What do healthcare workers think? A survey of facial protection equipment user preferences

Data on healthcare workers'(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was 'sufficient' to 'excellent'. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting.     

What do we know about hospital at home? Lessons from international experience

Hospital in the home' or 'hospital at home' services have become popular solutions to the apparent problems of conventional hospital care in many countries. Until recently their evaluation has been limited, and little has been known about their costs and benefits. A systematic review of randomised controlled trials of such services has failed to detect a difference in mortality and readmission rates of patients using hospital in the home, but does suggest that these services are acceptable to patients, although not necessarily to their carers. Important questions about professional roles and workloads in hospital at home services need further investigation. Overall it does not appear that such services produce cost savings, although this may depend greatly on local circumstances. This discussion paper uses the findings of a systematic review of the literature evaluating hospital at home and hospital in the home services to answer questions surrounding the supplementary or substitution status of these services.     

Complementary and alternative medicine: the next generation of health promotion?

This paper reports on a research study into the professional interface between health promotion and complementary and alternative medicine. The study was conducted in the UK, the USA and, to a lesser extent, Eastern Europe. Professionals from both sides of the interface were interviewed. The findings suggest that health promoters committed to individual empowerment and community action are the most likely to support some form of involvement with complementary and alternative medicine, while the least likely are those committed to structural changes through a public health agenda. The paper identifies the potential for closer integration but also reports on substantial barriers to collaboration between these two professional groups.     

Can the ministry collaborate to form the "next generation" of sponsors?

In looking to the future of sponsored ministry of Catholic institutions, the formation of future sponsors--both religious and lay alike--is an important issue. As this ministry continues to evolve, and sponsoring groups determine how best to prepare new sponsors, might it not be time to think about how to pool the ministry's collective wisdom on formation? Sponsors act not only in the name of the health care institution (or other ministry) but on behalf of the faith community engaged in continuing the compassionate healing ministry of Jesus. In Catholic ministry, and particularly health care ministry, sponsors carry out their responsibilities through a multiplicity of organizational relationships. Just as structures differ, so too do criteria that guide who will be called to join a sponsoring group. There are several core elements that are incorporated in the majority of sponsor competency sets. Elements identified by a committee of ministry members, and reviewed by hundreds of sponsors and other ministry leaders are: mission oriented, animated, theologically grounded, collaborative, church related, and accountable. If one is looking at the potential for convening dialogues about possible areas of collaboration in formation, these core elements, with examples of how they are lived out, may offer an outline of areas new sponsors might need to learn more about for their personal and professional development. Our Catholic health ministry depends on leaders who can create and steward organizational cultures that incarnate Jesus' healing. The possibilities for collaboration in the formation of future sponsors are endless, but there are challenges. If you are a member of a sponsor body/council/corporate member in Catholic health care, and are interested in nominating potential persons to take part in a representative group that would discuss possibilities for collaboration in sponsor formation, please go to www.chausa.org/sponsorformation and complete all sections of the nomination form.     

Influenza as an issue on the agenda of health care workers: What can we do? What do we need?

ESWI recommends that the 25 European Union nations strive to vaccinate one-third of their collective population every year by 2010. This translates into an annual vaccine usage of 150 million doses for a population of 455 million. However, the current vaccine usage in Europe is 79 million doses, meaning that only 40% of ESWI's recommended target population is being vaccinated in the EU-25. Indeed, the EU's current risk groups equal about 28% of its population, but it is estimated that less than 62% are being vaccinated with the current vaccine supply--the equivalent of 17% of the total population. Clearly, as ESWI noted in its concluding position paper at the Malta conference, "a large proportion of those traditionally assumed to be at most risk from influenza are not being vaccinated." How to change this and minimize the consequences of a pandemic? "It's very interesting how the arithmetic works, given the goal of immunizing 75 percent of Europe's high-risk group, " said Dr K.Nichol of the University of Minnesota Medical Center who chaired the session. "If you go from a trivalent vaccine to a monovalent one, then you triple the number of doses you can manufacture. Thus, you could produce enough doses for the entire population of the EU." However, there is no coordinated approach in Europe, meaning such an optimistic scenario is unlikely in the medium-term. For the time being, emphasis must be on raising public awareness and raising vaccination rates at the local level, starting with health care workers themselves. Here the role and attitude of health policy officials and--critically--health care workers are crucial. These front-line policy and healthcare professionals constitute both the problem and the solution to a more effective influenza vaccine effort in Europe: they know first-hand the institutional obstacles blocking progress--i.e., lack of resources, poorly focused public information campaigns, etc.--but their own work practices and attitudes can be misdirected, too. To identify the issues and help the participants produce a set of recommendations, ESWI brought in Penny Lawson from to facilitate Dr.K. Nichol to steer this session's workshop debate. The participants were a diverse group of 35 health care workers from Australia, Finland, France, Germany, Malaysia, Malta, Netherlands, Norway, Poland, Portugal, Spain, Sweden and the UK.     

