while calls concerning panic values and the blood bank (specifically therapeutic apheresis) increased. Conclusions.--The different patterns identified in calls between the 2 periods reflect the ever-changing role of the clinical pathologist within the hospital system and provide evidence that monitoring these shifting patterns could be a valuable tool in the education of clinical pathology residents., Clinical pathologists serve as consultants for physicians, nurses, and laboratory personnel alike. As leaders in the laboratory, clinical pathologists must possess excellent communication skills and understand how to solve problems [...]

After many years of concern about excess hospital capacity, a growing perception exists that the capacity of some hospitals now seems constrained. This article explores the reasons behind this changing perception, looking at the longitudinal data and in-depth interviews for hospitals in four study sites monitored by the Community Tracking Study of the Center for Studying Health System Change. Notwithstanding the differences for individual hospitals, we observed that adjustments to the supply of hospital services tend to be slow and out of sync with changes in the demand for hospital services. Those hospitals reporting capacity problems are often teaching hospitals, located near previously closed facilities or in population growth areas. These findings suggest therefore that approaches to dealing with capacity problems might best focus on better matching individual hospitals' supply and demand adjustments.

Byline: Ala Abu-Samaha This paper presents the lessons learnt from the usage of electronic data interchange (EDI) links between general practices (GPs) and hospital trusts in the UK for the exchange of laboratory test results. The investigation encompassed a number of interviews conducted over an extended period of time, which involved a number of general practices in the Avon Health Authority localities in the southwest of England. EDI is being used in this situation to replace the previous paper-based communication of pathology laboratory results. Although this intervention has proved successful at a technical level, it has proven problematic on the organisational and personal perspectives. The usage of these EDI links has provided general practices with an innovative way to classify and store laboratory results, the success of which was never realised for many non-technical reasons. Such reasons include the importance of the physical paper result, benefits realisation, and successful integration of EDI messages into working practices and information systems.