Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

AIM: This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards. BACKGROUND: Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent. METHOD: A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004. FINDINGS: The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds. CONCLUSION: Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods.     

Developing a framework for meaningful use of personal health records (PHRs)

Significant advancements have been made in the technological development of the personal health record (PHR). The goal of the PHR is to encourage patients and health consumers to take individual responsibility for their health by being more engaged in the health care process through the use of the PHR. Many PHR applications are extensions of the electronic health record (EHR) and have limited patient input in their design. As more patients and health consumers use PHRs, there is an increasing need to understand the ways in which patients or health consumers use them. The major objective of this paper is to introduce a framework for understanding meaningful use of PHRs and to discuss the associated challenges that may impede meaningful use. The primary challenges that may hinder meaningful use of PHRs relate to health system challenges such as health care regulatory and managerial policies and multiple institutional, societal, cultural, and economic issues. Additional challenges, such as technology, design, usability, and implementation, still exist that relate to socio-technical issues.     

The Pharmaceutical Pricing and Reimbursement Information (PPRI) initiative—Experiences from engaging with pharmaceutical policy makers

ObjectiveTo present the Pharmaceutical Pricing and Reimbursement Information (PPRI) initiative, as an illustrative example of an engagement with policy makers in the field of pharmaceutical pricing and reimbursement.MethodsThe paper is based on internal assessments and feed-back from the involved policy makers as well as an external evaluation.ResultsPPRI is a network of around 70 institutions, mainly public authorities for pharmaceutical pricing and reimbursement information from 41, mostly European, countries. It evolved from a European Commission co-funded project in 2005–2007 into a self-funded Member States borne initiative. The first years of PPRI were characterized by trust-building and developing a joint understanding and language. In the initial stages, country reports, so-called ‘Pharma Profiles’, written by policy makers, were among the most important deliverables. In the course of time, ad-hoc queries which require immediate, brief and precise answers have gained importance. PPRI is predominantly an internal network for and with policy makers; it is not a policy-making body.ConclusionsAfter nearly one decade of existence, the PPRI network appears to be a sustainable network. Policy makers are committed to provide and share data and to contribute to the network as they have an added value for their daily work from access to evidence and the exchange of information and experience with fellow colleagues from other countries. The change in organisation from a research project to an independent networking initiative offers flexibility to react quickly to current challenges, but implies limited funding for the research agenda.     

美国医改实施:政府间政治与制度设计困境

《可负担的医疗法案》是在美国两党政治对立的情况下颁布和实施的。本文认为,美国联邦和州政府角色权限的分配,加剧了该法案执行过程中的政治冲突。联邦和州层面的政治参与者(特别是州长和州立法机构)就该法案进行制度协调的不同途径,已经阻碍了医疗保险交易所的建立和医疗救助扩展计划。通过比较,本文认为制度设计时尽量减少政治冲突的医疗保险监管机制改革,在执行过程中大幅度减少了政治摩擦。此外,本文强调了多层次制度设计对实施一些重要改革所产生的政治影响。     

制药企业的文件管理

目的讨论制药企业文件管理体系问题,为落实新版药品GMP中关于文件管理的相关要求提供参考意见。方法从文件体系的建立,文件质量的管理,文件的维护、变更等方面对实施GMP过程中文件管理方面的问题进行分析。结果与结论提高对文件管理的认识,细化文件管理过程,提升文件管理水平,可有效实现企业生产质量的管理。     

Adopting,manipulating, transforming: Tactics used by gender practitioners in South African NGOs to translate international gender policies into local practice

This paper looks at what is lost and gained through the process of translating international policy from a global to a local space. It does this by sharing results from a multisite ethnographic study of gender practices in foreign-funded South African health organisations. This study identifies a number of tactics used by practitioners to deal with the funding constraints and unique knowledge systems that characterise local spaces, including: using policy to appeal to donors; merging gender with better resourced programmes; and redirecting funding allocations. These tactics point to how practitioners are adopting, manipulating and transforming international policies in order to suit their everyday working realities.