What can we learn from international comparisons of costs by DRG?

Objectives

The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries.

Methods

Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries.

Results

The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices.

Conclusions

It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.     

What should an MPH graduate be able to do at the end of the training period?

In sports or the arts, some people have natural talents. Others need considerable training to develop passable abilities. Some start off as "naturals" and when they receive training, it helps them to soar that much higher--to fine-tune their natural abilities. Teach a natural athlete a new throw or serve or swing and he or she will pick it up right away and add it as a new tool to the bag of tricks. Less talented people need the same training even more, and they don't pick up the skills as fast. The same is true for good feelings and positive experiences. Some people are depressed, anxious, angry, or burned out, with shut-off or deadened feelings. Others are naturally cheerful and happy, able to express strong views and feel deep emotions. The latter are the ones who are needed in public health, and schools of public health should attract, select, and encourage their sense of commitment and optimism, during their training and with suitable follow-up support afterwards as well. And by the way, some good luck helps too.     

What constitutes commercial bias compared with the personal opinion of experts?

Introduction: The presence of commercial messages in continuing medical education (CME) is an ongoing cause of concern. This study identifies actions perceived by CME participants to convey commercial bias from CME faculty. METHODS: A questionnaire listing actions associated with CME activities was distributed to 230 randomly selected participants from 7 CME activities designated for AMA PRA Category 1 Credit. The activities were held over an 8-month period. Participants were asked to complete the questionnaire before participating in the live activity. RESULTS: Nine actions identified by over 50% of all respondents were perceived to convey commercial bias. The most critical ones reflecting commercial bias were speaking about only one agent, not providing a balanced presentation of all agents, and faculty relationships with commercial supporters. Ten actions identified by over 50% of the respondents were perceived to convey personal opinion of the faculty. The most prevalent actions were the influence of mentors or teachers, relating general practice habits from the faculty member's own experience, and cultural differences among patient populations. More than half the respondents who indicated they perceived commercial bias in certified activities attributed this perception to an overall impression, instead of 1 or 2 specific actions. DISCUSSION: Actions were identified that conveyed differences between commercial messages and personal opinion. CME providers should define commercial bias for participants, faculty, and planners and provide education about that definition.     

What can Pakistan do to address maternal and child health over the next decade?

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.     

What can Pakistan do to address maternal and child health over the next decade?

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.

     

What do other local providers think of NHS walk-in centres? Results of a postal survey

OBJECTIVES: To ascertain the views of other providers of primary and emergency healthcare services about their local walk-in centre. DESIGN: Postal survey. SETTING AND PARTICIPANTS: National Health Service healthcare providers (general practitioners (GPs), practice nurses, pharmacists, Accident and Emergency (A and E) consultants) working in close proximity to 20 English walk-in centres. RESULTS: The overall response rate to the survey was 79% (n = 1591). Nearly one-third of respondents felt that patient expectations had increased since their local walk-in centre opened, although this varied across the different sites. Some providers had noticed a reduction in their workload, but 15% claimed that workloads had increased since their local walk-in centre opened. There was broad agreement that these new centres did address issues of access and that they provided appropriate care of a reasonable quality. Communication between walk-in centres and other local healthcare providers was an area of considerable concern; GPs, in particular, were anxious about the impact of the service on continuity of care. There were clear differences of opinion between different types of health professional, with doctors tending to be more critical and practice nurses being more supportive. CONCLUSION: It has been suggested that healthcare professionals, notably GPs, are universally opposed to the concept of walk-in centres. This survey shows that opinions were divided, but overall, more local providers were in favour of this new service than were opposed to it. There was more support for centres co-located with A and E departments than "shop-front"-type facilities, but there were concerns that the service offered was too limited. The success or otherwise of the walk-in centre initiative will depend, in part, on building good relationships between the centres and other local providers. Understanding the views of local providers is important for those developing walk-in centres, and for those engaged in planning services in the wider health economies where these services are placed.     

What do we mean by the concept of principles of investigation?

It is a review of basic epidemiological techniques used for investigation of an outbreak of epidemic. The author defines types of epidemics and characterizes conditions of their occurrence and progression in spatial and temporal ramifications. The basic types of epidemiological research used in epidemiological analysis such as cohort and case-control study are characterized and exemplified with application to the outbreak of epidemic. The article provides in the conclusion basic logistic and organizational principles for such an investigation.